Learn to Recognize the Differences Between These Common Causes of Leg Pain
Your leg starts hurting out of nowhere. Sharp, shooting pains are running from your lower back all the way down to your calf. Is it a pinched nerve, a herniated disc, or something else? Determining the root cause of radiating leg pain can be confusing, but understanding the differences between radiculopathy and sciatica is key to getting proper treatment.
While both cause similar symptoms, distinguishing between these two common culprits of leg pain allows you to take the right actions to find relief. Stick with us as we dive into the distinguishing features, causes, and treatments for radiculopathy vs sciatica so you can get to the bottom of your leg pain.
What is Radiculopathy?
Radiculopathy refers to a compressed or irritated nerve root in the spine, often caused by a herniated disc, bone spur, or spinal stenosis. This compression or inflammation of a nerve root leads to pain, numbness, tingling or weakness along the path of the affected nerve.
Radiculopathy can occur in any part of the spine, but is most frequently seen in the lower back (lumbar radiculopathy) or neck (cervical radiculopathy). Upper back (thoracic) radiculopathy is less common.
Lumbar radiculopathy is what causes radiating low back and leg pain. According to a study, its prevalence is estimated to be 3%-5% of the population, affecting both men and women. The compression of the nerve root in the lumbar spine can send symptoms down the sciatic nerve and into parts of the leg.
What Types of Radiculopathy Are There?
There are several types of radiculopathy depending on which part of the spine is affected:
|This is radiculopathy involving compressed nerve roots in the lower back (lumbar spine), causing sciatica-like pain that radiates down the leg. It’s the most common type.
|This type affects nerve roots in the neck (cervical spine), leading to pain, numbness, and weakness radiating down the shoulder, arm and hand.
|This rare type occurs in the middle back (thoracic spine) and can cause pain around the torso and abdomen.
Within lumbar radiculopathy, the L4, L5, and S1 nerve roots are most often affected with roughly 90% of compressive lumbosacral radiculopathies occurring at either of these levels, causing radiating leg and foot pain. Talk to your Kaly provider about which nerves may be involved in your case.
What are the Symptoms of Radiculopathy?
Radiculopathy causes symptoms that radiate out from the spine following the pathway of an irritated nerve root. Common symptoms include:
- Sharp, shooting, burning pain in the back that travels down the leg or arm
- Numbness, tingling or weakness along the leg, foot, arm or hand
- Muscle weakness or reduced reflexes in the extremity of the affected nerve
- Electrical, shock-like sensations down the limb
- More intense pain when coughing, sneezing or straining
What is Sciatica?
Sciatica refers specifically to pain, numbness or weakness that radiates along the path of the sciatic nerve, which runs from the lower back down through the buttocks and legs. It is a symptom of an underlying problem rather than a medical diagnosis itself.
The vast majority of sciatica cases are caused by lumbar radiculopathy. Other less common causes of sciatica include piriformis syndrome, pregnancy, tumors, or bone fractures.
Other symptoms can include:
- Numbness or muscle weakness along the path of the sciatic nerve
- Tingling, pins and needles sensation in the leg, foot or toes
- Difficulty moving the leg or foot
- A constant, dull achy pain in the leg that may worsen when sitting
Sciatica vs. Radiculopathy: What’s the Difference?
While sciatica and radiculopathy refer to the same underlying problem, there are some key differences:
|Nerve pain that radiates along the sciatic nerve from the low back down the leg
|More general nerve root irritation in any part of the spine that can cause radiating pain
|Typically shoots down one side from the low back through the buttocks into the back of the thigh and leg in a band-like distribution
|May radiate in different patterns depending on which nerve root(s) are affected
|Sciatica is often caused specifically by lumbar radiculopathy (nerve root compression in the lower spine)
|Radiculopathy refers to the actual medical condition of a compressed or inflamed nerve root. Sciatica is a symptom.
Sciatica pain is often described as more severe, sharp, electric or shooting than standard radicular pain. But both can be very painful.
In essence, sciatica is a specific type of radicular pain that radiates along the sciatic nerve. Determining the underlying cause, like lumbar radiculopathy, is important for finding the right treatment approach.
Relieving Pain from Radiculopathy and Sciatica
Living with chronic back and leg pain takes a toll on your physical health and emotional wellbeing. Some common options for relieving radiculopathy and sciatica include:
Over-the-counter anti-inflammatories and pain relievers can provide short-term relief. Prescription medications, muscle relaxers or even antidepressants that inhibit pain signals may be prescribed in more severe cases.
Specific exercises can strengthen muscles supporting the spine and improve flexibility. Your PT can also recommend proper stretching and posture modification techniques.
Epidural steroid injections directly around an inflamed nerve root can reduce inflammation and allow healing. Other targeted injections can be diagnostic as well as therapeutic. According to a study published in BMJ journal, epidural corticosteroid injections are 65% effective in treating sciatica due to disk herniation.
If conservative treatments fail and you have severe functional limitations, your doctor may recommend surgery to take direct pressure off a compressed nerve. These may include:
- Foraminal decompression
Managing your weight, proper lifting techniques, good sleep habits, stress reduction and avoiding long periods of sitting or standing can help keep symptoms under control.
When to See a Doctor for Radiculopathy or Sciatica
Radiculopathy and sciatica cause severe pain and disability, so it’s important to seek medical care promptly for proper diagnosis and treatment. Here are some general guidelines on when to see a doctor:
- Moderate to severe back pain shooting down your leg, especially below the knee – a classic symptom
- Numbness, tingling, or leg weakness in addition to radiating pain – could indicate nerve compression
- Difficulty controlling bladder or bowels – a sign of severe compression
- Sudden severe back pain with trouble standing/walking – seek emergency care
- Pain persisting over 1 week despite rest and medication
- Home treatments like ice/heat provide no relief
- Pain severely limits normal daily activities and quality of life
The key is not to ignore symptoms. Seek care if the pain is severe, lasts more than 1-2 weeks, or is accompanied by bladder issues, numbness or tingling, or muscle weakness. Early treatment is important for managing radiculopathy and sciatica.
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Is lumbar radiculopathy more painful than sciatica?
Sciatica tends to produce sharper, burning or electric-like pain that follows the path of the sciatic nerve down the thigh and into the foot. Radicular pain without sciatic nerve involvement may be duller and localized to where the affected nerve root is situated.
Can radiculopathy and sciatica occur together?
Yes, radiculopathy and sciatica can co-occur. Both conditions are caused by a herniated disc or bone spur in the spine that compresses or irritates a nerve root. Sciatica can be considered a type of radiculopathy where the affected nerve root is the sciatic nerve.
How does the VA rate sciatica vs radiculopathy for disability claims?
For both conditions, the VA assigns disability ratings from 10% to 80% depending on factors like the nerve affected, frequency of symptoms, and degree of paralysis. Higher ratings indicate more severe symptoms.
Specifically, the VA uses Codes 8520-8530 to rate paralysis of the sciatic nerve and other nerves in the legs. Mild incomplete paralysis is 10%, moderate is 20%, moderately severe is 40%, severe with marked muscle atrophy is 60%. Complete paralysis with foot drop and no active movement below the knee is 80%.
The terms mild, moderate, and moderately severe are open to interpretation for individual cases. But they give a framework for the VA disability rating based on objective medical evidence.
How are sciatica and radiculopathy coded differently in medical billing?
In medical coding, sciatica is given the code M54.3, while lumbar radiculopathy is coded as M54.16. Valid ICD-10 codes for lumbar radiculopathy include M54.3, M54.30, M54.31, M54.32, M54.4, M54.40, M54.41, and M54.42. The most common billable codes are M54.16 and M54.42. M54.3 is invalid for billing because it is not specific enough.