Despite its classic clinical presentation, and even when confirmed by compatible imaging findings of a herniated disc, the radiculopathy diagnosis provides only limited assistance for making decisions about treatment. The 2003 Medicare data revealed an eightfold variation in the rates of lumbar laminectomy and discectomy across geographic regions. In an effort to address this uncertainty in care, this article describes the management paradigm known as Mechanical Diagnosis and Therapy and its usefulness in decision-making for patients with lumbar radiculopathies, and reviews the relevant literature.