Physical Therapy for Nerve Related Low Back Pain

Posted on 12/17/21 by Michael in Peter B. Lewis Aquatic Center

With almost eight out of ten people experiencing it at some point in their life, low back pain is often referred to as the “common cold” of the musculoskeletal system. Pain originating from the low back, also known as the lumbar spine, can present with symptoms in a variety of areas depending on the cause. Low back pain symptoms can present locally to the low back, hips and pelvis or they may radiate down into the lower extremities.

It may be hard to believe, but sometimes pain we are experiencing in our legs may actually be coming from the nerves in the low back. The lumbar spine has five nerve roots that are named to correspond with the level of the vertebrae, or back bone. The peripheral nerves that exit from the spine control the strength of muscles in the lower extremities as well as the sensation to specific areas of the legs. In this picture, you can see the bones, nerves and intervertebral discs that make up part of the lumbar spine.

Source: https://link.springer.com/chapter/10.1007/978-3-319-21443-6_1

Symptoms of Nerve Related Low Back Pain

Individuals with nerve related low back pain may experience weakness in specific muscles of the lower extremity or may notice difficulty with walking due to these strength changes. Additional symptoms can include feelings of burning, numbness or tingling that radiates into the lower extremities and down to the feet. These sensation changes occur in specific areas of skin on the lower legs that correlate to the different nerve roots of the spine. These areas of sensation are known as dermatomes, which are mapped out in the graphic below.

Source: https://www.sciencedirect.com/science/article/pii/B9780124103900000366

Causes of Nerve Related Low Back Pain

Nerve related low back pain symptoms can occur for a variety of reasons, including irritation to the spinal nerve roots or to the nerve as it courses through the lower extremity. There isn’t always clear cause, as symptoms may be due to changes or sensitization of the nervous system - especially when symptoms are persistent. Causes of nerve related symptoms can include:

• Intervertebral Disc Herniation
• Spinal stenosis
• Extra-spinal entrapment of the nerve

Intervertebral Disc Herniation

The intervertebral discs, shown above, provide cushion and spacing between the bones in the spine. Changes, including movement of the disc material, can cause irritation to the nerve as it exits the spine. Disc herniations often affect individuals ages 30-50 years old and often occur after a bending or twisting movement.

Spinal Stenosis

Spinal stenosis means narrowing of the spaces in the spine, which causes irritation to the spinal cord or the peripheral nerves as they exit the spine. Depending on the location of the stenosis, symptoms can present in one or both legs. Because spinal stenosis encompasses any changes that impact spacing in the spine, it can be caused by a number of reasons.

Extra-spinal Entrapment of the Nerve

As the nerves exit the spine, they move through the lower extremity passing around other structures including bones, muscles and ligaments. Changes at these interfaces can also contribute to increased nerve tension and irritation causing symptoms.

Physical Therapy for Nerve Related Low Back Pain

The good news is, physical therapists can help treat nerve related low back pain, regardless of how long you’ve been experiencing symptoms.

Source: https://www.jospt.org/doi/full/10.2519/jospt.2021.0508

The first step is obtaining a comprehensive evaluation with a physical therapist to determine what may be contributing to the symptoms and what interventions will be most helpful. Therapeutic approaches will vary depending on the location of symptoms, how long the symptoms have been occurring and how the symptoms respond to different activities and movements. Physical therapy treatments that are beneficial for nerve related low back pain include:

• Specific back movements to help centralize, or reduce, symptoms in the lower extremity. For example, nerve symptoms may respond to repeated movements of the low back in a certain direction (bending backwards or bending forward).
• Manual therapy, or hands-on techniques, including neural mobilizations, joint mobilizations and manipulations.
• Exercise training, for strengthening, endurance, control and muscle activation.
• Education about pain including why we feel pain, how we feel pain, and changes that can occur in our nervous system with persistent pain.
• Aquatic therapy exercises

To learn more about the physical therapy treatments for low back pain, this article helps to explain the research backing low back pain treatment. Consulting with a physical therapist is the best way to determine which course of treatment will be most effective in managing your symptoms. For more information about physical therapy for low back pain or to schedule an appointment, call 216.595.7345 or email mgroesch@menorahpark.org.

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