Chapter 19 · Back & Spine
Nerve Pain — Low Back protocol
Indexed — full page in progressSource: Rehab Science · Ch 19 · PDF pp. 627–657📖 Rehab ScienceBuild my programme →
AMBER — get assessed before starting rehab
Screen for red flags before starting any protocol (safety check). Progress by symptoms and function, not by the calendar: > 3/10 pain → start phase 1; < 3/10 → phase 2 (PDF p. 205).Follow this programme to treat
- Numbness and/or tingling that radiate into the buttock, back of the thigh, and down the leg
- Sciatica (from the low back)
- Disc herniation
- Lumbar stenosis
Conditions in this protocol
- Sciatica (from the low back) PDF p. 628
- Lumbar disc herniation PDF p. 632
- Lumbar stenosis PDF p. 636
Questions the book answers
Good for
- Alleviating nerve pain radiating down the low back, hip, and leg
- Relieving muscle tension
- Warm-up for phase 2 and 3 exercises
Guidelines
- Perform every day
- Tools: foam roller, massage ball
- Add phase 2 when you have no pain at rest and no more than mild pain (3/10) with the exercises
Soft Tissue Mobilizations
▶ Spend 1‒2 minutes on each area · Perform in any order on both sides · Stop on tender points for 10‒20 seconds
diagram pending
Glute/piriformis mobilization
PDF p. 639 · instructions pending
diagram pending
Quad mobilization
PDF p. 640 · instructions pending
diagram pending
Lateral quad mobilization
PDF p. 641 · instructions pending
diagram pending
Calf mobilization
PDF p. 641 · instructions pending
diagram pending
Hamstring mobilization
PDF p. 643 · instructions pending
Good for
- Reducing nerve sensitivity
- Improving hip and lumbar flexion and extension range of motion
- Warm-up for phase 3 exercises
Guidelines
- Perform every day
- Tools: stretch strap, balance pad
- Add phase 3 when you can do the exercises with no more than mild pain (3/10)
Stretching Exercises
▶ Do 3 reps with 30- to 60-second holds · Perform in any order on both sides · Stop or back off the stretch if you feel tingling, numbness, or shooting pain
Mobility Exercises
▶ Do 3 sets of 10–15 reps · Active range of motion (AROM)—move as far as you can without pain · Pause at end range for 2–3 seconds
Lumbar flexion (choose one)
choose one▶ Do 3 sets of 10–15 reps · Active range of motion (AROM)—move as far as you can without pain · Pause at end range for 2–3 seconds
Good for
- Reducing nerve sensitivity and preventing future flare-ups
- Improving glute and hip strength
Guidelines
- Perform 3 or 4 days a week
- Tool: resistance loop
- Once nerve sensitivity calms down, add phase 3 exercises from the Low Back Pain protocol (here–here)
Mobility Exercises
▶ Do 3 sets of 10–15 reps · Active range of motion (AROM)—move as far as you can without pain · Pause at end range for 2–3 seconds
Resistance Exercises
▶ Do 3 sets of 10–15 reps · Push sets to fatigue · Add load or reps to make the exercises more challenging
Source: Rehab Science · Ch 19 · PDF pp. 627–638· 12 original research citationsshow sources ▾
Also cited by the book on these pages:
- [Ch 19·17] Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313-1317. find original ↗
- [Ch 19·4] Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for nonspecific low back pain: a Cochrane review. Spine (Phila Pa 1976). 2016;41(16):1284-1295. find original ↗
- [Ch 19·9] Warner WC Jr, de Mendonça RGM. Adolescent spondylolysis: management and return to play. Instr Course Lect. 2017;66:409-413. find original ↗
- [Ch 19·18] Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018;18(9):1715-1721. find original ↗
- [Ch 19·19] Vanti C, Panizzolo A, Turone L, et al. Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and meta-analysis. Phys Ther. 2021;101(3):pzaa231. find original ↗
- [Ch 19·20] Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. find original ↗
- [Ch 19·21] Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. find original ↗
- [Ch 19·22] Zhong M, Liu JT, Jiang H, et al. Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain Physician. 2017;20(1):E45-E52. find original ↗
- [Ch 19·23] Videman T, Battié MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J. Associations between back pain history and lumbar MRI findings. Spine (Phila Pa 1976). 2003;28(6):582-588. find original ↗
- [Ch 19·24] Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine (Phila Pa 1976). 2010;35(11):E488-E504. find original ↗
- [Ch 19·25] Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358(8):818-825. find original ↗
- [Ch 19·26] Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234. find original ↗
Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.