Lumbosacral radicular back pain. Up-to-date assessment and treatment guidelines.

Back Pain Treatment

What is lumbosacral radicular back pain? How do we know when we have it and how is it treated? Also commonly known as sciatica, lumbosacral radicular back pain is the clinical term referring to motor, reflex and/or sensory changes where a spinal nerve root is involved.

Causes and anatomical background

Causes of radicular back pain commonly include lumbar disc herniation, degeneration of the spinal vertebra and narrowing of the foramen. When these happen, the exiting nerve roots experience compression and damage with symptoms as a result. More uncommonly, trauma and the presence of a tumour can also be the culprits. The L4-5 and L5-S1 spinal segments are the areas often affected in this condition.

Clinical presentation and symptoms.

Whether a person has radicular pain can be obtained from a clinical examination which will reveal symptoms including

  • Pain following a dermatomal pattern
  • Paraesthesia
  • Tingling/numbness

Assessment and diagnosis

Your clinician should employ a combination of tests to diagnose the condition. These include a positive straight leg raise test, observation of your gait, determining whether your pain follows a dermatomal pattern and conducting a thorough interview to identify classic signs and symptoms.

Imaging and scanning options such as a CT or MRI should only be considered when neurologic signs and symptoms do not resolve after 4-6 weeks.

Recent evidence for treatment. What works and what does not work?

According to recent evidence, the use of TENS, manual therapy, ultrasound, acupuncture, traction and encouraging bed rest is not recommended for the treatment of this condition. Physical activity including tailored exercise rehab programs designed by your physiotherapist is highly recommended as well as clinician provided education and referral to a specialist. Having a multidisciplinary approach is also beneficial in addressing your condition.

Also read: Your Guide To Physio For Sciatica


Khorami, A. K., Oliveira, C. B., Maher, C. G., Bindels, P. J. E., Machado, G. C., Pinto, R. Z., Koes, B. W., & Chiarotto, A. (2021). Recommendations for Diagnosis and Treatment of Lumbosacral Radicular Pain: A Systematic Review of Clinical Practice Guidelines. Journal of clinical medicine, 10(11), 2482.

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