Any type of low back pain can become a hindrance to daily life, but in some cases, back pain is more than simple back pain—you may suffer from radiculopathy. Lumbar radiculopathy, also known as sciatica, is a pinched nerve in the spine that could lead to pain, weakness, and a numbing sensation.
Many patients come to Dr. Clymer at APEX Orthopedics with concerns about their back pain and discomfort. As an expert in lumbar spine treatments, Dr. Clymer specializes in diagnosis whether you have general back pain or suffer from lumbar radiculopathy.
Read on to understand and learn more about radiculopathy, treatment options, and how it differs from general back pain.
The anatomy of the spine
Oftentimes, many people don’t understand the basic parts of your spine and how the disruption of these parts could lead to back pain and/or lumbar radiculopathy.
In general, your spine has three main functions:
- Protecting the spinal cord and its nerve roots
- Providing support and balance to keep you upright
- Allowing for flexible motion
Your spine is a collection of 24 semi-rigid vertebrae, each separated by intervertebral discs. Those discs cushion the bone and stop them from rubbing together. They also provide shock absorption during impact and protect the nerves which run through the spine.
It divides those vertebrae into three sections—cervical (upper spine), thoracic (mid spine), and lumbar (lower spine). Together they create a natural “S” shape, with the curve being inward at the cervical region, extending out in the thoracic region, then curving back in at the lumbar region.
In a normal case, the spine is aligned, creating a strong baseline for your body’s structure. However, the joints, discs, and even nerves could lead to back pain.
The source of your back pain
Your physician will do a thorough assessment and perform a variety of examinations to understand the source behind your back pain. As we stated before, there are three main sources of back pain:
- The joints
- The discs
- The nerves
As you age, your spine loses the amount of padding in your cartilage. This results in set joints rattling, cracking, snapping whenever you try to move. The excess movement can cause stiffness and pain. Treatment for this kind of pain includes more conservative measures such as pain medication or cortisone injections. Fitness and weight reduction may also help alleviate back pain. More likely than not, Dr. Clymer will not suggest surgery for set joint pain.
Keep in mind that the discs between vertebrae can also hurt. Your discs are made of two parts—a circular outside lining called the annulus fibrosus and the inner soft cartilage. The annulus allows the back to twist and move while still holding the cartilage in place. The cartilage acts as a shock absorber to support weight.
Sometimes, the annulus wears, thins, and begins to bulge and stretch. If it stretches enough, it causes tearing and rupturing, leading to a herniated disc. Herniated discs can often cause lumbar radiculopathy. This happens because as the disc ruptures, some of the excess material will push out through the annulus and hit the nerve root. This nerve irritation is what causes radiculopathy (we will go into more detail later).
One treatment option for herniated discs is a joint fusion. During this procedure, a physician fuses the joints so they can’t move. While this can help with pain, it greatly reduces mobility. That is why Dr. Clymer often avoids fusions, and would much prefer to try different treatment options such as injections so as to not hinder your daily life. For example, if you were a roofer (or in any other line of work involving a lot of bending and twisting), a back fusion would essentially stop you from going back to work indefinitely.
What is lumbar radiculopathy?
Lumbar radiculopathy or sciatica is caused by irritation on nearby nerve roots in your spine. Along with herniated disks, injuries could cause damage to the intervertebral discs that could irritate and compress the nerves. Other common causes of radiculopathy include:
- Bone spurs
- Spinal tumors
- Compression fractures
- Poor posture
- Repetitive movement patterns
While you should always visit a doctor if you think you may suffer from sciatica, there are symptoms you can look out for. Unlike general back pain that may stay centered in one location, lumbar radiculopathy is more complex. Nerve pain often spreads from the low back down into the hips, buttocks, and back of the legs. It may start out as a sharp pain then extend all the way to your foot. Long periods of walking or activity can make the pain worse. However, it is not uncommon for the pain to wax and wane, meaning sometimes you may feel fine without treatments.
Other symptoms may appear such as:
- Sharp pain while sitting
- Pain when coughing
- Numbness in your leg and/or foot
- Tingling sensations in the back of the leg
How do you diagnose lumbar radiculopathy?
Proper diagnosis of lumbar radiculopathy versus general back pain can only come through a physician examination. Your physician may use his or her hands to feel around your spine, but your examination usually requires image tests such as MRIs, X-rays, or ultrasound for a full diagnosis.
Treatments for sciatica or lumbar radiculopathy
Unlike other joints, it is not possible to undergo a total joint replacement of the spine. However, there are still options that can help patients feel better and increase mobility.
It is always best to talk to your physician about which treatment option would work for you and your lifestyle. In some instances, your physician may prescribe multiple treatments to reduce pain and help you better manage your sciatica.
Below are a few of the primary treatments for radiculopathy.
Physical therapy promotes motion in the spine, which can help increase the flow of nutrients and oxygen. It can also ensure that your set joints don’t become too stiff, since stiffness can lead to even more pain. In addition, physical therapy can strengthen the muscles that support your spine to prevent any further damage.
At times, the pain becomes too much and hinders movement. In those instances, your doctor may recommend over-the-counter NSAIDs (anti-inflammatory medication such as Advil) or prescription medications. Especially with NSAIDs, you should always talk to your doctor to ensure they are the right treatment option for you. Side effects include stomach irritation, ulcers, or even kidney damage. Reasonable dosing and monitoring can help alleviate those side effects.
Another pain management option for lumbar radiculopathy are injections directly into the spine. Cortisone, steroid, or epidural injections can help with inflammation and tend to last for 3 to 6 months before you would need another one. Many people manage their lumbar radiculopathy simply through injections alone. Keep in mind that injections will not solve the underlying problem if you still have something compressing against the nerve root. It can only relieve pain that stems from the compression.
Although joint replacement is not an option, there is still another surgical choice. Dr. Clymer uses surgery to move the bulging herniated disc, or whatever is irritating the nerve, away from the nerve root. For most patients, this greatly improves the occurrence of pain. Surgery isn’t something that he pushes on his patients unless absolutely necessary; so if the pain is affecting your mobility to the point where you can no longer get around, surgery may truly be your best option. Along with the more conservative measures, surgery can help you manage your sciatica without it affecting day-to-day life.
How do I know which sciatica treatment is right for me?
At APEX Orthopedics, we believe in always putting the needs of our patients first. For that reason, Dr. Clymer has a detailed conversation with each patient about their pain and condition before creating a treatment plan. Even patients with the same severity of back pain could each benefit from different treatments.
During your initial appointment, Dr. Clymer will talk about your pain, your goals, and your lifestyle. More active people may require more intensive treatments to stay active, while someone who doesn’t need as much mobility may be fine with medication only. However, there are some treatments Dr. Clymer will not perform. If you insist on a spinal fusion, Dr. Clymer can refer you to another physician.
If you ever have any questions about a sciatica treatment, you can always contact our office for more information. Our team is always happy to inform our patients so they can be aware of what is available.
Get to know Dr. Clymer and APEX Orthopedics
Dr. Clymer specializes in upper and lower extremity general orthopedics along with total joint arthroscopy, lumbar spine treatments, and sports medicine. For decades he has successfully provided lumbar radiculopathy treatments for a variety of patients to help them move and feel better.
With the help of the APEX’s private practice model, Dr. Clymer ensures each patient receives the most value that doesn’t involve hidden fees or outlandish pricing.
The core of his success lies in proper diagnosis. An appointment with Dr. Clymer includes the highest quality technology to pinpoint a patient’s underlying musculoskeletal conditions. He will also ensure you understand what lumbar radiculopathy is and how it is different from general back pain. From there, he can better understand which sciatica treatment will work best for you.
For a thorough evaluation with Dr. Clymer, call us at 913-642-0200 or schedule an appointment today.