Tackling Sciatica and Radiculopathy: Non-Surgical Treatment Options

Sciatica is a common term patients use to describe the symptoms that occur when lumbar radiculopathy, or a pinched nerve in the low back, occurs. Radiculopathy can cause a shooting pain that typically feels like it starts in the gluteal region and then travels down the leg in various locations depending on the nerve root affected. The severity of symptoms will vary from person to person, ranging from mild discomfort to debilitating pain that disrupts your day-to-day life.

Although radiculopathy can be extremely painful, the good news is that for most people, the symptoms can be managed and relieved with proper treatment. The first step towards successfully managing radiculopathy is identifying your symptoms, followed by seeking care from a spine specialist. Relief from nerve pain is within reach with early diagnosis and targeted treatment.

What Exactly is Radiculopathy? 

Lumbar radiculopathy results from irritation or compression of a nerve root in the low back. This can cause pain, numbness, tingling, and/or weakness in the buttock and leg.  Notably, the term sciatica, while commonly used by patients to describe the symptoms of radiculopathy, is actually a misnomer. This term is only used by spine specialists to describe the actual pinching of the sciatic nerve, which is a peripheral nerve made up of several spinal nerve roots that starts in the buttock region, not the back. True sciatica is actually quite rare!

Symptoms of Radiculopathy

Lower back, hip, and leg pain can occur from a variety of reasons, including muscle strain and hip arthritis. Pain from radiculopathy differs from these conditions because the pain is often felt as a shooting pain that radiates from the back or buttock region into the thigh and often the lower leg and foot. Here are some common symptoms associated with radiculopathy:

• Radiating pain in the hip and leg: Radiculopathy usually feels like a shooting, burning, or tingling pain that travels from the lower back or the hip and buttock into the leg.
• Numbness, tingling, or muscle weakness in the affected leg or foot: In addition to pain, radiculopathy can cause abnormal sensation or difficulty controlling the leg or foot due to compression of the nerve root.
• Pain triggered by coughing, sneezing, or straining: Actions that increase intra-abdominal pressure can exacerbate nerve pain caused by disc herniation in the lumbar spine.
• Radicular pain when sitting for long periods: Extended sitting, including driving, can increase nerve pain from the lumbar spine.
• Lower back pain: Pain, muscle spasm, or joint stiffness in the lumbar spine is commonly associated with radiculopathy.
• Pain that is usually worse on one side: Radiculopathy usually impacts one leg on the side where the compressed nerve root is located, though in some cases, pain can travel down both legs.
• Leg cramping or spasms in the calf, thigh, or foot muscles: Radiculopathy can be associated with painful muscle spasms in the leg.

Causes of Radiculopathy

Radicular nerve pain occurs when the lumbar spinal nerve becomes irritated or compressed. The following conditions can cause radiculopathy:

• Herniated disc: The disc between the lumbar vertebrae pushes out and inflames or damages the spinal nerve root. This is the most common cause of radiculopathy.
• Degenerative disc disease: Discs lose height with age which is a normal finding, but in some cases, severe disc degeneration can create less space for nerves to exit, which can cause radiculopathy.
• Spinal stenosis: Narrowing of the spinal canal typically related to degenerative findings that causes compression of spinal nerves.
• Arthritis and bone spurs: Bony overgrowth typically associated with facet joint arthritis in the spine can compress nerves.
• Spondylolisthesis: Vertebral slippage that occurs due to spinal fracture or arthritis that places pressure on nerves.
• Spinal tumors or cysts: Abnormal masses are rare but if they grow in or near the spinal cord or nerves they can cause radiculopathy. 
• Infection: Also unusual, swelling from infection near the nerve roots can cause radiculopathy. 

Risk Factors for Radiculopathy

A person can develop radiculopathy from physical injury, lifestyle choices, or from age-related factors. There are a variety of risk factors associated with developing radiculopathy, including:

• Age: Radiculopathy occurs more frequently in older adults, especially after age 50, because of degenerative changes in the discs and joints.
• Obesity: Being overweight puts extra stress on the spine and can contribute to changes that lead to irritation or compression of the spinal nerve.
• Occupation: Jobs that involve heavy lifting, driving long distances, whole-body vibration, or prolonged awkward postures can increase the risk of radiculopathy.
• Sedentary lifestyle: Lack of exercise leads to deconditioning and weakness in the core and back muscles that provide spine support.
• Diabetes: High blood sugar levels can damage the nerves over time.
• Trauma: Car accidents, falls, or other impacts can dislocate, fracture, or slip the vertebrae.
• Pregnancy: Weight gain, posture changes, and hormonal fluctuations during pregnancy stress the spine.

How is Radiculopathy Diagnosed? 

Radiculopathy is often diagnosed based on a medical history and physical exam. Symptoms like radiating or shooting pain from the lower back or buttock down the leg are common indicators of radiculopathy. This pain may worsen with certain activities such as sitting, coughing, or sneezing.

During a physical exam, a spine specialist can reproduce the symptoms by maneuvering the back or affected leg in specific ways that stretch or compress the spinal nerve. Tests for strength, reflexes, and sensation along the nerve pathways can also indicate radiculopathy. 

If the diagnosis is still uncertain after an exam, imaging tests like X-rays, MRIs, or CT scans of the lumbar spine may be ordered. These can show common abnormalities like herniated discs, arthritis, bone spurs, spinal stenosis, and less common findings like tumors or infection that affect the spinal nerve. MRI gives the best visualization of soft tissues like nerves and discs.

Electrodiagnostic tests, which include nerve conduction testing and electromyography, could also be used to measure how well electricity travels along the lumbar nerve root pathway. Once the underlying cause is identified through this process, our physicians will work with you to create an individualized treatment plan specifically targeting the source of the lumbar nerve compression.

What are Non-Surgical Treatment Options for Radiculopathy? 

Radiculopathy is typically treated successfully with non-surgical treatments. Initial treatment focuses on relieving pain and inflammation through methods like activity modification, over-the-counter medications including anti-inflammatories, and ice/heat application. If pain persists, the next step is individualized physical therapy to reduce muscle spasms, improve the range of motion, and strengthen weak areas, including the core. Non-opiate prescription medications can also be used. Epidural steroid injections may also be considered for pain relief, especially if the pain is moderate to severe and limiting function. The goals of treatment are to alleviate nerve inflammation, manage lower back pain, and restore mobility. With a combination of conservative care and interventional treatments when needed, most patients achieve relief from their radiculopathy.

When to See a Spine Specialist in Arizona

If you are experiencing symptoms of radiculopathy, such as pain, tingling, numbness, or weakness in the lower back, buttocks, or legs, it may be time to consult a spine specialist in Arizona. The physicians at Desert Spine and Sports are experienced in treating a range of muscle, nerve, and bone issues to get you back to feeling like yourself again. Our physicians are experts in delivering the following non-surgical options to appropriately diagnose and treat your condition:

• Spine and Musculoskeletal Evaluations
• Individualized Physical Therapy Planning
• Spine Injections Under Fluoroscopy
• Joint, Tendon, and Bursa Injections using Ultrasound-Guidance
• Platelet Rich Plasma or PRP Therapy
• Electrodiagnostic Testing

In search of comprehensive, patient-focused care in Arizona? Desert Spine and Sports Physicians are experts at diagnosing and treating problems affecting the spine and musculoskeletal system. As “physicians of function,” rehabilitation physicians place an emphasis not only on relieving pain but also on restoring maximum function. Schedule a consultation today!