Lumbar radiculopathy is the medical term for a “pinched nerve”. The pain is severe, constant and radiating down the leg in specific patterns called dermatomes. This common term is “sciatica” and usually involves just one nerve on one leg. Each nerve will travel to a place specific to sensation and muscle strength. A physician will determine the nerve by the specific symptoms.
Radiating pain down the leg is the most common presenting complaint. It is frequently associated with numbness or tingling. Muscle weakness in part of the leg is possible and is a significant issue of nerve damage. If the nerve impairment is significant or progressive, early surgery is done to protect and recover the nerve.
This diagnosis is made best by the physician noting the specific patterns of pain distributions and confirmed by an MRI scan. The leg pain is always severe, but the presence of a neurologic deficit defines the need for surgery. The most common treatments included anti-inflamatories, physical therapy and commonly epidural steroids to calm the nerves. Most pain resolves in a matter of days to weeks. If the pain continues or the nerve deficit worsens, surgery to decompress the nerve root is recommended.
My simple rule of thumb, if it is a bother, try any active recovery is fine. If the pain is very debilitating, cortisone injections, guided by a live x-ray, will calm the pain nicely in well over half of the cases. If the cortisone injection works well, start your rehabilitation and use additional injections for severe attacks of pain up to three times per year. If the cortisone injections work for only a few weeks, you can try the series of three injections, but likely a surgery will be needed and helpful. If the cortisone injection does not help at all, surgery is the only option, but the results are not predictable for nerve recovery.