A.

LUMBAR RADIOCULOPATHY

Background & Etiology1

T
he lumbosacral radiculopathy is a disorder that causes pain in the lower back and hip
which radiates down the back of the thigh into the leg. This damage is caused by
compression of the nerve roots which exit the spine, levels L1- S4. The compression
can result in tingling, radiating pain, numbness, paraesthesia and occasional shooting pain.
Radiculopathy can occur in any part of the spine, but it is most common in the lower back
(lumbar-sacral radiculopathy). The sciatic nerve is commonly involved, so the condition is often
called sciatica.

Sciatica can be a type of lumbar radiculopathy as the sciatic nerve partially originates from the
lower lumbar spinal nerves. However, it can also occur when the sciatic nerve is pinched by
structures farther away from the spine, such as the piriformis muscle.
Risk factors for radiculopathy are activities that place an excessive or repetitive load on
the spine. Patients involved in heavy labour or contact sports are more prone to develop
radiculopathy than those with a more sedentary lifestyle.

1
Adapted from https://www.physio-pedia.com/Lumbar_Radiculopathy and https://www.spine-
health.com/conditions/lower-back-pain/lumbar-radiculopathy
2
https://www.mountnittany.org/articles/healthsheets/6916
A
radiculopathy is caused by compression, inflammation and/or injury to a spinal nerve root in
the low back.. Aging, injury, poor posture, extra body weight, and other issues can lead to
problems in the low back. These problems may then irritate nerve roots. Causes of this
type of pain, in the order of prevalence, include:
 Herniated disc with nerve compression in the lumbar spine. The damaged disk may then
press on nearby nerve roots.
 Foraminal stenosis.  Degeneration from wear and tear, and aging. can lead to narrowing
(stenosis) of the openings between the vertebrae. The narrowed openings press on nerve roots
as they leave the spinal canal.
 Unstable spine. This is when a vertebra slips forward. It can then press on a nerve root
causing nerve injuries.
 Diabetes3.

A slow onset of lumbar radiculopathy can occur from sitting or standing with poor posture
(slumped forward) for weeks, months, or years. Poor posture can slowly overstretch ligaments in the
back, allowing pressure to occur on a spinal nerve. As the pressure increases, the pain can travel
farther out along the path of the nerve, causing discomfort in the hip, leg or foot.
Lumbar radiculopathy can also develop from trauma, such as a fall, car accident or
osteoporosis — progressive bone breakdown that typically affects older women.

Signs and symptoms4

I
n a radiculopathy, the problem occurs at or near the site of the origin of the root of the
nerve as it exits from the spinal cord, but the pain and accompanying symptoms usually
radiate to the part of the body that is supplied by that specific nerve. An impingement in the
lumbar region can be manifested with symptoms in the foot.

Radicular pain radiates into the lower extremity (thigh, calf, and occasionally the foot) directly along
the course of a specific spinal nerve root. The most common symptom of radicular pain is sciatica (pain
that radiates along the sciatic nerve - down the back of the thigh and calf into the foot).

3
Adapted from https://www.mountnittany.org/articles/healthsheets/6916 and https://www.spine-
health.com/conditions/lower-back-pain/lumbar-radiculopathy
4
Adapted from https://smartypance.com/radiculopathy-rapid-review/
 Sciatica is one of the most common forms of pain caused by compression of a spinal nerve in the
low back. It often will be caused by compression of the lower spinal nerve roots (L5 and S1).
Indications for sciatica symptoms are : 
 Unilateral leg pain greater than low back pain, leg pain follows a dermatomal pattern;
 Pain travelling below knee to foot or toes;
 Numbness and paraesthesia in the same area;
 Straight leg raise positive, induces more pain.

T
he leg pain  is typically much worse than the low back pain, and the specific areas of the
leg and/or foot that are affected depends on which nerve in the low back is affected.
Compression of higher lumbar nerve roots such as L2, L3 and L4 can cause radicular pain
into the front of the thigh and the shin.

Radiation of the pain from the lumbar region to the foot 5

 L4 – patellar reflex
Anterior sciatica: pain which radiates along the anterior aspect of the thigh into the anterior leg is
due to L4 or L3 radiculopathy. L2 pain is antero-medial in the thigh. Pain in the groin usually arises
from an L1 lesion.
 L5 – Achilles reflex
Pain top of foot/big toe. Weakness-ankle dorsiflexion, inversion and eversion and great toe;

5
http://www.emdocs.net/em3am-back-pain/.
Posterior sciatica pain due to L5 radiculopathy may radiate to the dorsum (top) of the foot and to
the large toe;
 S1 – Achilles reflex
Pain lateral foot/sole;
Posterior sciatica when caused by S1 irritation it may proceed to the lateral aspect of the foot6.
Clinical presentation depends on the cause of the radiculopathy and which nerve roots are
being affected. Also important is the nature (sharp, dull, piercing, throbbing, stabbing, shooting,
burning) and localisation of the pain . Some patients report, besides radicular leg pain, also
neurological signs such as paresis, sensory loss or loss of reflexes.

Physical Therapy Inverventions7

L
umbar radiculopathy symptoms caused by disk herniation typically worsen with sitting or
bending forward. Therefore, exercises that involve these positions should be performed
with caution. The opposite is true for lumbar radiculopathy caused by stenosis or arthritis.
Bending forward typically reduces pain for these individuals.
Exercises for lumbar radiculopathy vary based on the underlying cause. For example, exercises
for spinal stenosis and sciatica are very different. However, they fall into the general categories of
stretching, posture training, strengthening, endurance and body mechanics.
 Stretching. Tightness in the muscles of your low back and hips can contribute to lumbar
radiculopathy. Tight muscles on either side of your low back, pelvis and hips can contribute
to radiculopathy. For this reason, stretching is an important component of your exercise
program. Flexibility exercises should be performed at least five days a week.
Stretches should not be painful. If your symptoms get worse while stretching, stop right away.
You should feel a gentle pulling sensation and might have mild discomfort, but you should not feel
sharp pain. Hold each stretch for 20 to 30 seconds and repeat three times.
Tight glutes, or muscles in your buttocks, can also contribute to lumbar radiculopathy. Hip
flexor muscles along the front of your hips and the quadratus lumborum and spinal erectors in your
low back should also be stretched.
 Posture. The body is meant to be in proper alignment while sitting and standing to reduce
stress on your spine. However, most people have difficulty maintaining an ideal posture.

7
Adapted from https://www.livestrong.com/article/405252-exercises-for-people-with-lumbar-radiculopathy/
 Positioning yourself in your chair and having your desk at the proper height are keys to
maintaining good sitting posture. Adjust your chair to a height that allows your feet to rest flat on the
floor.
Sit up straight as if being pulled up by a string attached to the top of your head. As you sit up,
you will notice a slight arch develop in your low back. Ideally, with time and practice, your back
muscles will become strong enough to hold you in this position. However, in the meantime, a small
rolled towel can be placed between your low back and the chair seat back to support this curve.
Whenever possible, give your back a break by standing every 20 to 30 minutes.
 Core-strengthening exercises. Begin by learning to contract the correct muscles with the
pelvic tilt. Lie on your back and bend your knees. Place your fingers on your hipbones, then
move 1 inch inward and 1 inch down.
Pelvic tilt exercises can be progressed as your strength improves. Try lifting one knee toward
the ceiling, then slowly back down while keeping your core muscles tight. Alternate legs as if
marching.
Work up to lifting both legs at the same time or lifting opposite legs and arms together. Pelvic
tilts can also be made harder by resting your legs on top of a therapy ball instead of on the floor.
Ankle weights can be added as well to make these movements more challenging.  Perform
strengthening exercises three to four times per week.
 Body Mechanics. When lifting objects from the floor, position your feet wider than your
hips. Tighten your core muscles to help maintain a slight arch in your low back. Squat,
keeping your weight in your heels. Do not bend over at the waist. Move slowly and avoid
jerking movements.

WORDS TO REMEMBER

Provide meanings to the following lexical units considering their morphological category:

hip  pelvis
tingling  prickly
originate  derive
labour  birth
prone to  disposed
underlying  hidden
tightness  contracted
glute  bum
alignment  adjustment
jerking  bouncy

I. Scan the text and answer the following questions:

1. What is lumbar radiculopathy?

* The lumbosacral radiculopathy is a disorder that causes pain in the lower back and
hip which radiates down the back of the thigh into the leg.
2. Is there any difference between lumbar radiculopathy and sciatica?
* The lumbar radiculopathy radiates pain in the lower back while the sciatica radiates
along the sciatic nerve.
3. What are the causes of the lumbar radiculopathy?
* The causes of the lumbar radiculopathy are a herniated disc with nerve compression
in the lumbar spine, unstable spine, diabetes.
4. Descrine the symptoms of the lumbar radiculopathy.
* The symptoms of the lumbar radiculopathy are unilateral leg pain greater than low
back pain, leg pain follows a dermatomal pattern, pain travelling below knee to foot or
toes, numbness and paraesthesia in the same area, straight leg raise positive, induces
more pain.
5. How does a physical therapist design the exercises?
* Lumbar radiculopathy symptoms caused by disk herniation typically worsen with
sitting or bending forward. Therefore, exercises that involve these positions should be
performed with caution. The opposite is true for lumbar radiculopathy caused by
stenosis or arthritis. Bending forward typically reduces pain for these individuals.
6. What are the general categories of exercises that could be practised ?
* The general categories of exercises that could be practised are streching, posture,
core-strenghtening and body mechanics.
TEAM WORK
The sentences below refer to exercises recommended by physical therapist for the recovery
from lumbar radiculopathy. Identify the types of exercises according to the specifications in the
diagram and insert the number of the sentence in the boxes aside:

1. It's important to stretch these muscles on both sides of your body, even though your symptoms
likely only occur on one side.

2. Core-strengthening exercises can also be performed while sitting on a large therapy ball. Tighten
your muscles and maintain this hold as you did while lying on the floor. You can then kick one leg
out at a time, lift one knee up and march, or lift opposite arms and legs without losing your balance.

3. Keep the object close to your body and lift and return to a standing position.

4. Symptoms from lumbar radiculopathy caused by disk herniation can become significantly worse
from sitting with poor posture.

5.The position of your upper back influences your low back posture. Squeeze your shoulder blades
together and down, as if you are trying to put them in your back pockets. Tuck your chin slightly
until your head is centered over your shoulders. If you're unable to maintain this position, exercise by
holding it for three seconds at a time, working up to three sets of 10 repetitions.

6. Leg muscles to target in your stretching program include the hamstrings on the back of the thigh,
quadriceps along the front of the thigh, adductors along your inner thigh and iliotibial band, or IT
band, on the outside of the thigh.

7.Symptoms from lumbar radiculopathy caused by disk herniation can become significantly worse
from sitting with poor posture.

8.Turn your whole body rather than twisting your spine.

9. Tighten your core by slowly pushing your low back into the floor. You should feel muscles get
tighter under your fingertips. Hold this position for a few seconds; then relax. Repeat 10 times,
working up to three sets in a row.
 3,5,8
1,6
....... Stretching Body
Exercises Mechanics

Lumbar
radiculopathy

Core- ........
2,9
4,7....... Posture strengthening ........
........ Exercises

FOCUS ON
Substitute the underlined words for their synonyms/ antonyms (words or phrases):
1. These problems may then irritate nerve roots.
 Disturb
2. Enumerate the types of exercises in the order of prevalence.
 Popularity
3. Degeneration from wear and tear, and aging. can lead to narrowing (stenosis) of the openings
between the vertebrae.
 Erosion  restriction
4. A slow onset of lumbar radiculopathy can occur from sitting or standing with poor posture.
 Commencement
5. This is when a vertebra slips forward.
 Moves
6. Symptoms usually radiate to the part of the body that is supplied by that specific nerve
 Given
7. The compression of the nerve root can result in tingling, radiating pain, and numbness
 Stinging  Dulness
8. An impingement in the lumbar region can be manifested with symptoms in the foot.
 Injury
GRAMMAR ACTION
ACTIVITY 1. Make the right choice for each sentence and fill in the gaps with a suitable tense of
the respective verb:

1. He allowed an extension for the delayed payment before I asked him about it.
a. allow b. handle c. loan
2. I was in arrears with the payment which fall due some time ago.
a. prevent b. fall due c. deposit
3. She borrowed money from him and received a remittance.
a. extend b. lend c. borrow
4. We made a legal action before he refunded the amount.
a. make b. threaten c. give
5. They recorded the operation after we deposited the bulk of the cash.
a. deposit b. credit c. cancel
6. The joint account was available to the couple as soon as they withdrew the signature specimens.
a. debit b. withdraw c. provide
7. The executor recorded the current account before he notified about it.
a. overdraw b. record c. loan
8. The retail bank gives the payments as soon as it had received customers’ personal documents.
a. do b. give c. make
9. The cashier counterfeited the bill before the police discovered him.
a. float b. notify c.counterfeit
10. The home bank acted as a trustee until the client found a good lawyer.
a. act b. manage c. bail

ACTIVITY 2: Read the sentences and insert the given compound nouns in the gaps below:

1. My grandfather has a recent greenhouse at his country cottage.

2. The new grammar book should have provided more exercises with prepositions.
3. Yesterday I went to a job interview and spoke to the editor in chief of a well-known local
newspaper .
4. The superintendent of the hostel never takes care of the freshmen in our faculty.
5. I have never liked to go at a fair and have a ride in a merry-go-round.
6. As she failed to observe the traffic rules the policeman fined her and took her the driving license.
7. The passer-by are not allowed on this side of the road.
8. The horseman and the horse must be very good friends.
9. She was the first woman-chef in our city.

newspaper grammar book passer-by editor-in-chief policeman

superintendent horseman merry-go-round
greenhouse woman-chef

KEY LANGUAGE

1. Match the images below with the names of the exercises designed for lower back pains:

1.Gluteal stretch 2.Cat and camel

3.Pelvic tilt 4.Partial curl
5.Standing hamstring stretch 6.Quadruped arm/leg raise
7.Stretching exercise 8.Side plank

b8 d9

8
https://stylesatlife.com/articles/upper-back-pain-exercises/
9
https://newleafwellnesscentre.com/how-to-stretch
g10 c11 a12

f13 k14 e15

1-g, 2-c, 3-a, 4-k,

5-e, 6-b, 7-d, 8-f.

10
https://docpods.com/gluteal-buttock-stretch-lying/
11
https://www.pinterest.es/pin/230879918369173380/
12
https://www.motherandbaby.co.uk/for-you/new-mum-yourself-your-body/new-mum-fitness/exercises-for-a-tighter-
tummy-the-pelvic-tilt
13
https://www.sarvyoga.com/vasisthasana-side-plank-yoga-pose/
14
https://harboursport.co.nz/partial-curl-2/
15
https://docpods.com/hamstring-stretch-standing/
 2. Fill in the blanks with the suitable words given below:

underlying(a) over-the-counter(b) commitment(c) pain-free(d)

pain-relieving(e) sacroiliac joint(f) buttocks (g) foster(h)
relieve(i) goals(j) flareups(k) relief (l)

In treating sciatica, physical therapy may provide symptom (1).............., promote healing of the
(2) ............. cause, prevent recurrences and (3).................
Physical therapy and exercise help strengthen and mobilize tissues in the lower back, pelvis,
abdomen, (4) ............., and thighs.
The (5) .............. of physical therapy and exercise in treating the signs and symptoms of sciatica are
to:
 restore (6) ............ functional movement patterns
 (7) ............. lower back, buttock, thigh, and leg pain
 reduce muscle spasm
 restore function of the lumbar spine and the (8) ..............
 improve mobility of the lower body
 (9) ............ a better healing environment in the lower back
 promote neurologic adaptations to reduce the perception of pain
 prevent future pain flareups and reduce fear associated with movement
(10) ........... and frequency are important attributes to a successful treatment outcome when using
physical therapy and exercise for sciatica. Physical therapy may or may not be combined with the
use of (11) .......... treatments, such as (12) .............. (OTC) or prescription medications or epidural
steroid injections.16  

1-l, 2-a, 3-k, 4-g, 5-j, 6-d,

7-i, 8-f, 9-h, 10-c, 11-e, 12-b.

16
https://www.spine-health.com/conditions/sciatica/physical-therapy-and-exercise-sciatica