What is low back pain (LBP) with leg pain (sciatica)?

Low back pain may be associated with severe pain radiating down the leg as far as the foot which is known as sciatica.

Studies have shown that over 80% of people will suffer with low back pain (LBP) at some point in their adult life. A small percentage will experience pressure on the nerve root adjacent to the disc. This nerve root pressure results in the severe pain radiating down the leg (sciatica). 90% will resolve without specialist input and more than 70% report improvements in their symptoms within 4 weeks.

Low back pain with leg pain (sciatica)

Common symptoms

Pain and stiffness in the lower back. Pain which radiates to the buttock area and down one or both legs depending on the exact nerve affected. There may be some sensory symptoms such pins and needles, tingling or numbness in the legs or feet and in rare causes individuals develop some weakness to particular muscle groups in the lower limb.

If you experience the above symptoms associated with any of the following  symptoms listed below you should seek urgent help immediately from your local accident and emergency department:

  • Being unable to pass urine when you feel the need to go
  • Lose control of your bowels
  • Go numb around your bottom
  • Worsening weakness in the legs
  • Unable to get an erection

Commonly, symptoms tend to be aggravated with static upright postures such as walking or standing as well as sitting in a slumped position.

Symptoms may be eased with exercises, postural and ergonomic modifications and maintaining general levels of activity.

How is LBP with nerve root pain diagnosed?

Nerve root pain coming from the lumbar spine can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature on examination is often a reduced range of spinal movement and the reproduction of leg symptoms when raising the affected leg (SLR test). Testing of sensation, power and reflexes is also normally performed.

X-rays are not required. A scan is not routinely required but may be requested if injections or surgery are being considered.

How is LBP with nerve root pain treated?

Non-surgical management

In the majority of cases, LBP with nerve root pain can be managed effectively by non-invasive measures as described below. The most effective are exercises, ergonomic modifications and maintaining activity levels.

Exercises

Specific exercises to relieve any stiffness in the spine and maintain flexibility at the hips. If the exercises below are particularly painful start with shorter repititions or durations and increase as your pain levels allow:

5×30 second holds, 2x per day

10-20 repetitions 2x per day

5×30 second holds, 2x per day

Medications

It is reasonable to try over the counter painkillers initially. Unfortunately, standard painkillers are not very effective in relieving radicular pain from nerve root compression. Your clinician will advise on medication that may help your symptoms. This may include muscle relaxants and anti-neuralgic medications.

Invasive treatment options

Injection therapy

For individuals who continue to suffer symptoms significantly affect their quality of life and who have undergone scans confirming the presence of nerve root irritation an injection around the nerve root may be offered.

Surgical management

Decompression surgery for the affected nerve root can be offered for patients who:

  • Have trialled at least a 12-week course of non-surgical management without success
  • Have scans confirming the presence of nerve root compression
  • Have consistent, disabling pain in the leg (not the lower back itself) which significantly limiting quality of life