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Lumbar radiculopathy – Within Normal Limits of Reason – Medium

The vertebrae, which protect the spinal cord and spinal nerves, through daily activities experience normal wear-and-tear. Sometimes this causes slight impingement of nerves, in turn causing spinal nerve inflammation and shooting pain down to the feet.

Radiating back pain

Back pain that shoots down the leg into some (not all) toes can be due to lumbar radiculopathy, which comes from impingement of the lumbar spinal nerves by otherwise normal day-to-day wear-and-tear of the vertebrae. Impingement causes pain not as much by mechanical compression as by inflammation and irritation of the nerves.

Spinal nerves

Irritation of a lumbar spinal nerve causes pain, spasm, and inflammation in body parts served by the nerve.

Areas of the skin served by a lumbar spinal nerve is its dermatome. For example, the dermatome of the L5 nerve includes the top of the foot.

Spinal nerve irritation will also cause spasms of its myotome — muscles under its control. This causes alterations in posture & activities that cause secondary pain.

Nerve irritation can also cause neurogenic inflammation in involved peripheral tissue. This is mediated by interactions between nerve endings and the immune system.

Chronic pain cycle

Even if pain sources are identified, frequently neck pain involves the entire “chronic pain cycle”. Treatment requires comprehensive management including biomechanical & psychological treatments.

Symptoms

  • Shooting pain down to some of the toes on one side
  • Spasms of buttock, thigh, leg, and foot muscles
  • Back & buttock pain

Diagnosis

  • Physical examination
  • X-ray, CT, and/or MRI of the lumbar spine
  • Other musculoskeletal conditions often co-exist
  • Rule out other “red flag” medical conditions

Treatment

  • Physical therapy strengthening the back and pelvic girdle muscles, improving posture
  • Epidural steroid injection under fluoroscopy guidance reduces inflammation around the spinal nerves.
  • Co-existing musculoskeletal conditions should also be treated.
  • Spinal cord stimulation (SCS) is sometimes an option for non-drug, convenient therapy.
  • Comprehensive pain management including pain psychology, physical therapy, and complementary & alternative medicine (CAM)

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