Causes of a Pinched Nerve in the Lower Back

A pinched nerve in your lower back (lumbar radiculopathy) is a condition caused by pressure on the nerves in your lumbar spine. It can be painful and potentially debilitating, affecting the area where it originated and one or both lower limbs from the hips, legs, calves, and even the feet. Both men and women are equally affected and recovery is favourable.[1]

Most of the time, a pinched nerve can be improved by using over-the-counter pain medications and ointments, physiotherapy, and lifestyle modifications. On the other hand, some situations will call for more serious intervention, like spinal injections or surgery. This condition can also occur in the neck, and is known as cervical radiculopathy.

What are the symptoms of a pinched nerve in the lower back?

Sciatica is the most common symptom, where pain, tingling sensations, numbness, and weakness are felt in the lower back and down the leg. Individuals can experience sharp pain upon moving, muscle spasms, and occasionally changes in reflexes.[2]

Some cases present primarily as lower back pain, but that is not always the case, as pain can affect the leg and foot. Diagnosis is made even more complicated because pain may be relatively mild, with the primary symptom being leg weakness.

What causes a pinched nerve in the lower back?

A pinched nerve can be caused over time, with age-related changes reducing the spine's cushioning and narrowing the nerve's exit points.

Common causes of a pinched nerve

• Herniated disc: Rupture of the disc will increase pressure on the nerves in the back.

• Trauma: Inflammation and injury caused by trauma can lead to a pinched nerve.

• Spinal stenosis: A degenerative condition causing narrowing and wear and tear in the spine.

• Bony spur formation: Abnormal bony growth on the spine, narrowing the nerve root exit points.

• Spondylolisthesis: A vertebra in the spine can slip forward and out of place, placing increased pressure on the spine and increasing the likelihood of a pinched nerve.

Diagnosis of a pinched nerve

Your doctor will perform a physical examination to determine the root cause of your problem, from the limitation of range of motion, any balance impairments, changes in the reflexes, especially in your leg, and assess for alterations in your sensation as well.[3] However, further evaluation is needed through imaging. The following diagnostic procedures include:

• X-rays: Used to visualise your bones, especially on the lumbar spine, to see if there are any degenerative changes in the area or any early signs of tumour or infection.

• Magnetic Resonance Imaging (MRI): Provides an image of your soft tissues, from the discs between your spinal bones, spinal cord, and the nerves connected to the area. Most disc herniations and nerve compressions are visible and utilised to confirm radiculopathy.

• CT Scans: An alternative option for a detailed picture of your lower back and nerves. According to the literature, this is less likely to be used unless an MRI is unavailable.

In its entirety, these measures will help your doctor to provide the proper intervention to treat the pinched nerve in your lower back.

Treatment of a pinched nerve

Once the diagnosis of a pinched nerve in your lower back is clear, there are multiple treatment options that you can consider.

Baseline treatments

Initially, your doctor will recommend supportive and conservative treatments that are non-invasive to relieve your symptoms, which is 95% effective. This includes exercises, stretches and physiotherapy.

Medications

Medication is frequently given for pain relief and other symptoms like inflammation; options include non-steroidal anti-inflammatory drugs or NSAIDs, acetaminophen, and in severe cases, opiates. These can only be prescribed by your GP and should never be taken without direct consultation with your doctor.

Physiotherapy

Working with a physiotherapist can also be a great choice because they can assess and diagnose your condition. They are experts in designing exercise programs to address underlying problems that may be leading to the pain.

Physiotherapy will focus on stabilising your spine and helping you function in tasks you are most having difficulty on, despite the pain, tingling sensation, muscle spasm, and numbness.

Home-based remedies

In some circumstances, your doctor will also suggest modifying your lifestyle to manage your pinched nerve in your lower back through the following:

• Relative rest - while we all know that movement is generally a good thing, we need to ensure that we do not overdo things when in acute pain. It is a good idea to avoid anything too physically exerting, especially in the acute phase of the injury.

• Ice and heat - depending on what suits your condition best, applying ice or heat for a minimum of 20 minutes can reduce pain and spasm in the affected areas.

• Frequent movement - keeping consistent physical activity and exercise can avoid the onset of pain and help relieve your pinched nerve symptoms.

• Sleeping position modifications - Particular sleeping positions can lead to an increase in pain, mainly lying on your stomach. For the best chance of a good night's sleep, lie on your side, with a pillow between your legs.

Higher-level treatments

If the conservative or baseline treatments do not offer relief, there are more invasive strategies that may come into play to treat your pinched back.

Steroid injections

Another option after oral steroids is injecting steroids on your back, for instance, epidural steroid injections. This can be beneficial to treat the severe pain and swelling caused by the impingement, and it is usually done in the doctor's office or under guided ultrasound.

Surgery

If all else does not work for your condition, the last resort of treatment is surgery. The type of surgical intervention will depend on the underlying cause of pain. For example, if you are suffering from a pinched nerve as a result of a herniated disc, then a microdiscectomy will be the most appropriate surgical option.This involves arthroscopic (keyhole) surgery to remove a part of the disc in the spine that is pressing on the nerve.

Anyone who has radiculopathy always has a choice regarding their treatment. It is worth noting that surgery carries risks and most likely would take a longer time for recovery.[4 ]

It is also only recommended that surgery shall be provided if conservative management has failed. It is sensible to try and improve symptoms for at least six weeks before considering more invasive treatment options. Furthermore, it is also good to know that non-pharmacological management is still effective in the long-term treatment of lumbar radiculopathy. Therefore, it is still best to seek other treatment options before having surgery.

Stretches and exercises

It is best to get medical advice regarding stretches and exercises before commencing any program.

These exercises are most effective when repeated two - three times each. Ensure to take deep breaths and use a yoga mat, a towel, or lie on the carpet where you can to make yourself as comfortable as possible.

1. Knee to chest

2. Firstly, lie on the floor on your back, then elevate your head just slightly with a pillow.

3. Once the head is stable, bend both of your knees and point them to the ceiling while your feet are flat on the floor.

4. Bring one knee up to your chest with two hands, and hold the position for at least 20 to 30 seconds. You should feel a stretch from your back thigh to your buttocks and the back.

5. Release the leg, and repeat the stretch on your other leg.

6. Mobilising stretch

7. From the same position as the knee to chest stretch, instead of bringing your knees to your chest, straighten the leg towards the ceiling without pointing your toes

8. Hold for the position in the air for 20 to 30 seconds before releasing. You should feel the stretch at the back of the leg.

9. Release the extended leg, and repeat the same procedure on your other leg.

10. Gluteal stretch

11. In the same lying position, bring one of your legs up, and rest your foot on your other bent leg.

12. From this position, grab the thigh of the leg where your foot is placed and pull it to your chest and chest and head. You should feel a gradual stretch on your buttock area.

13. Hold the position for at least 20 to 30 seconds and once released, repeat the exercise on your other leg.

The bottom line

There are a variety of treatments that a person can have for their pinched nerve in their lower back, and it is best to try non-invasive, conservative, or baseline approaches like stretching, exercises and physiotherapy before more invasive options. If you are suffering from back pain and think you may have a pinched nerve, see your local GP or physiotherapist.