Isolated lumbar extension resistance exercise in limited range of motion for patients with lumbar radiculopathy and disk herniation: clinical outcome and influencing factors

Key points

1. 01162 out of 168 completers (96.4%) reported significant symptom reduction; 86.9% were completely or nearly symptom-free
2. 02Pain and radiculopathy scores dropped by 54.8% on average (4.2 to 1.9 on NRS, p < 0.001)
3. 03Impact on mental health fell by 59.4% on average (5.9 to 2.4 on NRS, p < 0.001)
4. 04Isometric lumbar extension strength improved by 35.7% on average
5. 05Higher pre-treatment pain scores were the only factor weakly predicting worse outcomes; age, disc level, and strength gain did not matter

How it was conducted

Design

Retrospective consecutive case series (2002-2019), single centre

Participants

189 patients enrolled; 168 analysed (110 men, 58 women; mean age 37 years, range 16-50); MRI-confirmed LDH with radiculopathy and sensory impairment; all had failed prior conservative treatment

Intervention

18 sessions over 9 weeks (2 per week) of isolated lumbar extension resistance exercise (ILEX) in limited range of motion, adjusted to each patient's symptoms, plus supplemental core exercises

Primary outcomes

Pain/radiculopathy NRS (0-10), impact on mental health NRS (0-10), overall clinical outcome (0-100%), satisfaction NRS (0-10), and isometric extension strength before and after

Exclusions

Age over 50, prior spinal surgery, degenerative or inflammatory co-pathology (stenosis, spondylolisthesis, facet arthritis), fewer than 3 sessions completed

What they found

• 162/168 completers (96.4%) reported significant symptom reduction; 6 patients reported no change; 0 patients reported worsening
• Pain/radiculopathy NRS: 4.2 ± 1.5 pre to 1.9 ± 1.5 post (p < 0.001), a 54.8% reduction
• Impact on mental health NRS: 5.9 ± 2.3 pre to 2.4 ± 2.0 post (p < 0.001), a 59.4% reduction
• Mean satisfaction rate: 8.5 ± 2.0 (range 0-10)
• Mean overall clinical outcome: 78.9% ± 20.4 (range 0-100%)
• Isometric lumbar extension strength improved by 35.7% on average
• Pre-treatment pain (PR) weakly predicted clinical outcome (Spearman rho -0.261, p < 0.001) and satisfaction (rho -0.207, p < 0.01); pre-treatment IOMH also weakly predicted clinical outcome (rho -0.207, p < 0.01)
• Linear regression: clinical outcome decreased by 3.40% for each 1-point increase in baseline PR NRS (F(4,118) = 3.902, p < 0.01, R2 = 0.117); satisfaction decreased by 0.33 points per 1-point increase (F(4,118) = 3.174, p < 0.05, R2 = 0.097)
• Disc level and symptom duration did not significantly affect outcomes (p = 0.771 and p = 0.282 respectively)
• 21 patients dropped out for medical reasons (14 went to surgery, 7 chose to stop); their baseline PR and IOMH scores were significantly higher than completers (p < 0.05 and p < 0.01)

Limitations

• No control group; spontaneous disc regression (mean 67%) cannot be excluded as a contributor to recovery
• Retrospective design with no randomisation; outcomes rely on self-report scales
• 31% of patients were on analgesic medication at baseline, which may have influenced pain scores and strength tests
• Additional core stabilisation exercises were performed alongside ILEX, so outcomes cannot be attributed to ILEX alone

Why it matters

For patients

Most patients with lumbar disc herniation and sciatica who complete this 9-week exercise programme experience meaningful pain relief and avoid surgery, though those with very high pain levels may still need surgical assessment.

For clinicians

ILEX in limited ROM appears safe and effective for MRI-confirmed LDH patients without major neurological deficits or degenerative co-pathology; high baseline pain scores predict relatively worse outcomes and should guide surgical decision-making.

For readers

This is a large single-centre case series with no control arm, so results are promising but not yet confirmed by randomised trials; a controlled study is needed before ILEX can be recommended over other conservative approaches.