Sciatica often results from compression of the sciatic nerve, the largest nerve in the body, and causes radiating pain from the buttock into the posterior aspect of the leg. Meanwhile, lumbar radiculopathy refers to nerve root or spinal nerve irritation in the lower back, leading to specific paths of radiating discomfort, tingling, or weakness.
Written by
Angel Rigueras
Pain Management Specialist
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Written by
Angel Rigueras
Pain Management Specialist
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Navigating the challenges of sciatica and lumbar radiculopathy can be overwhelming, but understanding these conditions is the first step toward effective management. Both stem from nerve irritation or compression, yet their symptoms and effects vary significantly.
Sciatica often results from compression of the sciatic nerve, the largest nerve in the body, and causes radiating pain from the buttock into the posterior aspect of the leg. Meanwhile, lumbar radiculopathy refers to nerve root or spinal nerve irritation in the lower back, leading to specific paths of radiating discomfort, tingling, or weakness. Though sciatica is one of the most common complaints of acute gluteal cheek and leg pain, its distinct nature often calls for tailored care.
This blog will delve into the key differences between these conditions, their causes, and how to recognize and manage their symptoms. With expert insights from University Orthopedic Care, discover how to navigate sciatica and lumbar radiculopathy on your journey to improved spinal health.
By definition, radiculopathy describes pain that radiates down the leg or legs in specific regions of the legs. Patients often describe it as electric, burning, or sharp. The most common underlying cause of radiculopathy is irritation of a particular spinal nerve, a nerve that exits the spine and is most often a result of a compressive force.
This compressive force may occur within the thecal sac, as the nerve root exits the thecal sac within the lateral recess, as the nerve root traverses the neural foramina, or even after the nerve root has exited the foramina.
It may be related to disc bulging or herniation, facet or ligamentous hypertrophy, spondylolisthesis, or even neoplastic and infectious processes. The diagnosis of the causative agent and subsequent treatment starts with a thorough physical exam.
Diagnosing radiculopathy involves a thorough history and physical examination, including tests such as Lasegue’s sign, and a physical test for nerve root irritation, which involves raising the leg while keeping the knee straight and stabilizing the pelvis. If this maneuver triggers pain, it indicates possible nerve compression. Doctors also evaluate dermatomes (specific areas of skin supplied by certain nerves) and myotomes (muscle groups controlled by specific nerve roots) to determine the affected nerve. For example, sensory loss in a dermatomal pattern or weakness in a myotomal group can help pinpoint the problem.
Diagnostic imaging like MRI (Magnetic Resonance Imaging) is often used to confirm findings and identify the exact location of nerve compression. This scan provides detailed images of the spine and nerves, showing issues like herniated discs or tumors. If MRI is not available, a CT myelogram is a suitable alternative. In some cases, EMG (Electromyography), a test that measures electrical activity in muscles, and nerve conduction studies can further distinguish radiculopathy from other nerve disorders.
To enhance accuracy, nerve blocks, which involve injecting a numbing medication into a specific nerve area, can help identify the symptomatic nerve. Combining these tools ensures a comprehensive diagnosis, tailored to each patient’s unique presentation and needs.
Non-surgical treatments are often the first approach for managing radiculopathy and focus on relieving symptoms while encouraging recovery. These treatments include patient education, and promoting activities and exercises to keep the spine active and healthy.
Techniques like McKenzie exercises, which involve specific stretches and movements, can help reduce acute symptoms by improving spinal alignment and reducing nerve pressure. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to manage pain and inflammation. In some cases, oral corticosteroids may be prescribed as well to aid in the reduction of swelling and relieve nerve irritation.
For patients needing further relief, diagnostic and therapeutic injections such as epidural steroid injections or facet joint injections may be considered. These injections combine anti-inflammatory medications, like glucocorticoids, with long-lasting anesthetics to aid in diagnosis confirmation and provide pain relief. For example, if a patient’s relief improves after an injection into the facet joints, it suggests the facet joints as the pain source rather than a compressed nerve root.
When non-surgical treatments fail to alleviate symptoms, surgical intervention may be an option. The decision to proceed with surgery often depends on symptom severity and the patient’s condition.
Patients most likely to benefit from surgery include those with sequestered disc fragments, prolonged symptoms lasting more than six months, significant low back pain, or severe difficulty in daily activities. Ultimately, the timing of surgery is tailored to each patient’s specific needs and depends on the severity of their symptoms and how they respond to non-surgical care.
Sciatica refers to a condition characterized by irritation or compression of the sciatic nerve, the largest nerve in the body, which extends from the very lower back through the gluteal muscles and down the legs. This condition often results in shooting pain, burning sensations, or tingling that radiates along the nerve’s pathway, typically affecting one side of the body. While the term “sciatica” is frequently used to describe various types of leg pain, true sciatica arises when the sciatic nerve itself is pinched or inflamed.
Common causes include piriformis syndrome and lumbar spinal stenosis. Symptoms may vary from sharp pain and numbness to muscle weakness, and these symptoms can worsen with prolonged sitting, sudden movements, or forceful actions like sneezing. The sciatic nerve’s role in motor and sensory functions of the leg underscores the importance of accurate diagnosis and targeted care for this prevalent condition.
Sciatica is diagnosed primarily through a combination of medical history and physical examination. Patients typically report radiating pain down one leg, often following a dermatomal pattern.
Descriptions of the pain’s location, whether it extends below the knee, and associated sensory symptoms like numbness or tingling help guide the diagnosis. During the physical exam, tests like the straight leg raise (SLR) test are commonly used to detect nerve root tension. A positive SLR test often increases leg pain, supporting the diagnosis of sciatica.
Imaging, such as MRI or CT scans, are often used to confirm the presence and location of pathologic issues that can affect the sciatic nerve. Overall, a thorough history, physical exam, and careful use of imaging ensure accurate diagnosis and appropriate treatment planning.
Surgery for sciatica focuses on relieving nerve compression caused by issues like spinal canal narrowing.
The goal is to ease leg pain and related symptoms, not back pain. Immediate surgery is required for urgent cases like cauda equina syndrome, while elective surgery may be an option for persistent sciatica that doesn’t respond to other treatments.
Studies show that surgical decompression can provide faster relief for patients with severe sciatica, especially when symptoms persist for several weeks to months.
Preventing sciatica and lumbar radiculopathy involves a combination of lifestyle changes, physical activity, and ergonomic awareness. Maintaining a healthy weight via exercising is one of the most effective ways to reduce stress on the spine. Incorporating regular exercise into your routine, particularly activities that strengthen the core muscles, can improve spinal support and decrease the likelihood of injury. Exercises like yoga, planks, and bridges are excellent options for building core strength while promoting flexibility and stability.
Practicing proper posture during daily activities, whether sitting, standing, or lifting, is essential for spinal health. Ergonomic adjustments in workspaces, such as using a supportive chair or adjusting screen height, can also help reduce the risk of developing back-related issues. Additionally, being mindful of proper techniques when lifting heavy objects, like bending the knees and keeping the back straight, can protect the spine from unnecessary stress.
At University Orthopedic Care, we believe in empowering you to prioritize your spine health before issues arise. Our specialized team is here to provide personalized spinal care, from preventative strategies to effective treatments for these conditions. Let’s recap briefly.
Pain radiates down one side of the body from the lower back to below the knee. Often accompanied by muscle weakness, numbness, or tingling sensations. Pain may worsen with prolonged sitting or sudden movements like sneezing.
Compression of the sciatic nerve or of spinal nerves.
Imaging tests like X-rays, CT scans, and MRIs can identify spinal canal narrowing.
Physical exams assess motion range and areas of pain or tenderness.
Rest, followed by physical therapy to strengthen core muscles and improve posture.
NSAIDs for symptom relief. Possible piriformis injections or nerve blocks may help.
Surgery after failed conservative treatments.
Maintain an active lifestyle to reduce spinal strain and nerve compression risk.
Regular core-strengthening exercises like planks, squats, and stretches.
Practice good posture when sitting or standing for long periods.
Burning sensation or tingling along a specific nerve path on either side of the body. Muscle weakness is not usually present. The most common symptom of lumbar radiculopathy is pain or sensory changes along the affected nerve root.
Spinal nerve or nerve root injuries such as those caused by trauma (e.g., accidents or sports injuries).
In addition to MRIs, EMG tests can detect nerve function and compressed nerves.
Neurological exams evaluate nerve function and identify root compression.
Rest and physical therapy are tailored to the affected nerve path.
Similar use of NSAIDs for inflammation and pain. Pain injections, such as epidural steroid injections or facet joint injections, can provide relief.
Surgery for severe cases with persistent symptoms or failed conservative treatments
Maintain a healthy lifestyle to prevent diseases like diabetes that can damage nerves.
Similar focus on flexibility and strengthening muscles to reduce injury risks.
Avoid habits that contribute to spinal degeneration.
While sciatica and lumbar radiculopathy can disrupt daily life, effective treatments, and proactive care offer relief and restoration. From non-surgical options to advanced spinal care, we can find ways to alleviate symptoms, promote recovery, and prevent future complications.
At University Orthopedic Care, we are dedicated to helping you restore comfort and mobility. With personalized care plans and a patient-first approach, our team is here to support you every step of the way. Prioritize your spine health today and take the first step toward a healthier, more active future.
Contact University Orthopedic Care at (866) 962-1744 to schedule your consultation and discover the care and expertise you deserve.
