Lumbar Radicular Syndrome

Lumbar Radicular Syndrome

Lumbar radicular syndrome header

Body Chart

Lumbar radicular syndrome pain diagram
  • Pain radiating into the lower extremity in a quasi-segmental but not dermatomal distribution
  • Leg pain more than back pain

Background Information

Patient Profile

  • 25 – 60 years old


Compression of nerve root within intervertebral foramen by tumor, HNP, vertebral body fracture or degenerative changes (e.g. stenosis through spondylophytes, spondylolysis, compression fracture)
Peripheral nociceptive pain. Local inflammatory response common. Central sensitization possible due to prolonged high levels of pain


Constant (acute).

Mild compression has a good prognosis with physiotherapy. Severe paresis requires surgical intervention with subsequent physiotherapy. Within the first 6 months, significant improvement in QoL possible.
Psychosocial factors can negatively influence the prognosis.
Usually rather lengthy course with good prognosis if patient receives proper education, shows good compliance and does not have any yellow flags

History & Physical Examination


Insignificant trauma in history (twisting, lifting); possibly recurrent or at least history of less severe low back pain episodes

  • Intense
  • Deep
  • Burning pain
  • High intensity (acute) or varying intensity (subacute) VAS 5-10/10
  • Tingling/numbness in lower extremity up to paresis
  • More leg than back pain
  • Central cord compression can lead to cauda equina syndrome

Physical Examination

Relieving posture, typical shift or slight flexion

Functional Assessment
Pain apparent in all movement directions; significant increase with additional compression of the nerve; patient can provoke pain with ease; typically during transfers or apparent during gait (limping)

Passive Examination
PPIVMs & PPAVMs provoke pain on affected segment and segment above/below; stiffness and hypertonus of paraspinal structures; muscle length tests: Rectus femoris, glutei, iliopsoas…; in acute phase impossible due to pain

Special Testing


Further Testing

Differential Diagnosis

  1. PEP
  2. Facetjoint hypomobility
  3. SI-Joint dysfunction
  4. coxarthrosis
  5. Spinal stenosis

Concerning cause of compression:

  1. Tumor
  2. Vertebral fracture
  3. HNP
  4. Spondylolisthesis



Decrease pain in acute phase. Move into pain-free directionsSubacute phase: coordination, strength, endurance, and stability of trunk.Patient education



  • Treat surrounding structures and decrease compression
  • Traction
  • Movements into pain-free direction
  • Infiltration
  • Muscle relaxants/NSAIDs


  • Trunk stability
  • Motor control
  • Neurodynamics
  • Education on ergonomics


Download the new Physiotutors App

Are you ready for a learning revolution?

Experience the Physiotutors content you love in our new app.

App banner featured image


  1. Wiesner, R. and P. Westerhuis, Klinische Muster in der manuellen Therapie. Vol.2 2013: Thieme.
  2. Scaia, V., D. Baxter, and C. Cook, The pain provocation-based straight leg raise test for diagnosis of lumbar disc herniation, lumbar radiculopathy, and/or sciatica: a systematic review of clinical utility. J Back Musculoskelet Rehabil, 2012. 25(4): p.215-23.
  3. Tal-Akabi, A., Behinderung bei Rückenbeschwerden: Roland and Morris Disability Questionnaire (RMDQ), P. Oesch, Editor. 2010.
  4. Sullivan, M.J.L., Theoreticle perspectives on the relations between catastrophizing and pain, B. Thorn, Editor. 2001, The clinical journal of pain.
  5. Luomajoki, P.D.H., Artikel aus der Zeitschrift Physiopraxis: Wenn der Schmerz im Vordergrund steht. S2, Abschnitt: Angst vor Schmerzen nehmen.
  6. Hahne, A.J., et al., Outcomes and adverse events from physiotherapy functional restoration for lumbar disc herniation with associated radiculopathy. Disabil Rehabil, 2011. 33(17-18): p. 1537-47.
  7. K., B., The Quality of life of lumbar radiculopathy patients under conservative treatment, T.-T. S., Editor. 2009, Vajosanit pregl. p. 807-12.
Download our FREE app