Etiology

• Disc Herniation

Presentation

A type of Radiculopathy → Radicular pain

Most commonly affected:

1. L5-S1 → Affect S1

   e.g. Affect S1, presentation of LMN signs :

   • Muscle bulk: gastronomic atrophy
   • Power: S1 Myotome : hip extension, knee flexion, ankle plantar flexion
   • Sensory: S1 Dermatome: Sole and lateral aspect of the foot

2. L4-L5

3. L3-L4

4. Never affect L1

History:

• Pain is leg-dominant – around or below the gluteal fold and can extend to the:
  • thigh, calf, ankle, foot
• Leg pain is affected by back movement or position. Leg pain is always constant.

Physical Examination:

• Leg-dominant pain – the location on examination matches the location on history. Leg pain is affected by back movement or position.
• There must be an abnormal neurological finding:
  • a positive irritative test
    • SLR (L4 - S1)
    • FST (L2-L4)
    • Well Leg Test
    • Cross-over Test
  • and/or presence of focal neurological deficits

Exercise

• Treat like Pattern 1 - FA PEN

  • • Rest on Hands and Knees