Spinal Manipulation for Lumbar Radiculopathy: Reviving Relief

Introduction:

The spinal segments of the human system are divided into cervical, thoracic, and lumbar. The cervical at the topmost, the thoracic covers the middle and the lumbar at the lower region. So, lumbar radiculopathy results from pinching of the nerve or a tumor at the nerve roots in the lumbar spine. As a result, the person experiences lower back pain and muscular concerns. Lower back pain is the most common musculoskeletal issue worldwide, with a prevalence rate of about 7.5 percent and lumbar radiculopathy of three to five percent. It is known to affect both men and women.

What Is Lumbar Radiculopathy?

Lumbar radiculopathy is primarily lower back pain resulting from inflammation or injury of the nerve root at the lower lumbar aspects. The condition is also referred to as sciatica just because of the significant involvement of the sciatic nerve. Damage to the disk of the lumbar spine and decompression of the nerve is the cause of lumbar radiculopathy. In addition, age is considered a major risk determinant for the development of lumbar radiculopathy. So, the condition subsequently results from degeneration of the spinal column. The causes of lumbar radiculopathy include the following:

• Narrowing of the spinal canal.

• Cysts.

• Intervertebral disc herniation.

• Tumor.

• Infection.

What Are the Signs and Symptoms of Lumbar Radiculopathy?

Lower back pain is the predominant feature of lumbar radiculopathy. The other common signs and symptoms of radiculopathy include the following:

• Pain in the lower back region.

• Difficulty in bending forward and backward.

• Abnormal and weak reflexes.

• Loss of sensation and numbness in the affected area.

• Difficulty in walking on the toes.

• Muscle spasms.

• Muscle weaknesses.

• Tingling and numbness are felt from the lower back to the hip, buttocks, or legs.

Why Spinal Manipulation for Lumbar Radiculopathy?

Manipulation simply means the application of rapid directed thrust towards the joint closest to the physiological range of movement. Like mobilization, manipulation of the spine is the component of manual therapy for enhancing and improving movement potential. So, manipulating will work as a means of stimulating the lumbar spinal region to culminate in pain relief and mobilization betterment. Physiotherapists employ spinal manipulation in lumbar radiculopathy and other chronic lower back pain, considering its sound and efficacy in the management.

Clinical Rules for Spinal Manipulation:

The physiotherapists utilize the tool called clinical prediction rules for their plans and treatment goals. So, here are the prediction rules for spinal manipulation while most patients attained efficacy by meeting a minimum of four criteria.

• Pain not lasting more than 16 days.

• No pain or symptoms distant to the knee.

• Internal rotation is more than 35 degrees.

• Less than 19 in FABQ, fear avoidance belief questionnaire scores.

• Hypomobility for a minimum of one level with the lumbar spine.

How Does Spinal Manipulation Therapy Work in Lumbar Radiculopathy?

The appropriate means and mechanism of spinal manipulation are still uncovered. Still, the studies reveal that spinal manipulation contributes to a series of succession over biochemical, muscular, and neurological responses. The following are a few efficient and evident-based mechanisms.

1. Motor Neuron Excitability: Specific neurons at hyperexcitability states increase muscle activity. Hence, spinal manipulation concentrates and fixates motor neuron activity. As a result, these hyperactive muscles are calmed.

2. Muscular Activity: People with lumbar back concerns have spinal muscle hyperactivity (spasm) in association with typical pain. This is better illustrated by the pain-spasm cycle; the pain induces muscle spasms, and the spastic muscles cause pain. So, the spinal manipulation interferes with the pain spasm cycle through the medium of suppressing muscle activity.

3. Descending Pain Modulation Activation: Descending pain modulation pathways such as noradrenaline and serotonin are activated.

4. Segmental Inhibition: Generally, the smallest diameter nerve fibers carry pain stimuli while the larger ones block the entry of the smallest fibers and suppress the pain transmission. Spinal manipulation influences the mechanism.

5. Temporal Summation: This results as a consequence of heightened awareness of pain with the repetition of specific stimuli. Spinal manipulation of the lumbar spine diminishes the temporal summation.

6. Non-specific Responses: Spinal manipulation is known to influence psychological and other sectors with physiological means. However, the evidence is quite inadequate in supporting these responses.

What Are the Effects of Spinal Manipulation Therapy?

So, the physiotherapist gives quick thrust-like manipulation in the joint with regard to the range of motion. The average time for intervention is 12 sessions for six weeks duration as a means of relieving pain and improving functional abilities. The physiotherapist may recommend spinal manipulation as a sole treatment or in conjugation with other therapies. The efficacy of spinal manipulation in terms of lumbar radiculopathy is proved in the following means.

• A 2016 meta-analysis study reviewed the effectiveness of spinal manipulation in people with non-specific lower back pain and concerns when compared with placebo treatment.

• Another analysis compared the spinal manipulation and mobilization technique in the aspects such as pain, disabilities, range of motion, fear of movement, and overall quality of life. Results uncovered that spinal manipulation paved the way for disabilities, whereas not much in other concerns.

• Other clinical trials reveal the efficacy of both region-specific and non-region-specific manipulation of the spine for pain improvement in patients with chronic lower back pain.

Where Is Spinal Manipulation Therapy Contraindicated?

Spinal manipulation is contraindicated in the following aspects, as in association with low back pain.

• Pathology resulting in significant bone degeneration.

• In vascular scenarios like bleeding within joints or aortic aneurysms.

• Cord or nerve root compression further neurological risks.

• Lack of or inappropriate diagnosis.

• In case of an imperfect or unachieved patient’s position due to resistance.

Conclusion:

Spinal manipulation is a technique where the therapists utilize a device or their hands to apply a controlled compression or manipulation to the affected joint of the spine. This technique is indicated for various conditions, including lumbar radiculopathy. In addition to spinal manipulation, physiotherapists consider a treatment package comprising exercise and other manual therapies in combination with or without psychological intervention for lumbar radiculopathy. Therefore, the manipulations are primarily used with additional interventions to bestow considerable and favorable outcomes after one month of treatment in pain, motion, and function.