1. Chief complaint of pain and/or paresthesia in the lumbar spine with a distribution of symptoms that has extended distal to the gluteal fold into at least one lower extremity within the past 24 hours.
1. Known serious spinal pathology (e.g., spinal tumor, fracture, infectious disorder, osteoporosis or other bone demineralizing condition), or suspicion of serious pathology based on red flags noted in the general medical screening.
2. Modified Oswestry score ≥20%
2. Evidence of central nervous system involvement, including symptoms of cauda equina syndrome (i.e. loss of bowel/bladder control or saddle region paresthesia) or the presence of pathological reflexes (i.e. positive Babinski) in the physical examination.
3. Age at least 18 and less than 60 years
3. Patient report of a the complete absence of LBP and leg symptoms when seated
4. At least one of the following signs of nerve root compression:
5. Recent (within the past 2 weeks) epidural steroid injection for LBP and/or leg pain
I. Positive ipsilateral or contralateral straight leg raise test (reproduction of leg symptoms with leg raise <70°)
6. Current pregnancy
II. Sensory deficit to pinprick on the ipsilateral lower extremity
7. Known inability to comply with the treatment schedule (e.g., planned vacation, etc.)
III. Diminished myotomal strength of the ipsilateral lower extremity
IV. Diminished lower extremity muscle stretch reflex (Quadriceps or Achilles) of the symptomatic lower extremity