Lumbar Radiculopathy Treatment (Pinched Nerve in Back)
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Key Takeaways
- Lumbar radiculopathy occurs when a nerve root in your lower back is compressed.
- Herniated discs, ageing, spinal degeneration, and traumatic injuries are common causes of lumbar radiculopathy.
- There are non-surgical treatments for this condition, such as first-aid, medications, physical therapy, alternative therapies, and corticosteroids.
- Surgery for lumbar radiculopathy is rare and reserved for patients with severe conditions that have seen little improvement after some time.
What is Lumbar Radiculopathy?
Radiculopathy refers to a pinched nerve in the spine. The nerve root arising from the spinal column is compressed or irritated, resulting in pain, numbness, or tingling around the area supplied by the pinched nerve. Radiculopathy can develop in different parts of the spine, one of them being the lumbar (lower back).
Consequently, if you are suffering from lumbar radiculopathy, a nerve root in your lower back is irritated or inflamed, causing pain or other symptoms in your back or down one or both of your legs. The lumbar nerve root that is pinched often makes up the sciatic nerve as well, a large nerve made of multiple nerve roots in the lumbar spine that runs down the back of the leg to the foot, which is why lumbar radiculopathy is also referred to as sciatica.
Sciatica is the pain that travels along the sciatic nerve, down the back of the thigh and calf, ending in the foot. It is a symptom, whereas lumbar radiculopathy is the diagnosis of the specific condition.
Symptoms of Lumbar Radiculopathy
If you are experiencing a few of the following symptoms in your lower back or lower extremities, you may be suffering from lumbar radiculopathy.
- Pain in the lower back
- Muscle spasms or weakness that radiates into your butt, hip, groin, or leg
- Loss of reflexes
- Sciatica
- Feeling pressure or numbness
- Experiencing a pins-and-needles or tingling sensation
- Having difficulty walking
- Feeling a radiating, throbbing, aching, sharp, dull, burning, shooting, or electric pain
What Causes Lumbar Radiculopathy?
Lumbar radiculopathy occurs due to various reasons, such as ageing, poor posture, extra body weight, injuries, or other issues that lead to lower back problems that irritate the nerve root. Pressure exerted on the nerve root can cause inflammation and result in lumbar radiculopathy. Other causes of this condition are as follows.
Spinal degeneration and ageing
The wear and tear that naturally accompanies ageing results in bones and discs in the spine losing their shape and flexibility. These degenerative changes can cause the narrowing of the spinal canal (spinal stenosis), which presses on the nerve roots. Spondylolisthesis, where the vertebra slips forward and presses on the nerve root, can also lead to lumbar radiculopathy.
Disc-related conditions
The most common cause of lumbar radiculopathy is a herniated disc where the soft inner material of the spinal disc protrudes and puts pressure on nearby root nerves. Another reason is intervertebral disc degeneration where spinal discs are weakened or damaged over time.
Traumatic injury
Experiencing a traumatic event like a fall or a car accident that results in a spinal injury such as a fracture or dislocation can compress or damage nerve roots.
Other conditions
If you have scoliosis, the abnormal curvature of your spine will compress nerves on one side of the spine, which can cause lumbar radiculopathy. Moreover, other medical conditions, although less common, may exert pressure on the nerves in your lower back. For example, if you have diabetes, an infection like osteomyelitis, or a benign or cancerous tumour.
If you have had a previous spinal surgery, the scar tissue may also affect the nerve root. Having a bone spur that is growing on one of your vertebrae may also compress or irritate the root of your spinal nerves.
Risk Factors
Experiencing one or more of the following factors may put you more at risk of having lumbar radiculopathy.
- A man
- Between 45 to 64 years old
- Long-term driving where your body is constantly vibrating
- Doing taxing physical activities with poor form like frequent lifting with twisting motions
- Having a history of back pain or trauma
- Smoking
- Overweight
- Not being physically active and having a sedentary lifestyle
- Had multiple pregnancies
- Being of a taller height
- Having a chronic cough
- Mental stress
- Genetics
Diagnosing Lumbar Radiculopathy
Diagnosing with a Physical Examination
Your doctor will start with a physical examination first, and it is helpful for your doctor if you take note of anything that alleviates or exacerbates your pain. To accurately diagnose you, your doctor will examine the intensity of your pain and take your medical history.
While examining you physically, your doctor will also evaluate your strength, reflexes, walking ability, hip range of motion, and the symptoms of other diseases that might have contributed to your discomfort.
Your doctor will also test your motor, sensory, and reflex functions to identify how affected your nerve root is. Specific tests such as the Straight Leg Raise Test (Lasègue’s Sign), Crossed Straight Leg Test, or Femoral Nerve Stretch Test may also be conducted.
Diagnosing with Imaging Tests
Your doctor may also use imaging tests to screen you and rule out other problems such as a broken bone, fracture, alignment issues, or abnormal curvature of the spine. Imaging tests can also help your doctor determine any underlying issues, confirm their diagnosis, and prescribe treatment.
Trauma, osteoarthritis, and early signs of tumours or infections can be detected with X-rays, as a fracture or the narrowing and alignment change of your spinal cord can be highlighted as well.
Your doctor may consider surgery for you and use MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans to take a closer look at your condition. An MRI scan can identify disc herniation, nerve root compression, soft tissue damage, and spinal cord damage, whereas a CT scan provides detailed 3D images of your spine.
Tests like electromyography (EMG) and Nerve Conduction Studies (NCS) may also be used by your doctor to evaluate the electrical activity of your muscles to confirm their diagnosis, pinpoint the nerves involved, and determine if new damage has occurred. An EMG assesses the electrical impulses in your muscles to check nerve functionality, and an NCS locates the issue among your nerves by delivering a small amount of electricity through your nerves with electrodes.
Lumbar Radiculopathy Treatment Options in Singapore
Treating Lumbar Radiculopathy via First Aid
Based on your doctor’s recommendations, you can use ice or heat on your back to help reduce the swelling or relax any tight muscles.
Treating Lumbar Radiculopathy with Medications
Over-the-counter (OTC) medicine, acetaminophen, or non-steroidal anti-inflammatory drugs (NSAIDs) can help ease the pain, swelling, or irritation you are feeling in your lower extremities. However, do not take these medications for several days in a row without consulting your doctor.
Treating Lumbar Radiculopathy with Physical Therapy
If your doctor prescribes physical therapy to manage your condition, your physical therapist will be able to show you exercises and stretches to decrease your pain as well as improve your movement and function.
To reduce pressure on your nerves and alleviate the pain, exercises and stretches that target areas around the spine will help. By engaging in those exercises and stretches as recommended, you will also be able to strengthen your core muscles.
However, avoid forcing yourself to do certain movements that cause you pain while you are recovering, as it might aggravate your symptoms. If the exercises or stretches are hurting you, consult your doctor or physical therapist. They will also be able to suggest the best sitting, standing, and sleeping positions that will not worsen your symptoms. Correcting your overall posture will reduce the stress on your spine and relieve your symptoms.
Treating Lumbar Radiculopathy with Alternative Therapies
Treating your chronic pain with alternative treatments such as acupuncture, massage therapy, chiropractic manipulation, and spinal cord stimulation may help ease your discomfort. However, do consult with your doctor to see if such therapies are helpful for your condition.
Treating Lumbar Radiculopathy with Corticosteroids
Available in tablet form or as an injection, corticosteroids can help to momentarily relieve symptoms by decreasing inflammation and alleviating discomfort.
Treating Lumbar Radiculopathy with Surgery
Surgery for patients with lumbar radiculopathy is rare and commonly reserved for those who have severe symptoms that have impacted their quality of life, such as severe leg pain and significant or progressive muscle weakness. If your symptoms do not improve after four to eight weeks of conservative treatment, your doctor may recommend surgery to you.
Decompressive surgery is one option for those with severe lumbar radiculopathy, including procedures such as laminectomy, discectomy, microdiscectomy, chemonucleolysis, or percutaneous discectomy, all of which involve removing part of the vertebra or spinal disc. Another type of surgery that may be suggested is spinal fusion, which stabilises the spine by fusing two or more vertebrae.
How To Prevent Lumbar Radiculopathy
While many cases of lumbar radiculopathy cannot be prevented, you may do the following to reduce the risk of the condition or avoid degeneration of your spine or spinal discs that will ultimately lead to lumbar radiculopathy.
- Muscle training
- Pilates
- Core stability exercises
- Maintaining good spinal health and posture
- Weight lifting with proper techniques
- Avoid lifting anything beyond your capability
- Avoid twisting your body when lifting heavy objects
- Maintaining a healthy weight
- Stay physically active and exercise regularly
- Avoid prolonged sitting by taking breaks
- Avoid smoking
Getting Medical Attention
If you have persistent lower back pain, sciatica, numbness or weakness, consider consulting a back pain doctor in Singapore for an assessment and to determine whether lumbar radiculopathy or another spinal condition may be causing your symptoms. Book an appointment with us here at Avant Orthopaedics for a diagnosis and to find out what treatment options are available for you.
Our Orthopaedic Doctor for Lumbar Radiculopathy
Dr. Razmi
FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)
Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.
Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.
Frequently Asked Questions
With the proper treatment, you may start to feel better within a few days to a few weeks. Although it is an uncomfortable and inconvenient condition, rest assured that it is only temporary for most. Most patients will begin to see improvements in their symptoms within three months with nonsurgical treatments.
Your doctor will be able to advise you based on your personal habits, but you should return to your daily routine as soon as possible, because unnecessary delays may lead to worse outcomes. Depending on your normal activities, you may have to make modifications to avoid aggravating your condition.
While it is important to stay active, it is crucial that you engage in pain-free exercises that will not worsen your condition. Your doctor and physical therapist can advise you on when you can start exercising again and the types of exercises you should be doing.
Related Conditions
Sciatica is a condition where you experience pain along the sciatic nerve. The sciatic nerve originates near the base of your lumbar spine (in the lower back) and is the largest nerve in your body. It contributes to both motor and sensory functions for your legs and feet. Prompt treatment of sciatica is important because early intervention can help reduce pain and prevent symptoms from worsening.
Tailbone pain, or coccydynia, is discomfort at the base of the spine that may occur after a fall, prolonged sitting, or childbirth. It can cause sharp or aching pain, especially when sitting, standing up, or leaning back. Treatments range from lifestyle changes, cushions, and medications to physical therapy and, in rare cases, surgery.
