Exercises and Stretches to Resolve Low Back Pain, Radiculopathy, and Leg Pain

Low back pain affects most people at some point in their life. It is the leading cause of disability around the world. It is the most common musculoskeletal injury in the world. At any point in time, it has been reported that 577 million people in the world have back pain.

That's a lot of people affected by back pain. Apparently, the current method of treating low back pain isn't working. It is becoming abundantly clear that MRIs, pain medication, and rest are not the answer.

So what is the answer for low back pain relief? Is there an answer?

YES!

The current research is showing that movement, exercises, and manual therapy are able to significantly improve pain and decrease limitations. If your goal is to get back to exercise, running, deadlifting, CrossFit, hiking, or lifting your grandkids, don't give up! Many people have been in your exact position and have overcome low back pain. 

Keep reading to learn a self-assessment and self-treatment for low back pain.

Why Low Back Pain Is So Difficult To Fix

The problem with low back pain is that very often the back is not the cause of pain - it's the victim. Some other region of the body isn't doing its job and forces the low back to move or work too much. Overworking for too long will cause irritation and strain. This will turn into pain.

Additionally, low back pain doesn't always stay in the back. Foot pain, knee pain, or hamstring pain can all be originating from the back. Radiculopathy is when a nerve is irritated as it exits the spine at the intervertebral foramen, commonly called a "pinched nerve", and causes pain along the pathway of the nerve. Sciatica is a good example of this.

"... but my ______ doesn't even hurt!!"

To recap that last section: Low back pain is not often caused by the low back and low back pain does not always present in the low back.

This is why finding the cause of pain is difficult. But if you don’t fix the cause, you cannot get a long term fix. So, finding the cause is paramount.

I say it all the time and it is extremely applicable to low back and radicular symptoms: “The location of pain is not always the cause of pain”. That means that a disc bulge at L5 or S1 spinal segment could give pain in the foot, even if there is no pain in the back! So even if your back or hip doesn’t hurt, we need to assess that region for any contribution to pain.

This makes it nearly impossible to diagnose the pain on your own. Because how can you make a purely objective assessment when you feel such strong pain in a completely different place?

Assessment Of Low Back Pain

I just said that you cannot accurately diagnose yourself. And this is very true. But, that doesn’t mean you should sit there in pain. If you've read this far, you want something actionable!

The goal of NorCal Physiotherapy is to give you the tools and resources to become independent. So while you cannot precisely diagnose low back pain, you can get an idea of what makes you feel better and formulate exercises and stretches to make yourself feel better.

A good way to determine what will help is by considering what gives you short term relief. When you can find that movement or position, you can make that your treatment.

This paradigm is called McKenzie Directional Preference. It is one of many, many ways to treat low back pain but became popular due to its simplicity and effectiveness. Robin McKenzie, a Physical Therapist in New Zealand, found that certain movements made pain better. These movements were described as a “directional preference” and repeated movements in that direction were prescribed.

At the most basic level, we break it down into two positions – bending forward or leaning backward.

1 SUPER Important Concept: Centralization vs Peripheralization

Before we attempt to find that directional preference, you absolutely need to understand the concept of centralization versus peripheralization. It's all about the location of pain and how that changes. Here’s an example of each:

Example pain: Symptoms begin at the knee, thigh, and back.

Centralization: After completing some movements, the pain leaves the knee and is only in the thigh and back. Even if back pain is worse, we see this as a positive indicator.

Peripheralization: After completing some movements, the pain is no longer just in the knee, thigh and back, but has progressed to the lower leg and foot. This is a negative indicator.

We like centralization. We don’t like peripheralization. Use this as a guideline when finding your directional preference.

Finding your Directional Preference

We are trying to find specific movements that make your back and radiculopathy symptoms feel better. This can get very deep; but keeping it brief, this will just cover the two most common directional preferences - flexion and extension.

Extension Directional Preference

If leaning backward (spinal extension), lying on your stomach, or walking helps, this might be you. This group typically reports that standing or walking improves symptoms. Common causes of back pain and leg pain in this group are disc bulges or muscle trigger points.

This group does very well with the extension-based exercises and stretches that are shown below – prone lying, press ups, walking.

Flexion Directional Preference

If you find relief with bending forward (spinal flexion) you might have a Flexion Directional Preference. This group typically reports that sitting or bending forward improves symptoms. Also, walking while pushing a shopping cart seems to relieve pain because that puts the spine in a flexed position.

This is often seen in disc degeneration, spinal stenosis, and tight hip muscles. These examples will cause narrowing of the intervertebral foramen that we mentioned above. This narrowing decreases the available room for the nerve to pass through (think: big truck going through a small tunnel).  Common occupations that are included in this group are farmers, carpet installers, and general contractors.

This group does well with flexion-based stretches and exercises that are shown below – knee to chest, modified pigeon pose, and even seated hamstring stretches.

Self-Treatment For Low Back Pain

Now we get to the good part.

From the assessment, you should have an idea of your directional preference. The exercises are divided just as they are listed above - extension-based exercises and flexion-based exercises.

You've read this far. Now you can stop reading and watch the video to see what movements might help your pain.