From the Guidelines
For L5 radiculopathy, I recommend a progressive exercise program focusing on core stabilization, nerve mobility, and functional strengthening. This approach is supported by the American College of Physicians and the American Pain Society, which suggest that exercise is an effective self-care option for patients with low back pain and radiculopathy 1.
Key Exercises
- Gentle nerve glides: lie on your back, pull one knee to your chest while keeping the other leg straight, hold for 30 seconds, and repeat 5 times on each side
- Prone press-ups: lie face down, place hands under shoulders, and gently push your upper body up while keeping hips on the floor, hold for 5-10 seconds for 10 repetitions
- Bird-dog exercises: on hands and knees, extend opposite arm and leg while maintaining a neutral spine, hold for 5 seconds for 10 repetitions each side
- Bridge exercises: lie on your back with knees bent, lift hips toward ceiling, hold for 5 seconds, and repeat 10 times
- Walking: start with 10 minutes daily and gradually increase to 30 minutes to maintain mobility These exercises help by decompressing the affected nerve root, improving core stability to support the spine, and enhancing blood flow to promote healing.
Important Considerations
- Start gently and stop if pain increases
- Perform these exercises daily, gradually increasing intensity as tolerated
- Combine with proper body mechanics during daily activities to prevent further irritation of the L5 nerve root It is essential to note that while these exercises are beneficial, the natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management 1. However, for patients with persistent radicular symptoms despite noninvasive therapy, discectomy or epidural steroids are potential treatment options 1.
From the Research
Exercises for L5 Radiculopathy
- The most effective exercises for L5 radiculopathy include lumbar stabilization and thoracic mobilization in a closed kinetic chain, as they have been shown to reduce pain intensity and functional disability 2.
- A study comparing two exercise programs, lumbar stabilization exercise program in a closed and open kinetic chain (LSCO) and lumbar stabilization exercises and thoracic mobilization program in a closed kinetic chain (LSTMC), found that the LSTMC group had superior recovery in pain intensity and functional disability parameters 2.
- Exercises to strengthen the deep lumbar spine stabilizers, such as those included in an eight-week kinesiotherapy program, can also be beneficial for patients with L5 radiculopathy 2.
- In addition to exercise, other conservative management options, such as pharmaceutical therapy, physical therapy, and occupational therapy, may be recommended for the treatment of L5 radiculopathy 3, 4, 5.
- The specific exercises and management strategies used may vary depending on the stage of the disorder, with acute stage management focusing on pain education and individualized physical activity, sub-acute stage management adding strength training and neurodynamic mobilization, and chronic stage management focusing on restoring personalized functional capacity 5.