Stretches for Lower Back Pain

Listen To The Episode Below

Welcome to the Back Pain Solutions Podcast – Stretches for Lower Back Pain

If you like the show, we would be grateful if you would consider leaving the show a review on iTunes as well as Stitcher Radio. A couple minutes of your time can help the show immensely! Thank YOU!

Introducing Stretches for Lower Back Pain

Many patients are advised to do stretches for their lower back pain, including yoga based exercise and pilates. There is a lot of confusion from patients regarding the stretches that should be considered to support the management of lower back pain but should stretches be considered at all and can they even have a negative impact on back health?.

In this episode we discuss the research regarding stretches for lower back pain and why flexibility exercises are so often advised. We discuss some of the exercises we simply should be avoiding if we want to avoid aggravating a back problem whilst discussing the importance of introducing flexibility exercises for the hip. Whilst flexibility exercises may be beneficial for certain areas of the body they’re not necessarily helpful for the lower back.

Show Highlights Stretches for Lower Back Pain

We discuss why a focus on hip flexibility may be more beneficial than stretching the lower back but why patients often feel stretching the lower back feels comfortable. We break down some of the stretches that you must avoid if you’re to successfully resolve your lower back pain.

Interview Transcription for Stretches for Lower Back Pain

Ben James 0:00

When we’re young, we move with freedom and confidence with a great resilience to injury. Somewhere along the line we develop poor habits and become more vulnerable to back pain. Smart, strong features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.

Welcome back to the back solutions podcast with me Ben James, my co host as always, Jacob stain mon Jacob many. So today we’re talking stretches for low back pain. Good idea or bad idea, Jacob. What are your thoughts? We always been asked by patients about stretches. We’re always seeing advice for stretches of the lower back. Why are we seeing that when the evidence suggests particularly for low back pain? That is discogenic in nature. It’s a bad idea.

Jacob Steyn 1:01

I think the biggest reason is because it doesn’t address the actual cause of the problem. And so the actual tightness that we’re trying to stretch just keeps coming back.

Ben James 1:11

And what why do you think that people are getting recommended? stretches? Because it seems to me that people are saying, Well, yeah, the back feels stiff. And so is stretch, a stretch will do that makes sense. And yet the evidence doesn’t suggest it. So again, are we saying lack of knowledge for therapists, or it’s just a lip service for a patient that if I give them an exercise, then to stretch the back, then they’re going to feel better doing it and therefore, they’ll be alright.

Jacob Steyn 1:44

I think both of those reasons, probably, I think, you know, because of the obvious nature of wanting to lengthen or loosen something that’s tight. People think that if you stretch something or Sometimes mobilize something in length that it’s going to resolve the problem or it’s going to, it’s going to help the problem.

Ben James 2:07

So do you recommend any stretches at all for patients in the low back because not all stretches not all. stretches and flexibility exercises, yoga exercises are going to be all bad for all patients. As always, it’s it’s picking the right exercise for the right patients. But generally our recommendation will be avoid stretching through the low back. And when we, when we talk stretches some of the common stretches that we see patients do time and time again are the classic line on your back and pulling your knees to your chest or lying on your back and bending your knees to 90 degrees and turning them over to the right side and to the left side. A lot of twists in through the back there two of the classic stretching exercises that I often See, and patients will often say, Oh, yeah, it definitely feels better.

Jacob Steyn 3:06

Yes, yes, I, I don’t I don’t prescribe any stretches personally, in fact, especially when we’re talking about people who has an injury in the low back. So I stick to a, I have an approach where we avoid stretching. In fact, it’s, you know, I prefer we get on the go slowly in the morning, you know, taking our time warming up the tissues over a 45 minute period. And if you want you can even do relaxation exercises, but, you know, stay away from stretching because quite often if it is discogenic of nature, in other words, that this being irritated stretch is only going to worsen that. Yeah, sure.

Ben James 3:48

And I mean, the relief that everyone or a lot of people will feel is the is that stretch reflex in the erector spine, he said, they’ll get a stretch reflex that feels good after that stretch. do that exercise, but actually, it’s having a negative impact on the underlying problem. In this case, as you mentioned, particularly with disc injury and disc pain, and so it’s just kind of a vicious cycle that you’re going to get into where it feels better shortly. And then, actually, in the long term, it’s having a negative effect. And I think, even if that problem isn’t disco genic, even if it’s for set joints that are posterior, and you might want to gap and open those joints a little bit, you know, a stretch in itself isn’t offering a huge benefit, in my opinion, to justify that movement, particularly when you consider the negative impact it can have on other structures. Do you agree?

Jacob Steyn 4:45

Yeah, I totally agree with that. I think first of all, we have to understand the root cause of the nature of the problem. And if we do, then, we understand that stretching is not going to bring us anywhere. And I often explain to patients that if you have a swollen injured knee, would you be stretching that? good analogy? Yes. And no, of course not. You know, I mean, why would you stretch an injured inflamed knee when you have an injury there, and the same thing goes for the for the back. I mean, we have to understand that the muscles contract and react to what’s going on at the joints at the spine. So now we’re stretching the structure. We’re quite often stretching the spine, but we need to allow the spine to rest and recover and heal. And then we build up tolerance.

Ben James 5:40

Yes. And and the other thing is, and we’ve talked about this a lot, keeping that spine in neutral. And actually, as soon as you try and stretch through the low back, then you’ll you’re losing that neutral spine. And you know, that’s something that we can’t avoid. And so you are risking the underlying structures and you’re putting stressors on the Underlying structures that we want to avoid. And so the recommendation certainly from my end and same for you, Jacob is for those patients listening that are doing some stretches have been have advised some stretches stop, because they’re not really offering you any benefit whatsoever. There are some stretches and flexibility exercises that I think are important for the low back, but not specific to the lower back. So when we’re talking stretching, really, we’re talking range of motion around the hips more than we are through the low back because movement through the hips is far more potent, and this is something that everybody should be considering that big, powerful, stable joint, not moving through the low back. So keeping that back brace and not stretching would be a great first step for a lot of people to better manage their back pain and give themselves healthiest start to rehabilitation, I think it’s fair to say?

Jacob Steyn 7:05

Yeah, I totally agree there. It’s, it’s often a situation of deconditioning of not not using the hips properly. Instead, we want to move through the spine. And so if we can get someone to do to, to communicate to the right muscles and stabilize the spine and give more work to the hips, then we’re limiting the stresses and maybe the rotation that’s caused if there’s already an injury at structures in the spine.

Ben James 7:32

Yeah, and it’s that classic, I guess, reaction of will the pains there in the low back, or the stiffness, I feel in the low back, and therefore it makes sense to stretch. Whereas actually, what we’re saying is over the longer term, by doing something that might seem a little bit counter active as in keeping that bike straight and not stretching those tissues is going to have a Much better outcome. So it’s it’s being patient and again back to the education and understanding that those movements can have a negative impact and be patient that by doing different exercises that might seem counterproductive, for example, a bird dog where we’re extending that back leg and in some cases the arm and we’ll, we’re making those muscles in the low back and more so the focus on the glutes but we are making those muscles with low back work a little bit. That seems counterproductive because that’s, that’s potentially in people’s minds contributing to stiffness because I’m making those muscles already feel stiff work, work a little bit, but actually, it’s the underlying neutrality of the spine. That is the important point here as well as obviously the the endurance of the muscles that we’ve talked about before in stabilizing that spine.

Jacob Steyn 8:58

Just to add to that, The nervous system wants to feel the stability. And then it allows you them ability. And that’s what we do with a bird dog, the bird dog, if we do it correctly, gives the brain a feeling of stability in the spine in the joints. And so from there, the brain will then when you move after that give you the good feeling and a feeling that, you know, some people you’re already immediately have a feeling of, Okay, I can I can actually have a bigger range of motion in my spine. Not that I want to look it up, but that I have it because I feel stable. I feel strong. And yeah, so I totally agree there.

Ben James 9:39

Yeah, so I think take home message of this podcast, first of all, is stop stretching through your low back. So if you do any exercises that involve pulling those knees to the chest, or dropping those knees to the sideline on your back those classic low back structures that we see people do time and time again. Thank you. Stop, because even if it’s not a disc problem directly, it’s having a negative impact on the disc. And it’s not in our opinion and according to the research really affording you any great benefit. If if it is another structure in the low back that that is causing your pain or discomfort, so keep that back in neutral avoid those stretches through the low back. Now, in terms of stretching, there are some muscles that we want to take a consideration for that can become tight and can contribute to low back pain. And the classic muscle that we’ve we introduced in an earlier episode is the is the psoas. The psoas often gets tight that classic what we call lower cross syndrome where we’re sitting a lot more in our lives now than than ever before. A lot of office work desk work and that is making our anterior chain tighter and up stereo chain become weaker, so are our glutes and powerful muscles that were important stable stabilization muscles if you like, are becoming weaker and then muscles anteriorly such as the psoas that crosses the hip are becoming tighter now that definitely can contribute or exacerbate a low back problem. So, we would recommend trying to look at releasing that muscle Jacob.

Jacob Steyn 11:26

Yeah, my, I think the best approach to release or to get length in the service is not specifically to stretch it. But to actually work with strengthening the glutes at the back. So as we do a Glute Bridge, for example, we open up the front of the hips by using the muscles in the back. Again, the brain gets the feeling. If you do this continuously, or you know, over a certain period of time, that you’re getting stronger in your posterior chain you’re getting stronger in the glutes and hamstrings. And so it allows, again, the psoas to relax, and to open up in the front.

Ben James 12:06

Okay. I mean, that’s a great, that’s a great bit of insight there. Because, again, you know what I’ve said there in terms of releasing the sauce and stretching the so ice is that classic? Well, there’s the tightness. Let’s try and stretch release that, that muscle, which, which we can do, and there’s some simple things that that you can do to do that quite easily without really forcing that stretch. But actually, what you’re saying again, is if we get the balance, right, and we focus on, strengthen endurance of the glutes and adopt some exercising activities that strengthen that muscle, then the outcome of that is that the psoas muscle will be less tight anyway.

Jacob Steyn 12:49

Yeah, yeah. Exactly. And that’s, but if you do this, you’d have a great benefit in not only if you think about opening up the hip, when you You stand but it affects all your movement and especially affects your way of walking. Yes, you see a lot of people walking with very tight hips, especially in the front and you know, they can’t extend through the hips or you see a strange gait. Instead, instead of a hips more or less still, you see now that the hips are being sweet swung from side to side, people can’t extend properly through the hips. And so this can lead to low back pain problems. And just not not enjoying walking, because it’s more laboring than an actual fluid walking technique.

Ben James 13:38

Yeah, I was going to come on to that, actually, that we’ve recommended before the walk in is very, very therapeutic for low back pain sufferers, but we’ve got to be conscious of the fact that a lot of people in discomfort will, will walk in a lazy way for one of a better description and that’s not to say I want to be disrespectful to those patients, but there’s obviously a fear avoidance and a fear that they’re doing some damage but actually to, to be therapeutic, we’ve got to put some kind of pace into that walk. And actually, if we’re, if we’re really focused on walking and we’re focused on contracting those glutes, those big muscles in the buttock as we extend the legs, then naturally that’s going to open those hips a little bit more and give us that additional benefit of starting to stretch out that, that anterior chain that psoas muscle and be, you know, far more therapeutic and beneficial than like you say, those kind of walking gates that are that seemed just so labored and restricted.

Jacob Steyn 14:47

You know, exactly, exactly. I just wanted to mention also about the pulling up the knees when you lie on your back or dropping your knees to the side. This is quite often done in the morning. Yes. And as we wake up, we feel stiff. And then we want to stretch out the low back. And we think we’re doing good by doing these stretches. But this is actually the worst part of the day to do anything like this, especially putting pressure through the low back when you pull the knees to your chest, because of the hydration of the discs. Yes. So again, just coming back to that point that that we recommend you don’t do that. And especially not in the morning.

Ben James 15:32

No. Like you say those discs over the night, you know, with the with that process of osmosis, they draw fluid into the disk, they become super hydrated, and that often. Because of that it puts puts that feeling of stiffness into the low back for for people in a morning. And like you say, then their classic reaction to that is to is to stretch the low back. But actually you’d be far better. Keeping that back in neutral, not sitting for those first 30 minutes. Today, trying to do a 1015 minute walk before you get in the car or before you start your day’s work, do not do those stretches and just see how that feels for a five day period just by making those subtle changes. And the evidence and experience suggests that you’re going to feel far, far better by doing that. So I think that’s a really valuable point for people to take away is do not do stretches, particularly in the morning. There are far far better things that you can be doing. And if you understand if you understand the impact of some of those exercises, and we know that they are recommended by different practitioners, doctors that you know, I was just reading an article the other day, online that was very, very good It seemed in terms of the content, but then at At the end, it did talk about stretching to the low back. And I just, again, it, there’s a lot of information out there that is confusing. But the evidence, very much focused on the biomechanics of the spine suggests that stretching is, is isn’t a bad thing to do. And therefore we would recommend, stop it completely. And like we say, for the next five days, just avoid, but do those other things that we’ve talked about the walking, the front lying, relaxation, to allow that back to relax and just see how that how that feels on what a difference that makes. And I think this is something Jacob that we we would both recommend patients do as part of that spiral routine that hygiene every day. In the first kind of period of that rehabilitation, some some simple steps that people can do that they can take action on that are going to make a difference. To that, to that recovery.

Jacob Steyn 18:03

Totally agree.

Ben James 18:06

Awesome. Okay, so, guys, a pretty short episode on this occasion, but very much focused on that that flexibility issue because we feel it’s an important one. It’s a common theme we’re seeing. Patients generally consistently talk about stretching exercises, either they found online, they’ve decided that it just felt right to do or they’ve been advised to do. And it is it is a no. So avoid those stretches through the low back. Focus on those exercises that that we would recommend and as always, go over to the website to look at those exercises that are going to support your recovery because avoiding those flexibility exercises but focusing on those exercises that are going to contribute to building your core strength will have the kind of stuff secondary effect of allowing those that tightness feeling and the tightness in some of those of the muscles like the psoas to, to, to change and to relax and that ultimately will contribute improvement and recovery. So, Jacob, thanks for your input, as always, and guys, everybody listening, please do go over to iTunes, leave us a rating leave us a review, it really does help to raise the profile of the podcast, and hopefully, help other people like yourselves start to make that transition out of pain, to recovery and get back to those activities you love. So as always, Jacob thank you very much next time. Guys, we’ll be talking more about some of the things some of the exercises that you can be doing to improve your back health. We’ll focus on some specific exercises moving forward over the next couple of episodes that are really going to be better Official just break them down a little bit more. So we can help you to help yourselves to a better back. Jacob. Thank you

Share This Episode

Share on facebook
Facebook
Share on google
Google+
Share on twitter
Twitter
Share on linkedin
LinkedIn
Share on pinterest
Pinterest
Share on whatsapp
WhatsApp

WHAT ARE YOU WAITING FOR?

Start Your Journey to a Better Back Today