Radicular pain is a type of back pain that spreads from the back and travels down the leg below the knee. Sometimes there is no back pain and only leg pain. This sort of leg pain is thought to originate from irritated nerves near the spine. A more general term for this problem is sciatica. However, sciatica is usually used to describe pain down the back of leg—it does not indicate that the sciatic nerve, which is located in the muscles of your buttock and is about as thick as your thumb, is irritated or pinched. Rather, the problem is normally with a nerve branch that can get irritated where it exits the spine. This can lead to different regions of the leg becoming sore, depending on which nerve branch is irritated.
Tell me more about radicular pain.
The nerve branches that become irritated are called nerve roots and are labelled according to the area of the spinal column that they exit from. For example, you might have been given a diagnosis of ‘L5 nerve root compromise’ or ‘L5 radiculopathy’. While that sounds a little scary, all it means is that there is an irritation of the fifth lumbar (L5) nerve root. If there is compression on the nerve (eg, from swelling), you might experience weakness and numbness in your leg—this is known as radiculopathy. Most people who experience weakness related to this type of nerve compression recover their strength within one year, without any surgical intervention.
What causes radicular pain?
Radicular pain is thought to be related to problems with the intervertebral disc. Intervertebral discs are made of strong ligament and cartilage tissue. They function as natural shock absorbers for the spine. Because they are very strongly attached to the vertebrae above and below, the use of the terminology ‘slipped disc’ is not accurate. It is normal for intervertebral discs to bulge and swell. However, changes in the shape of the disc—sometimes referred to as a disc herniation—can irritate nearby nerves and soft tissues. Problems with discs are not necessarily permanent. Even large disc herniations can disappear over time.
How do I know if I have radicular pain?
If you have radicular pain, your leg pain might feel worse than your back pain, or you might have no back pain at all. Sometimes the leg pain is accompanied by a numb sensation in your foot or a feeling of weakness in your leg. Your physiotherapist is trained to distinguish between radicular pain and other causes of low back and leg pain. They will do this by asking you a series of questions about your pain and examining your back and legs. They might do some nerve tests, such as checking the reflexes, sensation and strength of your legs.
Imaging is not needed to diagnose radicular pain. Radicular pain is one of the few conditions where physiotherapists can make a fairly good estimate about the source of back and leg pain.
How can physiotherapy help with radicular pain?
A physiotherapist can help confirm that you have radicular pain and rule out other conditions that require additional testing and treatment. Once a diagnosis of radicular pain is confirmed, they can help you decide how to manage it. It is widely recommended that people with radicular pain have conservative treatment for six weeks before considering further tests or treatments. Your options might include self-management techniques, education, exercises or a combination of these.
How effective is physiotherapy for radicular pain?
There is limited evidence for the effectiveness of physiotherapy treatments for people with radicular pain. However, evidence suggests the long-term outcomes between surgery and conservative care are similar. Supervised exercise might provide some relief in the short term. The safety and efficacy of spinal manipulation (hands on therapy) for radicular pain has not been clearly demonstrated. There is evidence that patients who receive non-surgical management, including physiotherapy, for radicular pain have similar long-term outcomes to those who have surgery.
Some treatments are known to be ineffective for radicular pain. These include bed rest, traction (using a machine to lengthen and stretch the spine), and injections of steroid medications into the space near the nerve. Steroid injections could also have harmful effects.
Like in other types of back pain, it is important to stay active and return to your normal activities as soon as possible. Your physiotherapist can give you some strategies on how to do this.
What can I do at home?
Staying physically active is likely to help. Gradually upgrading your activity levels using the principle of pacing (do a bit more each week but not too much more) is also recommended. Remaining at work is important. If your work provokes your pain, your physiotherapist might be able to suggest some strategies to modify your work tasks and build your physical capacity.
How long until I feel better?
Radicular pain generally takes longer to recover than common forms of back pain. Some (around one in three) people with radicular pain improve within two weeks and most (nearly 90 per cent) improve within three months. Sometimes radicular pain can become persistent and a team approach to management is needed.