Lumbar Radicular Pain (Lumbar Radiculopathy)

Who: Anyone with back pain whose leg is now the problem. Lifting or twisting onset, or no onset at all.
What: Leg pain below the knee, worse than the back pain, in a dermatomal band, ± paraesthesia or weakness in the matching myotome.
How it behaves: Aggs: sitting, coughing, sneezing, straining, sustained flexion. Eases: unloading, standing, walking, gentle extension.

The illness script in one line:

A nerve root under mechanical and inflammatory load — so the pain runs down the leg further than the back pain does, and the nervous system tells you which root by where the numbness, weakness and reflex change land.

The one thing to take from this page:

The subjective makes this pattern. The objective keeps it safe. Four history and examination items do the diagnostic work; power, reflexes and sensation give you the baseline that lets you detect the only thing that actually changes management — progression.

[1][2][3][4][5][6][7][8]

✅ This is the one page in CliniStudy with a genuine Australian anchor — and that matters. The ACSQHC Low Back Pain Clinical Care Standard (2022) names sciatica and radicular pain, and Quality statement 1 prescribes the focused neurological examination: straight leg raise, deep tendon reflexes, and strength and sensation testing. It sets the emergency-referral triggers, cauda equina included. It directs that acute leg pain without severe or progressive motor weakness is managed the same way as acute low back pain.

What it does not carry is any radicular-specific management pathway — no timeframes, no surgical threshold, no neural mobilisation guidance, no medication algorithm. Those come from the KNGF physiotherapy guideline [9] and NICE NG59, and this page tells you which is which rather than blurring them together. When your educator asks "says who?", the neuro exam is Australian standard. The four-month surgical conversation is not.

Patterns > Labels. "L5 radiculopathy" names a root. Leg-dominant, below-knee, with a matching neurological story and nothing dangerous happening to it names the problem you can actually manage this week. Check the level with your educator; don't chase it with your hands.

Five stages, in order. This is where the pattern is made — and on this page that is not a slogan, it is the accuracy data. Four subjective and examination items gave AUC 0.95 against high-confidence clinical diagnosis in 394 primary-care consulters [1]. Nothing in section 5 comes close.

MAIN PROBLEM

"It started in my back, but now it's the leg. Down past the knee, into the outside of my calf. The back's almost settled."

Leg > back is the sentence you are listening for. Ask them to rank it: which one would you get rid of first?

BODY CHART

• P1 is usually distal in this pattern — calf, shin, foot — and that is the flip from the non-specific low back pain page, where P1 sits centrally in the back. Map P1 and P2 properly and the pattern often names itself.
• Draw the band, and draw where it stops. Below-knee is one of the four items. Buttock-and-thigh-only referral is a different conversation.
• Mark paraesthesia and numbness separately from pain, and mark the myotome any weakness sits in.
• Check and mark the other leg. Bilateral is a red flag question, not a body-chart detail.

BEHAVIOUR

• Coding: usually In early — intermittent, position-driven — moving toward P when it is irritable or acute. Morning stiffness in this pattern is usually M (<30 min); In (>30 min) should make you re-ask about inflammatory features.
• Aggs: sitting, driving, coughing, sneezing, straining, sustained or repeated flexion, and the first few steps out of a chair.
  Eases: unloading, lying, standing, walking, gentle extension.
• 24-hr pattern: sitting, driving and the first steps out of a chair build it; lying, standing, walking and gentle extension ease it. Morning stiffness codes M on this page; In re-asks the inflammatory features.
• Severity: VAS 0–10 at best / at worst / right now.
• Irritability decides your dosage — all three parts. Resting symptoms present? How vigorous is the activity that sets it off? How long does it take to settle? High irritability means SLR to P1 only, no overpressure (o.p.), and sliders rather than tensioners.
• Pain type, and don't assume it. Neuropathic pain prevalence in low back-related leg pain runs 19% to 80% depending entirely on how it was identified [10]. That spread is why you ask about burning, electric, shooting and numb qualities rather than deciding for them.

HISTORY

• Onset: sudden (lift, twist, sneeze) or insidious. Both are on-pattern.
• The trajectory so far. Back pain first, then the leg? Leg pain migrating distally, or centralising? Improving week to week, or flat?
• Baseline leg pain intensity is the one prognostic factor with strong evidence behind it — and what it predicts is subsequent surgery. Age, BMI, smoking and sensory disturbance predicted nothing across 14 cohorts [11].
• Previous episodes, previous imaging, previous injections or surgery, what helped and what didn't.
• What they've been told, and what they think is happening. Someone who has read "L5-S1 disc extrusion" on a report is managing a different problem in their head from the one in their leg.

SPECIAL / SCREENING QUESTIONS

Every patient. Every time. Before you touch them.

• Cauda equina, asked directly and unhurriedly: bladder (retention, poor stream, reduced sensation of filling, painless incontinence), bowel, saddle or perineal sensory change, sexual dysfunction, bilateral leg symptoms, progressive weakness. See section 4 for what these numbers are actually worth — and they are worth less than you were taught.
• Progressive motor deficit. "Is the foot getting weaker?" A foot drop that is worsening is a referral, not a rehab progression.
• The remaining lumbar red flags — malignancy, fracture, infection, inflammatory — carry over unchanged from the NSLBP page. Screen them; don't restate them here.
• Medications, including anything already tried for nerve pain. Section 6 explains why most of it disappointed.
• General health, weight change, night pain that doesn't vary with position.

CLOSE THE SUBJECTIVE PROPERLY

Before you stand up: do you have two of Stynes' four? Below-knee pain · leg pain worse than back pain · positive neural tension · neurological deficit. Two should raise the hypothesis. All four should make it your working pattern — and then the objective is there to test it, not to find it.

Top three, one discriminating feature each. Rule out the dangerous one first, then split the two that actually look alike.

And two more you should be able to name:

• Lumbar discogenic pain — central or bilateral back pain ± non-dermatomal buttock and thigh referral, dull and deep, worse sitting and in flexion, no root-level neurological deficit.
• Deep gluteal syndrome — posterior hip pain, difficulty sitting 30 minutes, tenderness in the deep gluteal space, no root-level deficit. A non-discogenic sciatic nerve disorder: same leg pain, different source [13]. It is a Level IV definition study with no accuracy statistics — use it for the history, never for a sensitivity.

The honest bit. Two competent physiotherapists watching the same assessment disagree about whether it is sciatica roughly one time in four. Reliability rose with diagnostic confidence, which is a polite way of saying the clear ones are clear and the rest are genuinely arguable. Take your ranking to your educator with the discriminator attached — "leg > back, below knee, +ve slump, absent ankle jerk, so I've ranked it radicular" is a reasoning conversation. "I think it's sciatica" isn't.