In this edition of the South Simcoe Physiotherapy blog, we are going to explore another real patient’s physiotherapy experience suffering from lumbar radiculopathy – right from the initial assessment and diagnosis to the patient returning to their goals, and graduating from physiotherapy!
What is lumbar radiculopathy?
In a nutshell, lumbar radiculopathy is the compression of a nerve root(s) in the lumbar spine that can cause pain in the lower back, hip and/or leg as well as possibly cause numbness into the leg.
The Case
How did this individual present at initial assessment?
Patient Background
The patient was a 45 year old male. He reports a dull, aching lower back pain radiating to the posterior thigh, calf, and lateral aspect of the right foot. He describes the leg pain as sharp and electric-like, often accompanied by tingling (“pins and needles”) and occasional numbness in the foot. Symptoms began insidiously about 4 weeks ago, initially as mild low back discomfort after prolonged sitting at work. Over time, the pain intensified and began radiating down the right leg. He denies any single traumatic event but attributes the onset to poor posture and long hours at his desk.
Pain Characteristics:
Intensity: 7/10 at worst (Numeric Pain Rating Scale)
Nature: Sharp, shooting pain in leg; dull ache in the lower back
Radiation: Right buttock → posterior thigh → calf → foot
Aggravating Factors: Prolonged sitting, bending forward, lifting heavy objects, driving
Relieving Factors: Lying on his back with knees bent, short walks, use of a lumbar roll
Duration of Symptoms: Most of the day, worsens by evening
Functional Limitations:
Difficulty sitting for more than 15–20 minutes
Disrupted sleep due to pain (especially when lying on his back)
Trouble performing work duties that involve computer use and meetings
Reduced participation in recreational activities like cycling and playing with his children
Patient’s physiotherapy goals were to:
1.Improve his pain so he can sleep better
2.Perform his work duties with minimal pain
3.Return to playing with his kids
The Physical Examination
- Observation: Flattened lumbar lordosis; antalgic posture with a slight lateral shift.
- Palpation: Tenderness at L5-S1 paraspinal region.
- ROM: Lumbar flexion and side bending limited and painful.
Neurological Examination:
- Decreased sensation in the right S1 dermatome.
- Weakness in right plantar flexion (S1 myotome).
- Diminished right ankle reflex.
- Special Tests:
- Straight Leg Raise (SLR) positive at 40° on the right side.
- Slump test positive.
Physiotherapy Diagnosis: Lumbar radiculopathy secondary to L5-S1 disc pathology with neurological involvement.
What did treatment look like for this individual?
Education
Initially, this individual was educated on what lumbar radiculopathy is. Lower back pain can be scary for individuals, therefore it was important to outline what lumbar radiculopathy is, how does it occur, what physiotherapy can do to help and how long will it take to get better. Typically, lower back pain can improve in 6-8 weeks, however, when a nerve is being affected, it will usually take longer as nerves take longer to heal. That being said, there will be improvements along the way.
Physiotherapy Treatment Plan
Goals of Treatment:
Reduce pain and inflammation.
Restore normal neural mobility.
Improve lumbar spine ROM and core stability.
Correct postural and movement dysfunctions.
Prevent recurrence and promote functional independence.
Phase 1: Acute Phase
Goals: Pain relief, reduce nerve irritation, and patient education.
Modalities:
- TENS for analgesia (20–30 min, lumbar paraspinals and leg)
- Ice or heat packs as per tolerance (15–20 min)
Therapeutic Exercises:
- McKenzie extension exercises (e.g., prone press-ups) for centralization of symptoms
- Gentle pelvic tilts in supine
- Sciatic nerve sliders and gliders
Manual Therapy (if tolerated):
- Gentle lumbar PA mobilizations (Grades I–II)
- Soft tissue mobilization for paraspinals and gluteals
Phase 2: Sub-Acute Phase
Goals: Normalize mobility, reduce nerve sensitivity, begin strength and stability work.
Stretching:
- Hamstrings, hip flexors, piriformis
- Gentle lumbar rotation in supine
Strengthening & Stability:
- Transversus abdominis activation in supine and quadruped
- Bridging exercises
- Dead bugs and bird-dog exercises for lumbar control
Neural Mobilization Progression:
- Continue nerve glides, progress to tensioners if tolerated
Manual Therapy:
- Mobilization with movement (e.g., Mulligan technique) for lumbar spine
- Myofascial release of tight structures
Phase 3: Functional Phase
Goals: Improve dynamic control, return to daily and work-related activities.
Advanced Core Exercises:
- Swiss ball exercises
- Planks (modified to full as tolerated)
- Functional core strengthening (e.g., resisted walking, diagonal lifts)
Balance and Proprioception Training:
- Single leg stance, BOSU ball, dynamic reaching tasks
Postural Retraining:
- Mirror feedback, postural drills, correction during tasks
Functional Integration:
- Lifting techniques, sit-to-stand drills
- Work-specific simulation (e.g., desk ergonomics, lifting/carrying tasks)
Phase 4: Return to Activity/Sport
Goals: Full functional recovery, independence in home program, recurrence prevention.
General Conditioning:
- Walking program, light cycling, swimming if appropriate
- Cardiovascular conditioning to improve overall health
Home Exercise Program:
- Tailored plan focusing on mobility, strength, and flexibility
- Long-term spine health maintenance exercises
Patient Education:
- Emphasize spine hygiene, activity pacing, and lifting mechanics
- Strategies to manage flare-ups
Adjunct Therapies:
- Dry needling or cupping for muscular tension (based on therapist’s expertise)
- Taping (kinesiology taping or lumbar support taping for proprioception)
Conclusion
This individual responded well to conservative physiotherapy management. Pain, functional limitation, and neurological symptoms significantly decreased. He was advised to continue with a home exercise program and regular follow-ups to prevent recurrence.