Low Back Pain

Is it a slipped disc? Pinched nerve? Sciatica? Leg Pain May Stem from pinched nerve in the low back

Marla S. Kaufman, M.D.

Edited By Marla S. Kaufman, M.D., Clinical Associate Professor, UW Orthopaedics & Sports Medicine
Last updated: December 31, 2009

Overview

Basics of lumbar radiculitis

Low back pain may be caused by disk herniation, facet joint arthritis, congenital narrowing of the spinal canal, and other conditions. Some patients have back pain that also associated with pain and/or other symptoms in their legs.

Lumbar radiculitis is an inflammation or irritation of a nerve root in the lower region of the spine. Often it stems from a herniated or prolapsed disc pressing against a nerve where the nerve enters the spinal column. Arthritis of a spine’s facet joints also can lead to nerve root irritation.

The compression or irritation creates pain that radiates out through the nerve's tendrils in the patient's back and down the leg.

Lumbar radiculitis may involve nerves originating from each side of the five lumbar vertebrae, as well as one nerve branching out from the sacrum. These nerves innervate all the muscles in the legs, and also communicate sensation from the legs to the brain.

Patients often describe a sharp and burning, or dull and aching, pain that can run through the gluteal muscle, to the thigh, calf, and foot. As symptoms worsen, the patient may begin to experience weakness, numbness and tingling in their legs, as well.

Immediate medical attention

Immediate medical attention is warranted if back pain and numbness is accompanied by any of the following:

  • loss of bowel or bladder control
  • new or worsening weakness or numbness in one or both legs
  • back pain from a fall or injury

Patients who have back pain associated with fever, or which interrupts a patient's sleep or causes a fall should be evaluated by a healthcare provider.

Facts and myths

Leg pain that originates in the back is frequently called "sciatica,” – but this is a misnomer, as sciatica refers specifically to the sciatic nerve. Sciatica describes pain in the back of the thigh, back of the calf, and foot – the route of the S1 nerve root distribution. Sciatica might be the most common presentation of radiculitis, but it is not the only one, as other nerve roots (from vertebrae L1-5) in the lumbar region can be involved, as well.

Symptoms & Diagnosis

Prognosis

Back pain, including lumbar radiculitis, may be either an acute or a chronic condition. If the symptoms are chronic, pain may wax and wane irregularly for the patient.

Patients that have a normal neurologic (nerve function and reflexes) exam and patients with a neurologic deficit – weakness, loss of sensation, loss of bowel or bladder control- can both have similar levels of pain.

Treating back pain early, soon after it first emerges, tends to result in better ability to manage the condition and optimize function. Waiting longer for treatment may result in a longer and more difficult treatment course.

Lethality

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) itself is not deadly. If a patient were to ignore signs that warrant immediate medical attention – loss of bowel or bladder control, back pain from a fall or other injury, or numbness in one or both legs – those symptoms could progress and contribute to a patient's paralysis.

Pain

Lumbar radiculitis can cause pain, tingling, numbness or a burning sensation in the back and legs. The symptoms can range from mild to severe over periods of hours, days or longer. Pain can fluctuate depending on a patient's physical position (sitting, standing, lying down) and activity.

Patients typically can accomplish daily tasks and manage discomfort with treatments of physical therapy, anti-inflammatory and other pain medication, and epidural injection of steroids.

Debilitation

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) generally is not debilitating. Patients typically can accomplish daily tasks and manage discomfort through a combination of physical therapy, anti-inflammatory and other pain medication, and injection of steroids.

Curability

Yes, it is curable by physical therapy, oral medications, epidural steroid injections (cortisone injections) into the spine, and, sometimes, surgery.

Fertility and pregnancy

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) should have no effect on a patient's ability to have children or get pregnant.

Independence

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) may, during episodes of acute pain, reduce a patient's independence. For instance, it might prove too painful to try to drive a car with a clutch, or to walk significant distances. Tasks such as taking out the trash or carrying groceries may be intermittently difficult or impossible, but usually patients are not debilitated for long spans.

Mobility

Patients with lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) may experience reduced mobility during episodes of acute pain but generally there is no long-term impact on a patient's mobility.

Daily activities

Intermittently and during periods of acute pain, lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) might reduce a patient's ability to participate in a household chores and other activities. For instance, tasks such as taking out the trash or carrying groceries might require help, and patients might need to modify their physical activities. Usually, though, these activity modifications do not occur for extended spans.

Energy

Indirectly, lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) could contribute to fatigue or metabolic change. For instance, when pain causes a poor night of sleep, or a patient’s inability to exercise for a couple of days results in lethargy, radiculitis could be an indirect cause.

Diet

Radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) typically does not correlate with a patient’s diet. Being overweight, however, can contribute to back pain; for instance, being overweight could create pain in a person’s knees, and a resulting change in gait could adversely affect the spine. In such instances, or if excess weight contributes to back pain, a change in diet, accompanied by exercise, could benefit the patient.

Relationships

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) is unlikely to have direct implications on relationships, though it could affect a person’s demeanor or their activity level – and thereby affect relationships with others.

Incidence

In the United States, research suggests that nearly 90 percent of adults experience back pain at some time in life. Acute low back pain is among the most common reasons for all physician visits.

Trauma that causes a herniated disc can happen at any age. Radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) stemming from facet joint arthritis is more typical in older populations (See video: Spine: Surgery for the Aging Spine). Men and women are equally at risk, as are athletic and non-athletic populations.

People can have nerve root impingements or herniated discs but have no symptoms of radiculitis.

Acquisition

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) is acquired in one of two ways:

  • by strain or trauma that causes a herniated or prolapsed disc between spinal vertebrae;
  • by arthritis occurring in the facet joints that protrude from either side of the spinal vertebrae. These enable your back to make controlled twists and turns.

Genetics

Genetics can predispose people to arthritis, and research has suggested that genetics plays a role in developing herniated discs. Stenosis, which can be an acquired or inherited narrowing of the spine, could also create pressure on nerves, causing radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs).

Communicability

A person cannot get lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) from someone else.

Lifestyle risk factors

Anyone can sustain a back injury that could cause a herniated disc.

Among physically active people, those who participate in contact sports put themselves at increased risk of damaging their spine. Additionally, people whose activities lead them to build strong muscles on the front and back of their legs (e.g., runners, cyclists) sometimes have unequally developed muscles that contribute to lateral movement (e.g., basketball, soccer). Those biomechanical imbalances can be a key component in back pain.

Conversely, people who have an inactive lifestyle could lack the muscular support to help them stave off injuries to the spine.

On-the-job manual lifting, bending, twisting, and whole body vibration may be associated with an increased likelihood of nonspecific low back pain – but stronger evidence suggests that psychosocial variables such as depression, job dissatisfaction, and physical trauma unrelated to work play greater roles in patients’ reports of back pain.

Additionally, research suggests an association between low back pain and smoking – possibly because smoking slows healing of tissues in the body.

Injury & trauma risk factors

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) often stems from an injury or trauma that causes a herniated or prolapsed disc. A simple activity or task that requires twisting and lifting could cause a painful event, as well.

Prevention

Physicians have recommendations for prevention, which include physical therapy and exercises to strengthening core muscles such as abdominals and obliques and ongoing vigilance about body posture and correct biomechanics to avoid injury to the spine.

Anatomy

The pain can radiate in the back, buttocks, thigh, calf, and foot.

Initial symptoms

Typically back pain, either dull or sharp, is the first sign of lumbar radiculitis. Its severity can vary between mild and acute. Numbness and tingling also emerge in the leg and foot.

Symptoms

Symptoms of radiculitis vary between patients, depending on which nerve root is affected. Some patients can experience numbness in the big toe and foot, and others will experience pain at or above the hip, the buttocks, and elsewhere. Pain can be stinging and sharp, or dull. Patients can find it difficult to be comfortable while lying down, sitting up, walking, etc.

Progression

As the irritation of the nerve roots continues, patients can experience a change in the pain’s intensity, frequency or character. Symptoms (pain, numbness, tingling) can worsen over time – or plateau at a level that the patient can manage.

Secondary effects

Lumbar radiculitis could affect a person’s ability to sleep soundly, so could make them more tired and lethargic during periods of acute pain. It could cause them to be absent from work or to reduce participation in activities that give them joy. Pain can affect a person’s disposition, making them feel sad or frustrated or angry. In these ways lumbar radiculitis could affect a person’s relationships.

Conditions with similar symptoms

Several conditions have symptoms similar to lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs). Outside the spine, a patient’s pain might stem, instead, from inflammation of a hip joint or the sacroiliac joint. Numbness and tingling in the leg and feet can stem from peripheral neuropathy caused by diabetes or a thyroid condition. A strained muscle, such as the gluteal or piriformis, could cause pain in the lower back, buttock and leg.

Metastatic cancer of the spine, perhaps as a soft-tissue tumor, also could cause regional pain. In addition, pain felt in the back may originate in the abdomen or pelvis.

Causes

Irritation of the nerve root in any of the five lumbar-vertebrae nerves or the sacral nerves could lead to radiculitis. The nerve irritation is typically caused by herniated or prolapsed disc, by arthritis of the facet joints in that region of the spine, or by narrowing of the lumbar spine, called stenosis.

Effects

Symptoms of radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) vary between patients, depending on which of six lumbo-sacral nerve roots is irritated. Some patients can experience numbness in the big toe and foot, and others will experience pain at or above the hip, the buttocks, and elsewhere. Pain can be stinging and sharp, or dull. Patients can find it difficult to be comfortable while lying down.

Ignoring symptoms can lead to a change in their frequency, intensity or character.

Diagnosis

A complete history and thorough physical examination is the first step in diagnosing lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs). Additional tests such as X-ray or magnetic resonance imaging (MRI) might be needed in some cases but are not indicated for every patient. Nerve tests (electro-diagnostics) and laboratory studies may also be useful in specific situations.

Diagnostic tests

A complete history and thorough physical examination is the first step in diagnosis. Additional tests such as X-ray or magnetic resonance imaging (MRI) might be needed in some cases but are not indicated for every patient.

Other diagnostics could include electromyography (EMG) and a nerve-conduction study to pinpoint what is causing the weakness or tingling/numbness in the leg(s).

Infrequently laboratory studies are needed for patients whose symptoms might have rheumatologic causes.

Effects

The EMG nerve stimulation diagnostic could be uncomfortable for some patients, as it involves a pin electrode and stimulation of the nerves. Patients who are claustrophobic might be uncomfortable getting an MRI, as it involves being inside a big tubular structure.

Health care team

Lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) could be diagnosed by a primary care provider, a sports and spine specialist, a physiatrist (PM&R doctor), a rheumatologist, or an orthopedic surgeon.

If causes outside the range associated with radiculitis are suspected, counsel could be sought from specialists in neurology, vascular disease, oncology, and other areas.

Finding a doctor

Generally orthopedic and spine specialists will have the most expertise in treating lumbar radiculitis; those specialists often can be located through the American Academy of Physical Medicine and Rehabilitation website, American Academy of Orthopedic Surgeons Web site, university schools of medicine, county or state medical or orthopedic organizations.

 

Treatment

The options for treating lumbar radiculitis range from managing pain with anti-inflammatory medication to reparative surgery

Symptoms may be improved with relative rest and lifestyle modification, education, oral medications, and physical therapy. Common oral medications comprise anti-inflammatories such as ibuprofen and Naproxen, acetaminophen for pain-management, and compounds such as Gabapentin, and Nortriptyline, which can also be used for pain and sleep.

Steroid injections may be indicated when other treatments fail, or used in conjunction with these other treatments.

Steroid injections generally are performed under X-ray (fluoroscopic) guidance. The steroid, a very powerful anti-inflammatory, is directed into the epidural space around the specific nerve root that is being compressed or irritated. The goal of the injection is to decrease inflammation in as direct manner as is possible. This typically reduces the patient's pain and facilitates the return of function. This would improve the patient's ability to participate in other treatments.

Patients who take prescribed blood thinners, have bleeding disorders, have allergies to contrast dye, or have active infections should contact their physician before considering this procedure.

Physical therapy also can help improve patients’ biomechanics and strengthen core muscles. Acupuncture and other complimentary therapies may be considered, as well.

Intractable pain and neurologic degradation in the wake of more conservative treatments are indications for surgery. A surgeon would pinpoint the location and cause of the compressed nerve, and aim to reduce or eliminate that pressure. (See video: Specific Indications for Spine Surgery.)

Self-management

Patients can adjust daily work activities and/or reduce participation in activities that cause or exacerbate discomfort of lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs).

If specific postures are more painful, explore posture changes that could provide relief. Physical therapy – to master a guided program of stretching and exercising at home – can be very helpful to reduce painful events; the programs are most effective if the patient diligently maintains the program while he or she is at home, apart from the physical therapist.

Health care team

A primary care provider, nonsurgical sports and spine specialists, orthopedic surgeons, and physical therapists all can help treat lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs).

Pain and fatigue

Acetaminophen, aspirin, and other non-steroidal anti-inflammatory drugs may be used for relief from pain due to lumbar radiculitis, but narcotics should usually be avoided. Higher levels of pain can be alleviated by steroid injections, but the number of injections per year is limited.

A TENS (Transcutaneous Electrical Nerve Stimulator) unit or biofeedback may be tried. A TENS unit is a small, battery-operated device which relieves pain by blocking nerve impulses. Biofeedback is a technique which can help control pain, blood flow, and skin temperature.

Meditation, hypnosis, and others may be learned from a psychologist who specialized in pain management.

Diet

Radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) typically does not correlate with a patient’s diet. Being overweight, however, can contribute to back pain; for instance, being overweight could create pain in a person’s knees, and a resulting change in gait could adversely affect the spine. In such instances, or if excess weight causes back pain, a change in diet, in conjunction with exercise, could benefit the patient.

Exercise and therapy

A physician’s exam and laboratory tests will help a doctor determine the appropriate time for a patient to start an exercise program.

Physical therapy can help improve patients’ biomechanics and strengthen core muscles that better support the spine and a person’s upper-body control. Building a program of range-of-motion stretches and strengthening exercises into one’s daily routine can be very helpful to reduce painful events; such programs are most effective if the patient is diligent at home, apart from visits to the physical therapist.

Patients can adjust daily work activities and/or reduce participation in activities that cause or exacerbate pain. If specific postures are more painful, explore other postures that could provide relief.

Acupuncture and other complimentary therapies may be considered, as well.

Medications

If back pain is not relieved using other forms of treatment, medication may be prescribed. The medication chosen depends on the back pain. For example, medications called analgesics can help relieve pain. If back pain is caused by arthritis, medication to reduce inflammation as well as relieve back pain may be prescribed. The most common medications prescribed are called nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen.

People taking medication for back pain should ask their doctor or pharmacist questions such as those listed below:

  • What will the medication do?
  • How long will it take before I notice results?
  • What is the name of the medication? Is there a generic brand?
  • Are there side effects I should know about?
  • How should I take the medication (i.e. before or after meals, with or without food, etc.)?
  • How often should I take the medication?
  • What should I do if I forget to take a dose at the specified time?

People taking medication for back pain should also let their doctors know if they are taking other medications. Sometimes certain medications cannot be taken together.

Surgery

Often surgery can effectively treat severe cases of lumbar radiculitis, when pain and instability, or other symptoms such as loss of bowel or bladder control, are sustained or worsening despite non-surgical treatments.

Joint aspiration

Joint aspiration is the process of removing some fluid from the sore joint(s). It is not indicated to treat lumbar radiculitis. Injection of anti-inflammatory steroids can be an effective pain reliever, though it will not change physiological structures that are causing pain.

Splints or braces

Neither splints nor braces are indicated to treat lumbar radiculitis.

Alternative remedies

Acupuncture and other complimentary therapies may be considered. Relaxation techniques, such as meditation, visual imagery, progressive muscle relaxation, yoga, or biofeedback may also be helpful for people with lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs).

Social impacts

Any chronic pain condition can have psychological impacts on patients. The frustration of untimely bouts of pain can cause patients to choose not to participate in social activities, and/or can bring anger and depression. Reduced participation in physical activities can contribute to weight gain.

However, managing chronic pain with a program of exercise, stretching and pain medication – as well as relaxation techniques – can help the patient maintain a more active role in social opportunities. Detecting this condition early on can give patients a better chance to manage their symptoms in the long term.

Long-term management

Many patients are able to adequately self-monitor their pain and other symptoms of radiculitis, managing with medication, physical therapy and other treatments, and visit a physician when their symptoms change markedly or degrade over a span.

Strategies for coping

Patients who report their lumbar radiculitis symptoms (pain, tingling, numbness or a burning sensation in the back and legs) early on can give themselves a better chance to manage their symptoms in the long term. A program of exercise, stretching and pain medication – as well as relaxation techniques – often can help the patient reduce pain maintain a more active role in social opportunities. Additionally, patients and their families should be informed about the condition, exploring therapies that have helped other patients. Patients may benefit from talking with a trained psychological therapist.

Asking for help

People with lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) should learn as much as they can about the disease and how to manage it. Sometimes talking to a family member or friend can provide much needed emotional support. Working with a counselor, psychologist, or social worker helps some people with lumbar radiculitis develop better coping skills.

Work

Most people with lumbar radiculitis (inflammation of a nerve root in the lower spine, causing pain, tingling, numbness or a burning sensation in the back and legs) can continue to work. Doctors and work supervisors should be able to help people with make any needed changes that will relieve the symptoms. This could include getting an ergonomic evaluation, and adjusting the work area or reducing the amount of time spent on particular tasks; sometimes even creating a reminder to change postures (e.g., stand up and stretch, take a brief walk) every hour or so can help.

An occupational therapist also can help find ways to modify activities or suggest tool modifications to put less stress on the spine.

Condition research

Medical researchers continue to learn more about nerve pain radiating from the spinal column. For instance, ongoing and recent research evaluates the efficacy of an implanted spinal-cord neuro-stimulation device, as well as epidural steroid injections and artificial disc replacement.

Research focuses on the potential promise of nonsurgical approaches, such as magnet therapy, and a neuro-protective dietary supplement in patients suffering from lumbar radiculitis.

Pharmaceutical research

Recent research by pharmaceutical companies and health organizations evaluated the efficacy and safety of the drugs lenalidomide and topiramate in the treatment of painful lumbar radiculopathy.

Non-surgical research

Research suggests that Vitamin D deficiency is a major cause of musculoskeletal pain and low-back pain. In one study of 299 patients with low back pain, 83 percent were vitamin D deficient, and most experienced some pain relief with vitamin D supplement doses of 5,000 IU/d or 10,000 IU/d for three months.

Research also indicates that massage can improve flexibility and reduce pain, and increase serotonin and dopamine, in patients with low back pain.

Surgical research

Statistically and clinically significant relief of neuropathic pain has been reported by doctors whose patients received Ziconotide via intrathecal infusion (implanted pumps). The pain relief was temporary, and subsequent infusions were required to maintain pain relief.

Cellular, genetics, or tissue research

Recent research studies the potential for replacing or re-growing spinal disc tissue that would supplant tissue removed in the wake of disc herniation.

Summary of lumbar radiculitis

Low back pain can have dozens of causes. Lumbar radiculitis stems from nerve impingement due to herniated disc(s), arthritis, or narrowing of the spinal canal. An experienced physician can discern which disorder is causing pain and discomfort, and set out an appropriate course of treatment.

Patients with lumbar radiculitis often describe a sharp and burning, or dull and aching, pain that runs through the buttock or hip, thigh, calf, and foot. As symptoms worsen, the patient may begin to experience weakness, numbness and tingling in their legs, as well.

Not all back pain needs to be treated with surgery. Many nonsurgical approaches can enable patients to adequately manage pain. Oral medications, steroid injections, physical therapy and other approaches can be beneficial to patients with chronic episodes of lumbar radiculitis.

Magnetic resonance imaging (MRI) is a very sensitive tool that is may assist in accurate diagnosis of the cause of an individual’s back pain.

Loss of bowel or bladder control, worsening weakness or loss of sensation all are causes for immediate medical attention.


View a list of Spine Patient Care Services at the University of Washington Department of Orthopaedics & Sports Medicine.

To schedule an appointment with one of our providers, please call (206) 520-5000 or (877) 520-5000.