Lumbar radiculopathy is a clinical condition involving the compression or irritation of spinal nerve roots in the lower back (lumbar spine). Your spine is made up of a stack of bones, separated by shock-absorbing discs, preventing the bones from rubbing against each other. Nerves leave the spine between these bones and travel down into your legs. If something puts pressure on one of these nerves, it can cause pain. The irritated disc can also release inflammatory chemicals that further irritates the nerve, which is why you may feel burning, tingling, numbness, or an electric-shock type pain in your back or down your leg, even when you are resting.

To understand the anatomy of lumbar radiculopathy, one must first visualize the anatomy of the lower back.

The lumbar spine consists of five large vertebrae (L1 -L5). Between these bony structures lie the intervertebral discs, which serve as shock absorbers. Each disc is composed of a tough, fibrous outer layer called the annulus fibrosus and a soft, gelatinous center known as the nucleus pulposus. Because the spinal cord ends in the upper lumbar region, the lower canal is filled with a bundle of nerve roots known as the cauda equina. These individual nerve roots exit the spinal column through small openings called the intervertebral foramina.

Radiculopathy occurs when the anatomical space within these small openings (foramina) is compromised, leading to the compression of a specific nerve root. This most commonly happens through two primary mechanisms: mechanical and chemical.

A disc herniation occurs when the nucleus pulposus breaks through the outer ring, physically pressing against the nerve. However, the anatomy is further complicated by the fact that the inner disc material is highly inflammatory. When it touches the nerve root, it triggers a chemical “burn,” causing the nerve to swell. Because the nerve is trapped within a rigid bony tunnel, this swelling further cuts off the tiny blood vessels that supply the nerve with oxygen. This lack of oxygen (ischemia) is the anatomical reason for the “pins and needles” and numbness often felt in the leg.

Furthermore, the surrounding soft tissues and joints play a significant role in the anatomical narrowing of these pathways. The facet joints, which are the hinges located at the back of each vertebra, can develop bone spurs or “osteophytes” due to osteoarthritis, protruding into the exit path of the nerve.

Similarly, the ligamentum flavum, a ligament that lines the spinal canal, can thicken and lose elasticity over time, a process known as hypertrophy. This combination of disc protrusion from the front and ligament or joint overgrowth from the back creates a “pincer effect,” leaving the nerve with nowhere to go. This anatomical crowding manifests as pain that follows the nerve’s specific “map” down the leg, known as a dermatome.

Nerves are the body’s electrical wiring. There are 31 pairs of spinal nerves that exit the spinal cord through small openings in the vertebrae and they perform two primary jobs:

• The Motor Path (Output): They carry electrical signals from the brain to your muscles, telling them to move. If you want to wiggle your toe, that command travels through a spinal nerve.
• The Sensory Path (Input): They carry information from your skin and organs back to the brain. This allows you to feel touch, temperature, and pain.

When one of these nerve roots get compressed or irritated by a herniated disc, bone spurs, or narrowing of the spinal canal (stenosis), your pain occurs. “Electric” Pain is the most common symptom. Instead of localized back pain, you feel a sharp, shooting, or burning sensation that travels along the path of the nerve. Sensory Interference (Paresthesia) occurs when the brain nerve signals are not being transmitted clearly. You then experience a “dead” feeling in a specific patch of skin or tingling sensation often describes as “pins and needles”. If the compression is severe, the signal to move simply doesn’t get through and you might find it difficult to lift your foot (foot drop).

There are a few reasons why you may be experiencing this pain.

• Herniated Disc: The inner “jelly” of the disc leaks out and touches the nerve.
• Spinal Stenosis: Age-related narrowing of the bone canal.
• Degenerative Disc Disease: Your discs lose height, causing the vertebrae to sit closer together and pinch the nerve.
• Spondylolisthesis: One vertebra slips forward over another.
• Bone Spurs (Osteophytes): Bony overgrowths due to arthritis.

• Herniated Disc: The gel-like center of a disc pushes out.
• Spinal Stenosis: Age-related narrowing of the spinal canal.
• Spondylolisthesis: One vertebra slips forward over another.
• Bone Spurs: Overgrowth of bone due to arthritis

Mild

You experience occasional pain, but it does not significantly limit your daily activities. Some days you have no symptoms at all, and when pain does occur, it is generally mild in severity. At times, you may feel sharp, stabbing, or shooting pain, as well as burning sensations or an “electric shock” feeling. The pain subsides quickly. You might also notice pins and needles or a tingling sensation. Despite these symptoms, you are able to sleep comfortably at night, remain active, and you do not experience any weakness in your leg.

Moderate

You experience pain more frequently, with symptoms present on a daily basis, and it slightly limits your daily activities. The intensity of the pain is higher and it takes a few hours to subside. At times you may feel sharp, stabbing, or shooting pain, along with burning sensations or an “electric shock” feeling. You might also notice pins and needles or tingling. The pain wakes you at night, and you experience slight weakness in your legs.

Severe

You experience constant, severe pain on a daily basis, which significantly limits your ability to perform daily activities. The pain may feel sharp, stabbing, or shooting, and can be accompanied by burning sensations or an “electric shock” feeling. You may also notice pins and needles or tingling, and some areas of your leg may feel completely numb. The pain disrupts your sleep, and you experience weakness in your legs accompanied with muscle “foot drop”. You have a loss of bowel/bladder control (Emergency!).

Our physiotherapists are highly trained in human anatomy and movement, with the expertise to identify lumbar radiculopathy as a potential cause of your back pain. We are skilled at distinguishing between pain originating from the lumbar spine, hip joint, or sacroiliac joint, ensuring an accurate diagnosis.

During your physiotherapy assessment, we will carefully assess your spine and surrounding structures to evaluate your range of motion and identify which movements provoke pain. This allows us to pinpoint the exact source of your symptoms and determine the priority of structures that need treatment. Once the cause is identified, we develop a targeted plan to address it effectively.

X-rays shows the integrity and alignment of joints and bones in your spine. So, this allows us to see if something is wrong with the structure of the spine and it’s connecting surfaces.

Your physiotherapist can refer you to get x-rays taken if necessary.

Sonar is not the best tool for investigation with lumbar radiculopathy. Diagnostic ultrasound shows the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).

If you need an ultrasound, your physiotherapist will refer you.

An MRI scan can image all of the structures in your spine, including soft tissue, discs, nerves and bones. However, an image like this is expensive and you need to be referred by a specialist. If your physiotherapist suspects anything more than an inflamed sacroiliac joint, you will be referred to the right specialist.

Initially, your lumbar radiculopathy is caused by irritation or compression of a nerve in your lower spine, often due to a herniated disc, bone spur, or narrowing of the spinal canal. This pressure on the nerve causes pain, tingling, or numbness that travels down your leg. Rest may provide temporary relief, but over time your muscles can become weaker and your joints stiffer. You may start compensating by using the wrong muscles at the wrong time, which can further aggravate your symptoms and disrupt normal movement patterns.

It isn’t easy to avoid putting pressure on your spine during daily activities. Walking, standing, bending, or climbing stairs can irritate the nerve, increasing inflammation and restarting the cycle of pain. This often leaves you unsure if it’s safe to move, trapping you in a cycle of discomfort.

Your nervous system may become hypersensitive, meaning even small movements can feel painful because your brain is on high alert. You might “guard” or move differently to avoid pain, which can place extra stress on other parts of your back and create new areas of discomfort.

Sometimes, people are overly cautious. Without gradually challenging the tissues during rehabilitation, the muscles and nerves never regain the strength and resilience needed for daily life.

Effective treatment of lumbar radiculopathy focuses on addressing the underlying cause. While medication may ease pain temporarily, it won’t prevent symptoms from returning if the root issue isn’t treated. Early intervention is important, as ignoring or pushing through the pain can lead to worsening symptoms and, in some cases, more serious or lasting nerve problems.

Waiting too long and not getting a proper diagnosis

A common problem we see is that patients wait too long before they seek help. By the time they come to us for help, they’ve had pain for months or years. In some cases, they’ve had recurring episodes of pain that they have done nothing about. The longer you wait, the more advanced the problem becomes and the longer it will take to get better.

If you don’t get a proper diagnosis from the start, it wastes time. If someone is treating your sacroiliitis and not looking for the underlying cause, it’s like putting a plaster on the problem. This is ineffective, and your symptoms are likely to return.

Trying out, but not completing different forms of treatment

Often, patients take anti-inflammatory medication in the hopes that it will ease their pain. When they feel somewhat better, they stop the medication and try to get back to a normal routine. But often their symptoms come back because they haven’t restored the movement of their sacroiliac joint.

Using a back brace or SIJ belt might be useful in the beginning to give you the stability you need, but it won’t be a long term solution. The longer you use it, the more dependent you become on it. In fact, your core muscles should be giving you that stability.

And then, a lot of people stop their treatment halfway through because they feel better. You need to address the deeper problems like hyper- or hypomobility or poor core muscle strength. That is the best long-term solution. Patience is key.

Resting too much or too little

It’s a natural response. But, resting too much causes your body to decondition and leaves you feeling weaker. Whereas, too much movement, exercise or stretching leaves you with even more pain and inflammation. People tend to stretch or foam roll to ease the stiffness, but you can easily overdo it. Finding the balance between resting and doing safe movements is key. Let us help you get the right treatment for your sacroiliitis and prevent it from stopping you in your tracks.

We provide effective treatment for sacroiliitis. We understand that you want pain-free movement again so that you’re able to stand and cook, go for a walk with the dogs or run around with your grandkids. That is why we are here to guide you and tell you what kind of treatment you need. As physiotherapists we implement a very effective and structured plan of action that treats all the aspects of your painful sacroiliac joint. Our treatment helps to decrease inflammation in order to get your movement and strength back to normal.

First we’ll confirm your diagnosis by testing your SIJ movements and eliminating other possibilities like pain coming from you lumbar spine. Your first goal is to protect it from further injury and create the ideal environment for it to start healing. Your techniques like mobilizations restores the SIJ movement if it’s moving too little, or we limit excessive joint translation using strapping and taping. We’ll control inflammation using laser and get rid of the guarding muscle spasms over your hip and lower back using various soft tissue treatments.

While we’re busy restoring the SIJ motion, we’ll focus on getting your core muscles to stabilize the sacroiliac joint, together with load displacement and firing pattern of your hip and lower back muscles. This requires a skilled professional to monitor and adapt your program as you progress through the stages of healing. As the SIJ movement improves, we’ll strengthen into the new available range.

Sacroiliitis takes anything from 6 weeks to a few months to treat, depending on the severity of your symptoms. You will need physiotherapy treatment twice a week for the first two weeks to work through the initial phase of treatment. The aim is to decrease inflammation and get your SIJ movement back to normal. After this, your treatment sessions can be spread out to once a week or once in two weeks. This is when you work on stability and strength and load displacement. Remember, you only spend an hour at a time with your physiotherapist. How fast you recover is greatly be up to you. At the end of your recovery process, your sacroiliac joint should be able to handle the demands of everyday life again.

Most cases (about 80–90%) resolve with conservative care within 6 to 12 weeks. Peripheral nerves (the ones traveling from your spine to your toes) regrow at a remarkably consistent rate: 1 millimeter per day. If your nerve was compressed at the L5 level (lower back) and you have numbness or weakness at your big toe, the nerve has to “re-innervate” that entire distance. Distance from lower back to foot: Approximately 30–40 inches (depending on your height). Estimated Time: This can take 12 to 18 months for the signal to fully reach the end of the line

• Your doctor might prescribe anti-inflammatory medication or give you a cortisone injection to treat sacroiliitis. Both of these medications gives temporary relief to the inflammation and pain. However, it isn’t the solution to your problem. Once the effect of the medication wears off, your pain could simply return.
• Getting your back ‘aligned’ or ‘clicked’ in the hopes of improving the pain will not improve the inflammation or the state of the surrounding soft tissue and muscles. It could even trigger an increased inflammatory response.
• A biokineticist will be able to help you in the final stages of your rehabilitation programme or to get you back to actively training for your sport.
• Wearing a back brace or SIJ belt could be useful if your pain is severe. Even though the support can help, it is something you could get dependent on. Active movement is still important.
• Stretching or foam rolling your back might ease some of your pain. But, forcing your spine into painful positions in the hopes of stretching or pushing the pain away, could actually worsen your inflammation response.

These treatments can be used in conjunction with physiotherapy. And at Well Health Pro, our physiotherapists will guide you in choosing the right treatment for your sacroiliitis.

Surgery is not something you need to consider straight away. If your pain is caused by sacroiliitis and it doesn’t respond to non-surgical treatment within 3 months, surgery could be an option. Discuss this with your physiotherapist and make sure you have the necessary information about the risks, expenses and long recovery time associated with surgery to your spine.

Before any surgery is done, an MRI should be taken to confirm the diagnosis. You would have to see a surgeon to discuss the results and surgical recommendations. A sacroiliac or lumbar joint fusion is one type of surgery that can be done for sacroiliitis. During this procedure the lumbar and/or sacral joints are fused together with pins and screws. After surgery, you have to wear a back brace for 2-6 weeks (depending on the procedure). And you have to comply to the specific doctor’s aftercare routine, like not being allowed to sit for a few weeks.

Regardless of which type of surgery you get, you are only halfway to a successful recovery. The rest of the process includes strengthening and letting your body adapt to the change. Physiotherapy after spinal surgery is vital to get you back to top form.

• SIJ Dysfunction
• Piriformis syndrome
• Lumbar Facet joint pain – especially painful to bend backwards or sideways. Lower back and sometimes buttock pain.
• Sciatica – burning, tingling type of pain that can spread from your buttock and lower back down your leg.
• Ankylosing spondylitis – this is a type of inflammatory arthritis that can cause some of the bones in your spine to fuse. It makes the spine less flexible and can result in a hunched posture.
• Buttock muscle strain – buttock pain that feels worse with movements like walking, climbing stairs or running.
• Hip joint pain – pain and stiffness in the buttock and groin area that can spread down your thigh. Difficult to bend your hip and cross your legs

• Sciatica