The lumbar spine is located in the lower back. It consists of the L1 through L5 vertebrae. Spinal nerve roots branch off the spinal cord and exit the spine through small openings created by adjacent vertebrae. These nerves become part of the peripheral nervous system and travel throughout the body to bring information to and from local tissues and the brain and spinal cord.

Compression on the spinal nerve root on one or both sides of the spine can cause symptoms of lumbar radiculopathy. While localized back pain is a common symptom of lumbar radiculopathy, because each pair of spinal nerves supplies sensory and motor function to distinct areas of the lower body, symptoms of lumbar radiculopathy can also be experienced in the buttocks, legs, feet or groin. Identifying the location of symptoms can help your provider localize the area of compression. For example, numbness, tingling or pain along the inside of the lower leg and ankle accompanied by foot drop or weakness in the muscles that lift the foot can indicate a radiculopathy of the L4 spinal nerve root.

While your PT may be able to identify the location of nerve compression based on symptoms and clinical testing, sometimes imaging like a CT scan, x-ray or MRI or tests like EMG or nerve conduction velocity are utilized to determine exactly which nerves are involved.

If you are experiencing any of the following signs or symptoms you might have a pinched or compressed nerve in your lumbar spine:

• Pain that is aching, dull, sharp, shooting or burning in the back
• Pain that is aching, dull, sharp, shooting or burning that radiates into the buttock, thigh, lower leg or foot
• Sciatica
• Numbness or tingling in the back, buttock, thigh, lower leg or foot
• Weakness in the leg or foot
• Decreased muscle tone in the leg
• Changes in gait or walking
• Drop foot or tripping when you walk
• Changes in bowel or bladder control
• Changes in sensation around the groin or genitals

• Urinary retention, urinary or fecal incontinence
• Numbness around the anus, genitals or buttocks
• Weakness or paralysis in the legs
• Pain in the back or legs
• Sexual dysfunction

CAUSES OF LUMBAR RADICULOPATHY

Anything that puts pressure on the spinal nerves in the low back can cause lumbar radiculopathy. Below are some potential causes:

• Bone spurs on the vertebrae
• A herniated disc
• Fractured vertebrae
• Spondylolisthesis
• Back muscle sprain/strain with swelling
• Back ligament sprain/strain
• Movement pattern dysfunction in the spine
• Spinal stenosis
• Spinal tumors

If you decide to work with a physical therapist to help correct your lumbar pain issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized radiculopathy physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your lumbar PT sessions yet in the comfort of your own home.

WHAT PHYSICAL THERAPY TREATMENTS ARE BEST FOR LUMBAR RADICULOPATHY?

After identifying a nerve compression in your spine, the goal is to reduce irritation or compression in the affected nerve which can relieve your symptoms. In cases where conservative treatment like physical therapy cannot fully address the nerve compression or the spine is injured, surgery may be recommended by your doctor instead.

While physical therapy for lumbar radiculopathy will always be individualized to your specific needs, below are some common goals and treatments of physical therapy to manage nerve compression in the low back:

TREATMENT TO REDUCE INFLAMMATION: Modalities like ice, ultrasound, taping, laser therapy, electrical stimulation or gentle motion may be used to reduce inflammation around the spinal nerve.

NERVE AND TISSUE MOBILITY EXERCISES: Nerve and soft tissue mobilization techniques are often used to ensure good tissue and nerve mobility which can lessen compression or tension on the nerve root.

JOINT MOBILIZATION AND MOBILITY EXERCISES: Passive joint mobilizations performed by your therapist or specific spinal mobility exercises performed by you such as spinal extension exercises following a disc herniation may be prescribed to reduce compression on nerves in the back.

BIOMECHANICS AND MOVEMENT TRAINING: In cases where mechanical compression or irritation of a nerve occurs due to faulty or non-optimal movement patterns, your physical therapist can teach you to move more optimally, and sometimes use supports like taping or bracing, to help lessen the stress on your nerves.

STRETCHING: Muscle stretching is often prescribed to improve muscle length if this is a factor contributing to your symptoms.

STRENGTHENING: Strengthening of muscles affected by the pinched nerve or contributing to the pinched nerve is often prescribed.

GAIT TRAINING: If nerve compression affects your ability to walk then gait training may be utilized to restore walking mechanics

NEUROMUSCULAR OR FUNCTIONAL ELECTRICAL STIMULATION: Electrical stimulation applied to muscles can help retrain muscles weakened by nerve or spinal cord compression.

While lumbar radiculopathy can significantly impact your function and quality of life, physical therapy can be a first-line treatment to reduce compression and alleviate symptoms or address the after-effects of nerve compression treated by surgery. If you are experiencing pain, weakness or tingling in the back, buttocks or leg, call Evolve Physical Therapy today to schedule an initial evaluation. Remember to visit the emergency room first, however, if any of the red flag symptoms noted above are present.