Sciatica Explained


Radicular pain vs Radiculopathy

by Lis Coffey, Physiotherapist at Form & Practice, Mt Evelyn

Most people are familiar with the term ‘Sciatica’ when it comes to explaining pain that comes from the back and radiates down behind either one or both legs. Whilst the sciatic nerve can be involved and irritated by disc bulges, bone spurs and narrowing in the joint, it is not the only terminology that we now use to explain back pain with associated lower limb symptoms.

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Radicular pain is the term used to describe an increase in nerve sensation – ie. Pain, which occurs peripherally due to an irritated, inflamed or compressed nerve root. An example of this may be an irritated disc in the cervical (neck) joints which causes arm or hand pain. Or in the case of the lower lumbar discs, a person may experience painful radicular symptoms as far down as the feet and toes. Simply put, as the nerves experience this chemical irritation, they send an increased amount of ‘traffic’ along the nerve which results in the increased sensation, pain, along the nerve distribution.

Radiculopathy is used to describe a reduction in the healthy function of a nerve root, resulting in neurological deficits which may include numbness, pins and needles, motor weakness and reduced reflexes. This can occur as a result of a compressed and irritated nerve root. Radiculopathy may occur in the absence of pain, and there may be no pain even in the spine itself. This is because a nerve requires adequate blood supply and a balance of pressure in order to function effectively. A nerve root that is under some compression from the spine may experience ischaemic (lack of blood) changes. As a result of this reduced function in the nerve, there is a loss of sensation along the nerve distribution, culminating in neurological deficits. 

Radicular pain and radiculopathy can occur individually or in combination with one another. When occurring together the term used is Painful Radiculopathy. A person may have neurological deficits accompanied by pain in the nerve distribution. 

There are various other complex conditions which may also masquerade as painful radiculopathy, and a physiotherapist will be able to differentiate these from other conditions. At times, various conditions can present in conjunction with Radicular pain or radiculopathy which can complicate the diagnosis.

In terms of treatment of radicular pain or radiculopathy, every person’s back is different and therefore there is no ‘cookie cutter’ approach to management and treatment.  

Firstly, it is important to find someone who can listen and acknowledge your level of pain and discomfort, which for many people can be extreme and have a big impact on their daily living. 

A thorough assessment and individualised treatment plan by a physiotherapist is required, and treatment will usually  involve a combination of hands-on therapy (such as massage, mobilisation and dry needling) and guided strengthening program of the trunk and postural muscles that support the spine. 

In extreme cases where symptoms do not begin to improve within 3-5 sessions of physiotherapy, further imaging and sometime more interventional treatment (painkilling injections, surgery) may be required.

Book online for a Physiotherapy appointment with Lis Coffey via our website or call us at Mount Evelyn on 03 9736 2565, or Olinda 03 9751 0400