Frequently Asked Questions
Radiculopathy (“pinched nerve”)
Radiculopathy is commonly thought of as a pinched nerve,, a condition where a nerve is irritated or compressed as it passes through the tunnel made by two adjacent vertebrae along its path to the arm or leg, and typically occurs from middle-age onwards in both men and women.
The most notable symptom is severe nerve pain in the arm which can often be shooting or burning and finding relief is difficult.
When a nerve is truly pinched, there may be pain in the neck and shoulder region, but the worst pain is commonly felt in the arm. It is also common to feel sensations of pins and needles in the fingers or parts of the arm. There may be some numbness in the tip of the thumb, or one or two fingers, depending on which nerve is involved. Muscles in the arm or hand may also become weak. Symptoms are often quite severe and it is difficult to find positions of relief which impacts on the ability to sleep.
Physiotherapy diagnosis is made after considering the nature of the pain and other symptoms as well as an examination of the neck and neurological system (testing reflexes, muscle strength and sensation in the arm). An X-ray or MRI may help confirm the clinical diagnosis.
There are 3 phases during the course of this condition requiring different treatment:
- acute (the first 1-6 weeks) – physio treatment focuses on pain-relieving medication, gentle manual therapy as well as individualised pain management advice along with education in care for the neck and comfort positions during sleep and work
- subacute – once the severe pain has reduced, your physio will progress treatment to gently mobilise both the joints and nerves of the neck to further decrease residual pain, and gently progressed exercises are added to ensure that the nerves can move normally with day-to-day movement of the arms and to ensure return of good muscular control of your neck.
- persistent – unfortunately some people have intermittent but lesser pain in the arm that persists for several weeks or months. In these cases, physiotherapy methods such as manual therapy for the joints of the neck and nerve structures can be helpful but a comprehensive exercise program is an important aspect of management
Usually physiotherapy is the first treatment approach, but if severe pain continues and muscles become weaker, neck surgery may need to be considered. However, studies are showing that two years down the track there is no difference between those who have, and those who have not, had surgery.
Radicular pain is a type of back pain that spreads from the back and travels down the leg below the knee (sometimes there is only leg pain and no back pain). This leg pain is considered to originate from irritated nerves near the spine and is commonly known as sciatica. However, the term sciatica is usually used to describe pain down the back of the leg arising from irritation or pinching of the sciatic nerve which is located in the buttock muscles.
Radicular pain is due to irritation of a nerve branch where it exits the spine with the area of pain in the leg being dependent on which nerve branch or nerve root is irritated. For example, if your physio diagnoses an irritation of the L5 nerve root, or L5 nerve root compromise, this will describe an irritation of the nerve branch that exists at the last (5th) spinal vertebral level.
Radicular pain is thought to be related to problems with intervertebral discs that, secondary to injury, have changed shape and herniated (bulged, swollen and protruding) and are irritating nearby nerves and soft tissues. Problems with discs are not necessarily permanent and even large disc herniations can disappear over time.
If you have radicular pain, your leg might feel worse than your back pain, or you might have no back pain at all. If there is compression of the nerve you might also experience weakness and numbness in your leg. Most people who experience weakness related to this type of nerve compression will recover their strength within a year and without surgical intervention.
Your physiotherapist is trained to distinguish between radicular pain and other causes of low back and leg pain. They will do this by asking you a series of questions about your pain and examining your back and legs before performing nerve tests such as checking the reflexes, sensation and strength of your legs. Imaging (scans and X-rays) are not needed to diagnose radicular pain.