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Could Resisted Lumbar Extension Help Patients with Lumbar Radiculopathy and Disk Herniation?

When performing an exercise with the goal of improving strength and muscle mass, experiencing, localized fatigue, a ‘pump,’ and subsequently delayed onset muscle soreness is often desired, indicating the individual exercised hard and potentially promoted adaptation. People tend to seek those feelings everywhere except for the back. There is a misconception that back ‘pumps’ and soreness are harmful and indicate you exercised incorrectly. Yet, the back is full of powerful muscles that we want to develop to help with lifting tasks. Furthermore, the lumbar paraspinals tend to atrophy after developing low back pain and in sedentary individuals. Wouldn’t we want to specifically develop those muscles? Isometrics can induce hypertrophy and strength, but only if they are at a moderate to high intensity (RPE 7-9, like isotonic exercise), and they are inferior to concentric and eccentric exercise. Bridges will only take you so far.

We know deadlifts are an outstanding exercise for developing back strength, in addition to the gluteals and hamstrings, but can we also use a more isolated approach? This study explored the use of isolated lumbar extension resistance exercises for patients with lumbar radiculopathy and disk herniation. The protocol limited the range of motion to 72 degrees of flexion (42 degrees if acute) but used appropriate loading, bringing the patient to muscle fatigue at a rep range of 12-15 reps. They included other compound back exercises as well, such as rowing and pull-downs. The outcomes were strong for both pain and mental health. We shouldn’t fear training the low back with targeted concentric and eccentric exercises. We should embrace it.

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