20 Best Treatments for Lower Back Arthritis

🔑 Key Takeaways

• Most precise diagnosis? MRI + blood work (HLA-B27) + symptom pattern.
• Best long-term strategy? Combine physical therapy, diet, and anti-inflammatories.
• Fastest pain relief? Steroid injection or nerve block.
• Hidden cause of pain? Inflammatory arthritis—especially if under age 45.
• Most underutilized treatment? Weight loss. It changes the mechanical and inflammatory game.
• Best surgery? Laminectomy if you have stenosis and leg symptoms—not just back pain.

---

“Why Does No One Talk About Weight Management as a Primary Treatment?”

Because it’s not glamorous—but it’s transformative. Every pound you carry exerts 4x that pressure on your lumbar spine with each step. That’s 40 lbs per step for just 10 lbs of excess weight. Yet, weight isn’t just a mechanical issue—it’s biochemical. Fat cells secrete cytokines that inflame joints from within.

Smart tip: Use waist circumference, not just BMI, as a metric. Visceral fat is particularly inflammatory.

📊 Weight & Spine Strain:

Factor	📉 Impact on Spine	💡 Insight
+10 lbs	+40 lbs spinal load	More strain on facet joints
Visceral fat	↑ Cytokine release	Drives OA and AS
Weight loss	↓ Inflammatory markers	Improves mobility, reduces drug reliance

---

“Are Anti-Inflammatory Diets Legit or Just Trendy?”

Legit, with pharmacological-grade effects in some cases. Omega-3s from fatty fish compete with arachidonic acid to reduce prostaglandin E2—directly lowering joint inflammation. Polyphenols in berries? They inhibit COX enzymes just like NSAIDs.

Pro tip: Add turmeric with black pepper (piperine boosts absorption 2000%).

🥗 Anti-Inflammatory Eating Essentials:

🍽️ Food Group	🌟 Why It Helps	🧠 Expert Tip
Fatty fish	Blocks inflammatory pathways	Aim for 2-3x/week
Leafy greens	Rich in flavonoids	Combine with citrus for better absorption
Olive oil	Contains oleocanthal (like ibuprofen)	Use extra virgin, cold-pressed
Avoid: Refined carbs, sugar	Spike CRP and insulin	Replace with legumes and whole grains

---

“Isn’t Physical Therapy Just Stretching?”

Absolutely not. It’s precision-engineered retraining for your spine’s support system. For arthritis, neuromuscular re-education and core activation reduce micro-instability in facet joints. It’s like fine-tuning your car’s suspension.

Core fact: The transverse abdominis is your spine’s best friend—more so than the visible six-pack.

🧘‍♀️ Therapy Beyond Stretching:

🏋️‍♂️ Technique	🔍 Purpose	✅ Benefit
Pelvic tilts	Activate deep core	Stabilize lumbar segments
McKenzie extension	Centralize discogenic pain	Good for radiating pain
Water therapy	Load-reducing resistance	Great for severe OA or obesity
Consistency	3x/week minimum	Builds spinal endurance

---

“Do I Really Need a Rheumatologist If It’s Just My Back?”

Yes—if your pain is worse in the morning and improves with movement, you might have inflammatory arthritis. That’s not something to manage with ibuprofen and hope. HLA-B27 testing and MRI of SI joints are often skipped in general clinics but can change your diagnosis—and treatment—entirely.

Key differential: OA pain worsens with use; AS pain improves with use.

🔍 OA vs. Inflammatory Red Flags:

❓ Symptom	🦴 OA	🔥 AS/PsA
Morning stiffness > 30 min	Rare	Common
Night pain (2nd half of night)	Rare	Common
Improves with rest	Yes	No—worsens
Responds to NSAIDs	Sometimes	Dramatically

---

“What Treatment Works Fast Without Major Risks?”

Radiofrequency ablation. It’s an outpatient procedure that uses heat to deactivate pain-transmitting nerves around arthritic facet joints. Relief can last 6–18 months.

It’s ideal for mechanical pain, especially OA-related. Not for inflammatory causes like AS.

🔥 Fast-Acting Options Ranked:

🚀 Speed	🧬 Therapy	🎯 Best Use Case
Same-day	Corticosteroid injection	SI joint or nerve root inflammation
1 week	Nerve block	Diagnosis + short relief
1-2 weeks	RFA	OA, facet pain
Variable	Acupuncture	OA, muscle tension, low side effects

---

“Why Do Some People Get Surgery and Others Don’t?”

Because surgery treats structure, not disease. A person with nerve compression (stenosis, disc herniation) may need decompression (laminectomy). Someone with mechanical instability might require fusion. If pain stems from inflammation, no surgery will help—that’s a pharmacological battle.

🧠 Surgical Decision Matrix:

🏥 Problem	🛠️ Surgery	❗ Note
Spinal stenosis	Laminectomy	Good for leg pain, not back pain
Unstable motion	Fusion	Motion sacrificed for stability
Disc-specific pain	Artificial disc	Only if no facet arthritis
Inflammatory pain	No surgery	Use DMARDs, not scalpels

---

“Can I Mix Treatments?”

You must. Arthritis isn’t linear, and neither is treatment. Medication dulls the fire, but diet and movement prevent flare-ups. Procedures control acute spikes, but long-term health depends on what you do every day.

Think of it like a recipe—not a single ingredient.

🧩 Synergy Table:

🧱 Foundation	🔗 Linked Strategy	🌈 Outcome
Weight loss	Aquatic therapy	Easier mobility
DMARDs	Anti-inflammatory diet	Reduced flares, lower doses
RFA	Ergonomic rehab	Prevents new pain cycles
Acupuncture	Yoga/Tai Chi	Reduces tension, improves alignment

---

FAQs

---

💬 “Can lower back arthritis cause radiating leg pain, or is that always something else like sciatica?”

✔️ Yes—facet joint arthritis, sacroiliac joint dysfunction, and spinal osteophytes can all refer pain down the legs, even without disc involvement.

The misconception that leg pain equals herniated disc or classic “sciatica” leads to underdiagnosis of referred patterns from joint-related degeneration. In lower back arthritis, bone spurs or facet hypertrophy can compress nerve roots (often L4–S1), mimicking radicular symptoms.

But unlike true sciatica, referred pain from arthritic changes doesn’t always follow a dermatomal map, may not be sharp or electric in quality, and often lacks neurological signs like foot drop or reduced reflexes.

📊 Arthritic Referred Pain vs. True Radiculopathy

⚖️ Symptom	🦴 Facet/SI Arthritis	⚡ Discogenic Sciatica
Pain location	Achy, diffuse, buttocks/thigh	Sharp, shooting, calf/foot
Triggered by	Prolonged standing, extension	Bending, coughing, sitting
Neuro signs	Rare	Common (weakness, numbness)
Imaging	Facet hypertrophy, bone spurs	Disc bulge, nerve impingement

---

💬 “Are CBD or medical cannabis actually effective for spinal arthritis, or is it just hype?”

✔️ Cannabinoids can reduce pain perception and inflammation in some arthritis patients, but efficacy is highly individual and formulation-dependent.

CBD (cannabidiol) works via indirect modulation of CB1/CB2 receptors, helping regulate pain signals and immune response without the psychoactive effects of THC. Medical cannabis products that include THC in low doses may provide enhanced analgesic synergy, but often with cognitive or mood-related side effects.

Sublingual tinctures and transdermal creams are preferred for back pain because they offer localized or systemic absorption without pulmonary involvement. Dosing requires titration—start low, go slow.

📊 Cannabinoid Therapy Breakdown

🌿 Compound	🧠 Mechanism	📈 Best Use Case
CBD isolate	Modulates serotonin, vanilloid receptors	Anti-inflammatory, mild pain
Full-spectrum CBD	Entourage effect with terpenes, minor cannabinoids	Neuropathic pain, stress-linked flare-ups
CBD+THC (1:1)	Balanced euphoria + pain relief	Chronic arthritis with sleep disturbance
Topical balm	Local anti-inflammatory action	Facet joint tenderness, muscle spasm overlay

---

💬 “Is there a way to predict which arthritis treatments will work best for someone?”

✔️ Yes—genetics, pain phenotype, comorbid conditions, and lifestyle behaviors all influence treatment response.

Patients with central sensitization (where the nervous system amplifies pain) respond better to neuromodulators like duloxetine and graded movement exposure, whereas those with isolated mechanical joint degeneration may respond well to interventional approaches like radiofrequency ablation.

Individuals with elevated CRP/ESR and fatigue likely benefit more from systemic anti-inflammatory strategies, including biologics if inflammatory arthritis is confirmed.

Precision pain mapping using functional MRIs and quantitative sensory testing may eventually guide therapy, but right now, tracking response to class-based interventions is most effective.

📊 Matching Treatment to Patient Profile

👤 Profile Type	🧬 Treatment Target	💡 Preferred Interventions
High inflammation	Immune overactivation	NSAIDs, biologics, anti-inflammatory diet
Mechanical overload	Facet/SI strain	RFA, PT, ergonomic supports
Central sensitivity	Brain-gated pain	SNRIs, cognitive therapy, tai chi
Neuropathic overlay	Nerve compression or irritation	Gabapentin, nerve blocks, decompression surgery

---

💬 “How important is posture really? Can it reverse arthritis symptoms?”

✔️ Posture won’t reverse cartilage loss—but it can dramatically reduce mechanical stress, inflammation, and secondary muscle compensation.

Arthritic joints are sensitive to micro-instability. Poor posture—especially prolonged anterior pelvic tilt, lumbar lordosis, or thoracic kyphosis—exacerbates uneven joint loading. Over time, this contributes to capsular inflammation, worsens facet approximation, and accelerates joint wear.

Postural correction isn’t just about “standing tall”—it’s about neutral pelvic positioning, balanced muscular tension, and spinal decompression. Daily habits matter: how you sit, lift, bend, and even sleep.

📊 Posture Correction Impact on Arthritis

🧍 Issue	💥 Consequence	🧠 Solution
Swayback posture	Anterior shearing of vertebrae	Strengthen glutes, stretch hip flexors
Forward head	Increased lumbar strain	Chin tucks, scapular retraction drills
Poor sleep posture	SI joint misalignment	Side sleeping with knee pillow
Slouching at desk	SI/lumbar overload	Sit/stand desk, lumbar roll support

---

💬 “How do I know if my lower back arthritis is progressing or stable?”

✔️ Monitor changes in functional capacity, symptom frequency, and flare severity—not just imaging results.

X-rays may show worsening degeneration even in asymptomatic individuals, while stable scans can coexist with worsening pain. That’s because pain is multifactorial—influenced by inflammation, nerve sensitization, and compensatory dysfunction, not just cartilage erosion.

Progression is often indicated by:

• Increasing morning stiffness duration
• Loss of range in lumbar rotation or side-bending
• Reduced response to previously effective therapies
• New onset of referred pain or neurological deficits

Functional assessments like the Oswestry Disability Index or Roland-Morris questionnaire are more predictive than static imaging alone.

📊 Signs of Worsening vs. Stability

🚦 Change	📉 Meaning	📌 Next Step
Stiffness > 1 hour	Inflammatory shift	Consider ESR/CRP lab work
New leg tingling	Possible nerve compression	MRI and neuro exam
Decreased PT benefit	Mechanical progression	Evaluate for procedural options
Stable function, stable pain	Controlled disease	Maintain current regimen

---

💬 “What’s your take on inversion therapy or traction devices?”

✔️ Inversion and traction can offer temporary decompression, but must be used with precision and caution.

Inversion therapy uses gravity to reduce disc pressure and facet joint compression, potentially alleviating pain for some with mild disc narrowing or facet OA. However, for those with uncontrolled hypertension, glaucoma, or herniated discs, it can be dangerous.

Traction (manual or mechanical) may provide short-term nerve root relief, especially in early stenosis, but doesn’t “cure” arthritis or correct joint degeneration.

Key is frequency and form—short durations (1–2 minutes to start), low angle, and physician approval are essential.

📊 Spinal Decompression Tools at a Glance

🛠️ Modality	🎯 Target	⚠️ Use With Caution If…
Inversion table	Facet compression, disc load	High BP, glaucoma, osteoporosis
Manual traction	Nerve root relief	Severe instability or acute flare
Over-the-door traction	Cervical spine—not for lumbar	Lumbar arthritis (ineffective)
Decompression boots	Gravity-assisted lumbar stretch	Safe if supervised

---

💬 “Is there a difference between lumbar arthritis and spinal stenosis, or are they basically the same thing?”

✔️ They’re related but not interchangeable—one is a disease, the other a complication.

Lumbar arthritis refers to degenerative changes within the spinal joints, including facet joint osteoarthritis and disc degeneration. Over time, these changes can produce bone spurs (osteophytes) and joint thickening, which narrow the spinal canal or foramina—the hallmark of spinal stenosis.

Stenosis is the result, not the disease itself. It’s like a traffic jam caused by collapsed roadways—arthritis weakens the structural integrity, stenosis slows or compresses the neurological “traffic.”

📊 Spinal Arthritis vs. Stenosis: Know the Distinction

🦴 Feature	🤕 Lumbar Arthritis	🧠 Spinal Stenosis
Primary issue	Joint and disc degeneration	Narrowed spinal canal or nerve foramen
Symptoms	Localized back pain, stiffness	Leg numbness, heaviness, walking fatigue
Movement impact	Worse with extension	Worse with standing/walking, relieved by sitting
Diagnosis	X-ray, MRI (facet hypertrophy)	MRI showing compression or narrowing

---

💬 “Are arthritis flare-ups real in the lower back, or is that just inflammation hype?”

✔️ Flare-ups are not only real—they’re a defining feature of arthritic progression, especially in active joints like the lumbar spine.

During a flare, the synovial lining of the facet joints becomes inflamed, increasing local pain, swelling, and sometimes creating muscle guarding that limits range of motion. Triggers include weather shifts, overuse, poor sleep, psychological stress, or even subtle dietary slip-ups in high-inflammatory foods.

These aren’t random—flares have a biochemical signature: elevated interleukins, TNF-alpha, and C-reactive protein. They resolve, but left unmanaged, can contribute to cumulative joint erosion.

📊 Flare-Up Triggers & Responses

🔥 Trigger	💣 Biological Effect	🧘 Immediate Strategy
Overexertion	Microtrauma to joint lining	Ice + gentle decompression
Poor sleep	↑ Cortisol, ↓ tissue recovery	Prioritize sleep hygiene
High sugar intake	↑ CRP, ↑ insulin resistance	Anti-inflammatory diet reset
Emotional stress	Alters pain threshold	Breathing, mindfulness, magnesium support

---

💬 “How does arthritis affect spinal discs vs. facet joints? I keep seeing both on my MRI.”

✔️ They degenerate differently, but their fates are linked.

Discs are cushions—they lose hydration, height, and resilience with age. This reduces their shock-absorbing ability, making surrounding structures work harder. As the disc space narrows, it alters spinal alignment, increasing stress on the facet joints, which then develop arthritic changes like cartilage wear, cyst formation, and osteophytes.

Facets are stabilizers—they bear more weight when the disc fails, accelerating their own degeneration.

It’s a domino effect: disc → misalignment → facet overload → arthritis.

📊 Discs vs. Facets: Comparative Breakdown

🧩 Structure	🎯 Function	🧬 Degeneration Consequence
Intervertebral Disc	Shock absorber, height maintenance	Flattening → nerve compression, instability
Facet Joint	Controls motion, supports load	Inflammation → stiffness, referred pain
Ligaments (interspinous)	Stability	Thickening → contributes to stenosis
Annulus fibrosus	Disc boundary	Tears → potential herniation risk

---

💬 “Is back bracing helpful or harmful for lumbar arthritis?”

✔️ Bracing can relieve acute strain but should be used strategically—long-term use weakens the very muscles that stabilize your spine.

Back braces offload stress from arthritic joints, especially during flare-ups, lifting, or extended standing. However, overuse—especially passive, non-customized bracing—can lead to atrophy of deep core stabilizers like the multifidus and transverse abdominis.

Smart use means treating the brace like a crutch during healing, not a permanent solution. Look for dynamic or modular braces that allow controlled mobility.

📊 Brace Use Guidelines for Arthritic Relief

🛡️ Brace Type	📌 When to Use	🚫 Avoid If
Rigid lumbar brace	Severe flare, post-procedure	Daily routine use (>2 hrs/day)
Elastic compression	Support during travel or work	If causing muscle fatigue
Custom-fitted orthosis	Instability with confirmed joint erosion	Prolonged sitting or sleeping
Nocturnal bracing	Not recommended	May impair spinal fluid dynamics

---

💬 “Are hot tubs and heat packs actually doing anything for the arthritis itself?”

✔️ Yes—but the benefit is neuromuscular, not structural.

Heat increases blood flow, soft tissue elasticity, and pain threshold. For lumbar arthritis, where muscle guarding and fascial restriction amplify joint pain, targeted heat can interrupt the feedback loop between joint stiffness and compensatory spasm.

Moist heat (like hydrotherapy or warm Epsom baths) penetrates deeper than dry methods. While it won’t “cure” degeneration, it creates a neurological environment conducive to healing movement.

📊 Heat Therapy Cheat Sheet

🌡️ Application	🤸‍♂️ Benefit	🧠 Best Practice
Heat pack (20 min)	Muscle relaxation	Use before stretching
Hot tub immersion	Decompression + warmth	100–104°F, 15–20 mins max
Infrared sauna	Deeper tissue penetration	Promotes circulation + recovery
Avoid with swelling	May increase inflammation	Use cold first if joint is inflamed

---

💬 “How do I know if my mattress is worsening my back arthritis?”

✔️ If you wake with increased stiffness that eases after 30–60 minutes, your mattress might be contributing.

Arthritic spines need neutral alignment and pressure relief. Too-soft mattresses allow spinal sinking, stressing facet joints. Too-firm mattresses create point loading at the shoulders and hips, altering lumbar curvature.

Ideal firmness varies, but medium-firm, zoned support foam or hybrid mattresses often provide optimal contour and stability. Look for materials like high-density memory foam, latex, or coil + foam hybrids designed for spinal support.

📊 Mattress Metrics for Arthritic Support

🛏️ Feature	🧠 Why It Matters	🔍 Ideal Specification
Zoned lumbar support	Reduces lordosis stress	Targeted mid-back firmness
Medium-firm surface	Balances support + pressure relief	6–7/10 firmness scale
Edge support	Prevents misalignment during turning	Reinforced perimeter foam
Temperature control	Enhances sleep quality	Gel-infused foam, open-cell design

---

💬 “Are cortisone shots bad in the long run for lower back arthritis?”

✔️ Cortisone injections offer targeted anti-inflammatory relief but can damage joint integrity when overused.

Each injection delivers glucocorticoids, which reduce local swelling and dampen pain signals, especially around facet joints or the sacroiliac region. However, repeated use—especially more than three times per year in the same site—may degrade cartilage, weaken surrounding soft tissue, and accelerate osteoarthritis progression.

While they can break a pain cycle and aid in physical therapy initiation, they must be part of a broader strategy, not a crutch. Steroids do not “heal”—they modulate immune response, buying time for corrective interventions.

📊 Cortisone Injection Risks vs. Benefits

💉 Dose Frequency	⚖️ Outcome	🧠 Use With
1–2 per year	Anti-inflammatory reset	PT, anti-inflammatory diet
3–4 per year	Temporary relief	Reassess structural causes
>4 annually (same joint)	Tissue thinning, cartilage wear	Transition to RFA or biologics
First-time injection	Diagnostic + therapeutic value	Confirms pain generator

---

💬 “What role does sleep play in lumbar arthritis flare-ups?”

✔️ Poor sleep fuels systemic inflammation, impairs tissue recovery, and lowers pain thresholds—creating a vicious feedback loop.

Sleep deprivation elevates interleukin-6 and TNF-alpha, worsening joint inflammation. It also dysregulates cortisol rhythms, reducing the body’s ability to counteract overnight inflammation. In people with spinal arthritis, non-restorative sleep leads to stiffer joints, heightened morning pain, and increased fatigue perception.

Optimizing sleep for arthritis means more than duration—it’s about reducing micro-arousals caused by pain or poor support. Investing in a mattress, ergonomic pillows, and pre-bed routines can significantly improve both pain perception and joint resilience.

📊 Sleep & Inflammation: Pain Cycle Breakdown

💤 Sleep Issue	🔥 Impact	🛠️ Solution
Interrupted sleep	↑ Proinflammatory cytokines	Magnesium glycinate, low-dose melatonin
Shallow stages (N1/N2)	↓ Tissue recovery	Limit screen time, consistent bedtime
Pain-induced awakenings	Poor REM cycling	Warm bath, nighttime heat therapy
Inadequate support	Increased joint load	Medium-firm mattress, side sleeping pillow

---

💬 “What are the best natural supplements for long-term back arthritis management?”

✔️ Several evidence-backed nutraceuticals support joint health, reduce inflammation, and buffer cartilage degeneration without pharmacologic side effects.

Glucosamine sulfate and chondroitin support cartilage matrix repair. Boswellia serrata inhibits 5-LOX, reducing leukotriene-driven inflammation. Curcumin from turmeric modulates NF-κB, a master switch in inflammatory signaling. SAMe (S-adenosylmethionine) helps with pain, mood, and joint stiffness, and omega-3s reduce joint space narrowing through prostaglandin balance.

Form matters: Curcumin needs piperine or liposomal delivery, and fish oil should be in triglyceride form for optimal absorption.

📊 Top Natural Arthritis Allies

🌿 Supplement	🧬 Mechanism	✅ Clinical Target
Glucosamine sulfate	Stimulates cartilage synthesis	Early-moderate OA
Boswellia	5-LOX inhibitor	Inflammatory joint pain
Turmeric (Curcumin)	NF-κB modulator	Chronic low back inflammation
SAMe	Methyl donor + cartilage protector	Pain + mood synergy
Omega-3s (EPA/DHA)	Anti-inflammatory prostaglandins	Structural + systemic benefit

---

💬 “Can pelvic alignment impact lumbar arthritis symptoms?”

✔️ Absolutely. Misaligned pelvis alters lumbar loading, increasing joint strain and muscular compensation.

The pelvis acts as a keystone between the spine and legs. Anterior pelvic tilt, often from tight hip flexors and weak glutes, increases lumbar lordosis, forcing facet joints into compression. Lateral tilt or sacroiliac asymmetry causes uneven weight distribution across spinal segments, accelerating wear on one side.

Addressing this biomechanical distortion through manual therapy, targeted core work, and glute activation restores alignment, reduces asymmetrical loading, and slows degenerative progression.

📊 Pelvic Alignment & Spinal Stress Map

📐 Misalignment	🔩 Lumbar Effect	💪 Correction
Anterior tilt	Increased lordosis, joint jamming	Hip flexor stretch, TVA/core work
Posterior tilt	Flattened curve, disc strain	Glute activation, hamstring lengthening
Lateral shift	Unilateral facet overload	Pelvic stabilization, single-leg drills
Rotational asymmetry	SI joint stress	Manual realignment + oblique retraining

---

💬 “Do EMFs or environmental toxins actually affect spinal arthritis?”

✔️ Emerging evidence links environmental load—especially heavy metals and persistent organic pollutants—to chronic inflammation, including joint-related pathways.

Lead, mercury, BPA, and phthalates can impair mitochondrial function and exacerbate cytokine expression. EMFs (electromagnetic fields) don’t cause arthritis, but in sensitive individuals, may intensify systemic inflammatory signaling, particularly in those with methylation gene variants (e.g., MTHFR).

Environmental detox involves both exposure reduction and biotransformation support—including sulforaphane, NAC, and glutathione. These don’t “cure” arthritis but can reduce the inflammatory burden, helping other therapies work more effectively.

📊 Environmental Impact on Joint Health

⚠️ Toxin	🌡️ Inflammatory Trigger	🧬 Detox Pathway
BPA (plastics)	Endocrine disruption → inflammation	Phase II liver detox (glutathione)
Mercury	Mitochondrial damage	Selenium, alpha-lipoic acid
EMFs	Cellular stress signaling	Grounding, blue-light filters
Airborne pollutants	↑ Oxidative stress	Sulforaphane, cruciferous vegetables

---

💬 “Is there such a thing as arthritis-specific physical therapy?”

✔️ Yes. Arthritis-focused PT differs from general rehab by emphasizing joint protection, pain modulation, and inflammatory cycle interruption—not just mobility.

The program targets low-load, high-frequency movements that respect joint limits while stimulating synovial fluid production. It integrates isometric stabilization, graded exposure, aquatic resistance, and often manual joint mobilizations to improve proprioception.

Therapists also train patients in joint pacing, flare management, and postural recalibration to prevent cumulative wear. Outcome-driven arthritis rehab uses functional metrics, not just ROM benchmarks.

📊 Arthritis-Focused PT Framework

🏋️‍♂️ Method	🎯 Therapeutic Goal	🧠 Frequency
Isometrics (core/glutes)	Joint unloading + stabilization	Daily
Water therapy	Load-free strength and mobility	2–3x/week
Joint glides	Capsule mobility, pain relief	1–2x/week
Nerve flossing (if needed)	Reduce neural tension	Only with radicular signs