What is S1 Radiculopathy?

What is S 1 radiculopathy?
When a nerve at the L4-5 or L5-S1 level is affected (bottom two levels), this dermatome is usually the sciatic nerve, which runs down the back of each leg to the foot. … Radicular pain may also be accompanied by numbness and tingling, muscle weakness and loss of specific reflexes.

Lumbosacral radiculopathy is a disorder that causes pain in the lower back and hip which radiates down the back of the thigh into the leg. This damage is caused by compression of the nerve roots that exit the spine, levels L1- S4. The compression can result in tingling, radiating pain, numbness, paraesthesia, and occasional shooting pain. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar-sacral radiculopathy) and in the neck (cervical radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy).

Overall, lumbosacral radiculopathy is an extraordinarily common complaint seen in clinical practice and comprises a large proportion of annual doctor visits. The vast majority of cases are benign and will resolve spontaneously, and thus, conservative management is the most appropriate first step in the absence of clinical red flag symptoms. In cases where symptoms fail to resolve, imaging studies, electromyography, and nerve conduction studies can assist in making a diagnosis.

  • Radiculopathy describes a range of symptoms produced by the pinching of a nerve root in the spinal column.
  • The pinched nerve can occur at different areas along the spine (cervical, thoracic or lumbar).
  • Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness, and tingling.
  • A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation, or other conditions.
  • Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients.

When radiculopathy occurs in the lower back, it is known as lumbar radiculopathy, also referred to as sciatica because nerve roots that make up the sciatic nerve are often involved. The lower back is the area most frequently affected by radiculopathy.

While radiculopathy can’t always be prevented, staying physically fit and maintaining a healthy weight may reduce your risk of radiculopathy. Using best practices for good posture while sitting, playing sports, exercising, or lifting heavy objects is also important for preventing injuries.

Cervical radiculopathy describes a compressed nerve root in the neck (cervical spine). Because the nerve roots in this area of the spine primarily control sensations in your arms and hands, this is where the symptoms are most likely to occur.

Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine, which is your upper back. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution and can cause pain and numbness that wraps around the front of your body.

  • A physical exam and physical tests may be used to check your muscle strength and reflexes. If you have pain with certain movements, this may help your doctor identify the affected nerve root.
  • Imaging tests, such as an X-ray, CT scan, or MRI scan, are used to better see the structures in the problem area.
  • Nerve conduction studies, along with electromyography, can also be used to help pinpoint whether the problem is neurological or muscular.

Radiculopathy treatment will depend on the location and the cause of the condition as well as many other factors. Nonsurgical treatment is typically recommended first and may include:

  • Medications, like nonsteroidal anti-inflammatory drugs, opioid medicines, or muscle relaxants, to manage the symptoms
  • Weight loss strategies to reduce pressure on the problem area
  • Physical therapy to strengthen the muscles and prevent further damage
  • Steroid injections to reduce inflammation and relieve pain

Some people may need more advanced treatments, such as surgery. Surgery is typically used to reduce the pressure on the nerve root by widening the space where the nerve roots exit the spine. This may involve removing all or parts of a disc and/or vertebrae. Cervical posterior foraminotomy is one of the minimally invasive spine surgery options available.

S1 Radiculopathy
S1 Radiculopathy Pain Pattern

 

 

 

 

 

 

 

 

 

 

 

How is S1 radiculopathy treated?

Most radiculopathy symptoms go away with conservative treatment—for example, anti-inflammatory medications, physical therapy, chiropractic treatment, and avoiding activity that strains the neck or back. Symptoms often improve within 6 weeks to 3 months.

What does the S1 nerve control?

The S1 nerve root also supplies innervation for the ankle jerk (tap on the Achilles tendon and the foot goes down), and a loss of this reflex indicates S1 impingement, although it does not create a loss of function.

What does S1 nerve pain feel like?
Pain, generally felt as a sharp, shooting, and/or searing feeling in the buttock, thigh, leg, foot, and/or toesNumbness in the foot and/or toes. Weakness in the leg and/or foot muscles and an inability to lift the foot off the floor (foot drop).
What does radicular pain feel like?
Radicular pain is a type of pain that radiates from your back and hip into your legs through the spine. The pain travels along the spinal nerve root. The leg pain can be accompanied by numbness, tingling, and muscle weakness. Radicular pain occurs when the spinal nerve gets compressed (pinched) or inflamed.
What are the symptoms of S1 nerve damage?

This pain can come in the form of numbness, tingling, weakness, and shooting. S1 nerve root Radiculopathy may cause pain or numbness in the little toe and top of the foot. Consequently, patients find it difficult to stand on their tip-toes or raise their heels off the ground.
Is radiculopathy serious?
Sometimes, radiculopathy can be accompanied by myelopathy — compression of the spinal cord itself. Herniated or bulging discs can sometimes press on the spinal cord and on the nerve roots. When the spinal cord is involved, the symptoms can be more severe, including poor coordination, trouble walking, and paralysis.
 Is radiculopathy permanent?
The longer a person leaves radiculopathy untreated, the higher the risk is for their damage and symptoms to become permanent. In fact, in severe cases, paralysis may occur if radiculopathy is left untreated for an extended period of time.
How is S1 nerve damage treated?
Treatment of L5-S1 usually begins with Medication. Over-the-counter (OTC) medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first for pain stemming from L5-S1. For more severe pain, prescription medication, such as opioids, tramadol, and/or corticosteroids may be used.
How do you fix radiculopathy?
Nonsurgical treatments for cervical radiculopathy typically include one or more of the following:
  1. Rest or activity modification. …
  2. Physical therapy. …
  3. Ice and/or heat therapy. …
  4. Medications. …
  5. Cervical epidural steroid injection. …
  6. Manual manipulation. …
  7. Cervical traction.
What is the best treatment for lumbar radiculopathy?
  • Physical therapy and/or exercises that are designed to stabilize the spine and promote a more open space for spinal nerve roots are recommended.
  • Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain and analgesics to relieve pain.
How can I sleep with lumbar radiculopathy?
Lie flat on your back and keep your buttocks and heels in contact with the bed. Bend your knees slightly towards the ceiling. Slide a pillow under your knees. Slowly add additional pillows until you find a comfortable knee and lower back position.
How long does radiculopathy take to heal?
Generally speaking, most patients who undergo radiculopathy treatment will achieve relief within about 6 – 12 weeks, if not sooner.
Who fixes pinched nerves?
Physical therapyA physical therapist can teach you exercises that strengthen and stretch the muscles in the affected area to relieve pressure on the nerve. He or she may also recommend modifications to activities that aggravate the nerve.
What doctor treats radiculopathy?
Although radiculopathy may be suspected or diagnosed by the person’s primary care physician, the condition should be treated by an experienced neurosurgeon.
How do you diagnose radiculopathy?
  1. A physical exam and physical tests may be used to check your muscle strength and reflexes. …
  2. Imaging tests, such as an X-ray, CT scan, or MRI scan, are used to better see the structures in the problem area.

Massage for S1 Radiculopathy & Low Back Pain

Is massage good for cervical radiculopathy?
Traction can help provide immediate relief from pain and arm numbness. Your physical therapist also may gently massage the muscles of your cervical spine and shoulder blade area. This helps your muscles relax and improves circulation to promote healing and pain relief.
Is it OK to massage a pinched nerve?
Applying gentle pressure around the affected area may help relieve tension, and a full body massage can help the muscles relax. Deep tissue massages may not be a good idea because the extra pressure may make the symptoms worse.

Common Causes of Lower Back Pain:

  • Spondylosis of the Lower Back – refers to degenerative changes in the facet joints and eventual ankylosing of the joint.  Spondylosis also refers to the degenerative osteoarthritis of the joints between the center of the spinal vertebrae and/or neural foramina.
  • Slipped Disc / Disc Herniation – is a medical condition affecting the spine in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer rings. This causes pressure on the spinal nerve roots which in turn causes subsequent sensory and/or motor disturbances, such as pain, paresthesia, or muscle weakness in the limbs.
  • Lumbago – general, non-specific term for low back pain
  • Sciatica – or lumbar radiculopathy, is a set of symptoms including pain caused by general compression or irritation of one of five spinal nerve roots of each sciatic nerve—or by compression or irritation of the left or right or both sciatic nerves. Symptoms include lower back pain, buttock pain, and pain, numbness or weakness in various parts of the leg and foot. Other symptoms include a “pins and needles” sensation or tingling and difficulty moving or controlling the leg. Symptoms usually manifest on one side of the body.

Lower Back Massage: 

Types of Lower Back Pain – Symptoms:

  1.  With lumbar degenerative disc disease, pain is noted across the lower back and hips, occasionally into the legs. It is worse with activity. There is a history of back injury.
  2.  With lumbar disc herniation, the pain is deep and poorly localized. With a lower lumbar disc lesion, it starts centrally at the level of the affected disc and over time moves laterally and increases in intensity. Eventually spreads down the back, into glutes, down the thigh, leg, and foot.
  3. A nerve root impingement in the lumbar spine can lead to bladder and bowel dysfunction and numbness across the low back ( depends on what nerves are impinged), glutes, and hips.
  4. With Piriformis Syndrome, there is pain and paresthesia in the posterior thigh, (sometimes calf, foot). Pain is usually just on one leg. Weakness in abduction, flexion, and internal rotation of the affected hip.

 Lower Back Massage:

OBSERVATION:

  • With Degenerative Disc Disease in the lumbar spine, whether a hyperlordosis or flatback posture may be noted. The client may slouch, placing the lumbar spine in flexion. ( Disc breaks posterolaterally first )
  • With acute herniation in the lumbar spine, a decrease in lumbar lordosis may be present. In the posterior view, a leg length discrepancy or scoliosis may be noted.
  • With sciatica, guarding of the affected limb, ataxic gait due to pain, difficulty sitting/standing prolonged due to pain

Lower Back Pain Assessment:

 Orthopedic Tests:

  •  With DDD, AFROM and PRROM reduced lumbar flexion and extension. Pain may be present. ARROM may reveal a weakness in affected mm with later stages of degeneration.
  • • With acute herniation, AFROM and PRROM reveal ranges limited by pain and muscle spasm. AF flexion may have a deviation to one side, as the client attempts to move away from the painful side.

Special Tests:

  •  Motor and sensory testing reveal weakness and abnormal sensation is distributed for affected vertebral level
  •  Deep tendon reflexes for mm innervated by affected nerves are reduced
  •  Valsalva’s, slump, kemp’s, kernig’s, SLR may all be (+) Take note of the differences of the test… space-occupying lesion, nerve root involvement, etc.

Motor Testing:

  • L4 – Tibialis anterior ( dorsiflexion and inversion) ( heel walking)
  • L5 – extensor dig longus, ext hall longus) ( toe extension)
  • S1 – ( gastrocs, soleus, peroneals) ( plantarflexion, eversion)( toe walking, inner foot walking)

Sensory Testing:

  • L4 – medial foot, the big toe
  • L5 – top of the foot, middle 3 toes
  • S1 – lateral foot, little toe

Reflex Testing:

  • L3- L4 –patellar tendon
  • L4-L5 – tibialis posterior tendon ( need to do plantarflexion and inversion to pop out)
  • L5-S1 – semimembranosus tendon ( the most medial hamstring tendon)
  •  S1-S2 Achilles tendon

Lower Back Massage Therapy Treatment Goals:

  • Decrease Sympathetic Nervous System firing
  • Reduce compression on the disc and nerves
  • Reduce pain and spasm, hypertonicity, and trigger points
  • Maintain tissue health

Lower Back Massage Contraindications:

  • with saddle anesthesia (loss of sensation to buttocks and perinea) and bladder weakness, refer to a medical doctor
  • if no comfortable position can be found, refer to a medical doctor
  • No position that aggravates symptoms
  • do not mobilize hypermobile joints
  • with acute herniation, do not remove protective muscle spasm
  • modify pressure on the area of atrophy

Tight muscles in Lumbar Spine DDD:

  • Hyperlordosis: Quadratus Lumborum, hip flexors, hips, Iliotibial band, quadriceps femoris, tensor fascia lata
    • Joint play and traction: hips, sacrum
  • Flatback/ Posterior Pelvic Tilt: Quadratus Lumborum, hamstrings, Quadriceps femoris, calves
    • Joint play or traction: hips and sacrum

Lower Back MASSAGE Therapy TREATMENT:

For Lumbar Spine Disc Disease: Herniation, Lumbago, Spondylosis, Slipped Disc:

  • Heat to tight areas
  • position for comfort, pillow to support
  • Massage to reduce edema, spasm, and pain in muscle crossing herniation
  • Myofascial Release, Swedish techniques to treat hypertonicity and trigger points  to the affected area
  • Treat postural dysfunction  (likely and Hyperlordosis and Flatback for Lumbar spine DDD)
  • Joint play to adjacent hypermobile vertebrae to relieve pressure on the affected area
  • GTO release, petrissage, passive stretching, fascial work to tight muscles

For SCIATICA: Lower Back Massage

  • Heat to tight areas
  • GTO release, petrissage, passive stretching, fascial work to tight muscles
  •  Ligaments- sacrotuberous ( ischial tuberosity to the sacrum) to release sacrum.
  •  The entire gluteal area treated using fascial work and petrissage
  • Treat glute max thoroughly so piriformis can be reached. Treat glue medius and minimus.
  • Treat piriformis using origin and insertion,  finger kneading, muscle stripping, ischemic compressions to piriformis trigger points – follow up with piriformis stretch
  • Passively rotate patient’s hip internally and externally while applying pressure to piriformis using the fist or elbow

Lower Back Pain Self Care

  • Find pain-free positions, with posterior herniation, maintain lumbar lordosis. Lie prone, progress to propping up on elbows
  • Hydrotherapy -cool to reduce spasm and pain
  • Back extension exercises
  • Strengthen muscle crossing affected area
  • Teach correct lifting
  • Pain-free ROM
  • Avoid sitting with knees rolling out to the side
  • Sleep with a pillow between knees to avoid internal rotation of the hip ( stretching the piriformis for too long will irritate it, better to be in neutral)
  • Take breaks from aggressive activities/ running to stretch
  • Chiro adjustment for SI joint displacement
more info at:
Therapeutic Swedish Massage, Sports Massage Therapy in Santa Barbara, Goleta.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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