By: John Crawley, PT, DPT, OCS
Low back pain known as lumbar radiculopathy or more commonly as sciatica can be a debilitating condition. The condition is marked by severe pain that can present from the low back to the foot. The pain can be intermittent to unrelenting. Characteristics of this type of pain are the feeling of tightness, achiness, or pulling. The pain can be dull to sharp. Severity of the symptoms can also range from barely noticeable to excruciating. Numbness and tingling and muscular weakness are often associated with this type of injury. No matter what level of your symptoms it is important to address the root of the pain which is often just that, the nerve roots of the lumbar spine. If you have this pain on one side of your body there is good news. Research with promising results has been conducted to determine if positioning the body based on biomechanical factors of the back could open up space to off load the nerve and provide pain relief.
Based on a study that looked at individuals with unilateral lumbar disc prolapse and radiculopathy, researchers found that a specific trunk position, known as the modified reversed contralateral axial rotation (MRCAR) position, can decompress impinged nerve roots. The study investigated the real-time effects of this position on the cross-sectional area (CSA) of the lumbar intervertebral foramen (LIVF) which is the space that surrounds the nerve root. The patients were divided into three groups based on the level of their disc prolapse: L3/L4, L4/L5, and L5/S1. Imaging was performed in a neutral supine position to get a baseline measurement, followed by the MRCAR position, and then again after the patient used the position therapeutically for 48 hours. In addition to looking at the spacing, they assessed a straight leg raise (SLR) which is a common test performed to determine the presence of a lumbar radiculopathy. Increases in angle of SLR suggest a decrease in severity of symptoms.
The results showed that the mean values for both the LIVF’s CSA and (SLR) test angle increased significantly in the MRCAR position compared to the supine position. The study also found that using the MRCAR position four times daily for 20 minutes each session over a 48-hour period led to even greater increases in both the LIVF’s CSA and the SLR test angle. These improvements were considered clinically relevant due to the large effect size observed in the study’s findings.
The MRCAR position’s ability to increase the LIVF’s size and the SLR angle suggests that it can alleviate nerve root compression, restore neurological function, and improve nerve root mobility. This is significant for patients with sciatica, as the pain and other symptoms are believed to be caused by mechanical nerve root compression, restricted blood flow, and inflammation.
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