序章

Lumbar radiculopathy or radicular lower back pain occurs due to compression of the nerve roots originating from the lumbar spine. Nerve compression may be a manifestation of disc herniation, spondylosis, and degenerative disc disease. Poor posture and lifting body mechanisms also contribute to the onset of lumbar radiculopathy along with trauma, infection, inflammation, and malignancy of the lumbar spine. Different sections of this article discuss the etiological factors, symptoms, and treatment of lumbar radiculopathy in the light of the normal healing cycle. 

What is Lumbar Radiculopathy?

Lumbar radiculopathy is referred to as a pain syndrome that arises due to the compression of nerve roots of the lumbar spine. Lumbar radiculopathy affects both male and female populations with its prevalence being approximately 3-5%. [1]  

Symptoms of Lumbar Radiculopathy

The clinical features of lumbar radiculopathy are listed down below. [1]   

1. Paraesthesia
2. Lower back pain that radiates to the foot indicating a positive straight leg raising test 
3. Weakness during hip flexion, hip adduction, knee extension, an extension of the big toe, inversion, eversion, and dorsiflexion of the foot.   
4. Loss of sensation of the anterior region of the thigh
5. Reduced patellar reflex 
6. Reduced muscle strength in severe cases
7. Atrophy of tibialis anterior and extensor digitorum brevis 

Causes and Risk Factors of Lumbar Radiculopathy 

The causes of lumbar radiculopathy are as follows. [1]   

1. Nerve root compression leads to inflammation, edema, or ischemia. 
   1. Spondylosis (narrowing of the lateral recess, neural foramen, or spinal canal)
   2. Disc herniation (acute injury or degeneration of the spine)
   3. Degenerative disc disease 
2. 感染 
3. Inflammation such as rheumatoid arthritis and osteoarthritis 
4. Malignancy 
5. Trauma such as whiplash injury and sprain or strain of the muscles 
6. Vascular disease 
7. 姿勢が悪い 
8. Poor body mechanics while lifting weight 
9. 坐骨神経痛 

通常の治癒サイクル 

It is important to acquire basic knowledge of the normal healing cycle before understanding the treatment and management of lumbar radiculopathy. Acute inflammation lasts for a shorter duration. On the contrary, chronic inflammation persists for up to several months or years. It is characterized by the onset of proliferation and inflammation stages of the healing cycle simultaneously and failure of the affected site to achieve resolution. The stages of the healing cycle are described as follows. [2]

1. 炎症段階

This is the first stage of the healing cycle. The inflammation stage is characterized by a cascade of reactions that involve the secretion of cytokines and other inflammatory mediators by the inflammatory cells. These chemical substances recruit immune cells to the affected site and eradicate the cause of inflammation. The completion of the inflammation stage is marked by a clean wound site that is free of any harmful pathogens. The cardinal signs of inflammation are loss of function, swelling, redness, warmth, and pain. 

2. 増殖段階 

The proliferation stage of the healing cycle is characterized by the formation of new blood vessels, deposition of collagen fibers by proliferating fibroblasts, production of extracellular matrix, and re-epithelization. Under normal circumstances, the proliferation stage is autoregulatory and marked by suppression of excess scar tissue and collagen formation by negative feedback mechanisms. Abnormalities of this stage of the healing cycle manifest as trigger points or muscle knots and fascia restrictions. This may limit the range of movement.  

3. 成熟段階 

The maturation stage is the final stage of the healing cycle. During this stage, wound contraction and scar formation occur. Type 3 collagen in the scar tissue is replaced with type 1 collagen. This stage reflects the resolution of the healing cycle. 

Ineffective Treatments of Lumbar Radiculopathy

Following treatment modalities may provide temporary pain relief, however, these treatments do not cater to the inflammation and proliferation stages of the healing cycle.

1. Ice and heat application
2. 電気刺激 
3. フォームローラーによるマッサージ療法
4. マッサージ療法 
5. ストレッチ 
6. 炎症段階での筋力トレーニング 
7. Mobilization of the affected joint(s)

Effective Treatments of Lumbar Radiculopathy

1. One shall maintain correct posture to avoid muscle straining and nerve compression. 
2. One must opt for proper body mechanics while lifting weights. 
3. One shall also focus on core stabilization. 
4. Individuals suffering from lumbar radiculopathy shall stay active and participate in pain-free activities. 
5. One may perform back exercises to alleviate the symptoms of lumbar radiculopathy and promote healing. 
6. The resolution of the inflammation stage of the healing cycle comprises the following steps.
   1. 癒しを促進するために十分な休息をとる必要があります。
   2. Consumption of anti-inflammatory plays an integral role in the resolution of the inflammation stage of the healing cycle. One shall abstain from the consumption of alcohol, trans fat, and refined carbohydrates that aggravate inflammation. An anti-inflammatory diet comprises fruits, legumes, black pepper, turmeric, green tea, and ginger. [3] 
   3. The MagnaHeal device uses the principles of magnetic therapy to modulate inflammation. A device is made of a rare magnet called neodymium and coated with anti-inflammatory substances. MagnaHeal 1 has a magnetic force length of 2 inches and works best for mild inflammation. MagnaHeal 2 has a magnetic force length of 3 inches and works best for severe inflammation. [4] 
   4. The AskASTR program is used for the identification of nutrient deficiencies as well as for the determination of suitable nutrient supplements to overcome such deficiencies. 
7. The resolution of the proliferation stage of the healing cycle comprises the following steps.
   1. A1 tool is employed for releasing the aponeurotic and superficial fascia restrictions.
   2. A3 tool is employed for releasing muscle trigger points and superficial scar tissue. 
   3. A5 tool is employed for releasing epimysium, perimysium, and endomysium fascia restrictions as well as for releasing trigger points and deep scar tissue.  

結論

Along with numerous other health conditions, the progression and clinical picture of lumbar radiculopathy is determined by the status of inflammation and proliferation stages of the healing cycle. simultaneous resolution of both the stages of the healing cycle plays an important role in the alleviation of symptoms and treatment of lumbar radiculopathy. Important tools include MagnaHeal, A1, A3, A5, and AskASTR program. 

参考文献 

1. https://www.ncbi.nlm.nih.gov/books/NBK546593/ 
2. https://www.ncbi.nlm.nih.gov/books/NBK518964/
3. https://pubmed.ncbi.nlm.nih.gov/28350517/  
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617815/