If you have low back pain, you're part of the majority in the adult population. It's one of the most common conditions treated by health care professionals. In fact, 60 to 90 percent of people will experience low back pain within their lifetime, according to a 2018 report by StatPearls. Of the people with low back pain, 12 to 40 percent of them will have radicular symptoms, according to the same report. Lumbar radiculopathy often causes low back pain, along with other symptoms radiating to the legs.
The spine is made up of 33 stacked bones called vertebrae. Between each of these bones are cushions called intervertebral disks. The spinal cord runs down through the middle of the vertebrae. The lumbar spine, located in the low back, consists of five vertebrae called L1-L5.
Between the vertebrae, nerves emerge on the right and left sides. These nerves provide sensation to the legs and power your leg muscles. Lumbar radiculopathy is a term that describes multiple conditions that can affect these nerves.
Read more: Exercises for Healing Lumbar Strain
Causes of Lumbar Radiculopathy
Before you begin lumbar radiculopathy exercises, it's important to understand what's causing your nerve compression symptoms. Exercises that are helpful for one condition can make another condition worse.
The most common causes of lumbar radiculopathy are degenerative conditions. These conditions include degenerative disk disease, disk herniation, stenosis from arthritic changes and repetitive overuse injuries. Degenerative changes always occur with age, but not everyone will develop nerve pathology.
Lumbar radiculopathy can also develop from trauma, such as a fall, car accident or osteoporosis — progressive bone breakdown that typically affects older women. Lumbar radiculopathy physical therapy exercises are most effective and appropriate for this category of conditions and nerve irritation caused by degenerative changes.
Radiculopathy can also be caused by cancers or infections. Symptoms that occur with radiculopathy can be caused by medical conditions as well, such as diabetes-related neuropathy. These conditions require medical treatment and do not resolve with exercise.
Symptoms of Lumbar Radiculopathy
The main complaint associated with lumbar radiculopathy is pain. Even though the problem originates in the low back, some people with this condition have no back pain.
Each lumbar spinal nerve provides sensation to a specific part of the leg. These areas, called dermatomes, are often where a person with radiculopathy will experience the most pain. Radiating nerve pain is frequently described as piercing, dull, sharp, burning or throbbing.
Tingling, decreased sensation or numbness can also occur with nerve compression. These symptoms also develop in the corresponding dermatome.
Each spinal nerve also powers a particular group of muscles, called a myotome. Compression of a spinal nerve can cause weakness in the muscles it supplies. In severe cases, the muscles may stop functioning completely.
Lumbar radiculopathy can cause difficulty walking. According to a study published in 2014 by World Journal of Anesthesiology, people with this condition often walk slower, take smaller steps and spend less time standing on the affected leg.
Lumbar Radiculopathy Versus Sciatica
Many people automatically associate leg pain with sciatica. This condition causes pain along the back of the thigh, sometimes reaching as far as the calf or foot. Tingling and numbness can also occur.
Sciatica can be a type of lumbar radiculopathy as the sciatic nerve partially originates from the lower lumbar spinal nerves. However, it can also occur when the sciatic nerve is pinched by structures farther away from the spine, such as the piriformis muscle, according to the Mayfield Clinic & Spine Institute.
Precautions With Lumbar Radiculopathy
Lumbar radiculopathy symptoms caused by disk herniation typically worsen with sitting or bending forward. Therefore, exercises that involve these positions should be performed with caution. The opposite is true for lumbar radiculopathy caused by stenosis or arthritis. Bending forward typically reduces pain for these individuals.
See a physical therapist for specific exercise instruction based on your diagnosis.
Lumbar Nerve Compression Exercises
Exercises for lumbar radiculopathy vary based on the underlying cause. For example, exercises for spinal stenosis and sciatica are very different. However, they fall into the general categories of stretching, posture training, strengthening, endurance and body mechanics, according to the American Physical Therapy Association.
Consult your health care provider for an accurate diagnosis prior to beginning an exercise program to avoid making your condition worse.
Improve Your Flexibility
Tightness in the muscles of your low back and hips can contribute to lumbar radiculopathy. For this reason, stretching is an important component of your exercise program. Flexibility exercises should be performed at least five days a week, according to Princeton University Athletic Medicine.
Stretches should not be painful. If your symptoms get worse while stretching, stop right away. You should feel a gentle pulling sensation and might have mild discomfort, but you should not feel sharp pain. Hold each stretch for 20 to 30 seconds and repeat three times.
Read more: Stretches for the Lower & Middle Back
Leg muscles to target in your stretching program include the hamstrings on the back of the thigh, quadriceps along the front of the thigh, adductors along your inner thigh and iliotibial band, or IT band, on the outside of the thigh, according to Princeton.
Tight glutes, or muscles in your buttocks, can also contribute to lumbar radiculopathy. Hip flexor muscles along the front of your hips and the quadratus lumborum and spinal erectors in your low back should also be stretched.
It's important to stretch these muscles on both sides of your body, even though your symptoms likely only occur on one side. Tight muscles on either side of your low back, pelvis and hips can contribute to radiculopathy.
Fix Your Posture
The body is meant to be in proper alignment while sitting and standing to reduce stress on your spine. For example, symptoms from lumbar radiculopathy caused by disk herniation can become significantly worse from sitting with poor posture. However, most people have difficulty maintaining an ideal posture.
According to PhysioMed, positioning yourself in your chair and having your desk at the proper height are keys to maintaining good sitting posture. Adjust your chair to a height that allows your feet to rest flat on the floor.
Sit up straight as if being pulled up by a string attached to the top of your head. As you sit up, you will notice a slight arch develop in your low back. Ideally, with time and practice, your back muscles will become strong enough to hold you in this position. However, in the meantime, a small rolled towel can be placed between your low back and the chair seat back to support this curve.
The position of your upper back influences your low back posture. Squeeze your shoulder blades together and down, as if you are trying to put them in your back pockets. Tuck your chin slightly until your head is centered over your shoulders. If you're unable to maintain this position, exercise by holding it for three seconds at a time, working up to three sets of 10 repetitions.
Whenever possible, give your back a break by standing every 20 to 30 minutes.
Read more: Why is Posture Important?
Strengthen Your Core
When core muscles are mentioned, abs often come to mind. However, your core is also made up of several additional muscles in your spine and pelvis. Before performing core-strengthening exercises, it's important to make sure you're using the correct muscles.
Core-strengthening exercises begin by learning to contract the correct muscles with the pelvic tilt. Lie on your back and bend your knees. Place your fingers on your hipbones, then move 1 inch inward and 1 inch down.
Tighten your core by slowly pushing your low back into the floor. You should feel muscles get tighter under your fingertips. Hold this position for a few seconds; then relax. Repeat 10 times, working up to three sets in a row.
Pelvic tilt exercises can be progressed as your strength improves. Try lifting one knee toward the ceiling, then slowly back down while keeping your core muscles tight. Alternate legs as if marching.
Work up to lifting both legs at the same time or lifting opposite legs and arms together. Pelvic tilts can also be made harder by resting your legs on top of a therapy ball instead of on the floor.
Core-strengthening exercises can also be performed while sitting on a large therapy ball. Tighten your muscles and maintain this hold as you did while lying on the floor. You can then kick one leg out at a time, lift one knee up and march, or lift opposite arms and legs without losing your balance.
Ankle weights can be added as well to make these movements more challenging. Princeton recommends performing strengthening exercises three to four times per week.
Mind Your Body Mechanics
You might not have realized it, but performing your daily tasks such as taking out the garbage and doing laundry are also forms of exercise. It's important to use proper body mechanics to protect your spine as you move through your day.
When lifting objects from the floor, position your feet wider than your hips. Tighten your core muscles to help maintain a slight arch in your low back. Squat, keeping your weight in your heels. Do not bend over at the waist. Keep the object close to your body and lift and return to a standing position.
Move slowly and avoid jerking movements. Turn your whole body rather than twisting your spine.
- StatPearls: Lumbosacral Radiculopathy
- A System of Orthopaedic Medicine: Applied Anatomy of the Lumbar Spine
- World Journal of Anesthesiology: Lumbar Radiculopathy and Its Neurological Basis
- Mayfield Clinic & Spine Institute: Leg Pain (Sciatica)
- American Physical Therapy Association: Physical Therapist's Guide to Herniated Disk
- Princeton University Athletic Medicine: Lumbar/Core Strength and Stability Exercises
- PhysioMed: Correct Sitting Posture: Office
- Aurora Health Care: Spine Safety and Body Mechanics
- Southern California Orthopaedic & Musculoskeletal Associates: Lumbar Radiculopathy