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Spine Range of Motion: The Problem

What do you think of you when you hear these “instructions”: “Pull your knees to your chest” and “Bend over and touch your toes”?  These are the two most common low back stretches prescribed by clinicians today for patients with low back pain. Why? Is it because you need more range of motion in your spine? Is it the loss of spine range of motion causing your low back pain? Probably not. So why do it? It feels good doesn’t it? Well, if the doctor told me to do it and if it feels good, it must be good for me. Then I ask you this question, why does your back pain return?

I can’t tell you how many patients I’ve seen who have been instructed by someone (doctor, chiropractor, friend, internet) to pull their knees to their chest to stretch their back. By performing these stretches you may benefit from some short term relief, but you may actually be doing more harm than good. First off, with any flexibility exercise, at some point you should notice a change. Meaning, at some point, you don’t need to do that stretch anymore. You’ve accomplished what ever goal you set out to achieve, i.e., increased range of motion to a satisfactory range. Then why do ‘Lower Back Pain’ patients constantly have to stretch their spines? I’m constantly amazed at the number of chronic low back pain patients who have been instructed to pull their knees to their chest several times a day for years! YEARS! At what point do you stop banging your head against a wall and at what point do you change your treatment strategy? Generally, for patients with low back pain, spine flexibility or spine range of motion, or whatever you want to call it, is not the problem and should not be emphasized. Biering-Sorensen and Battie et al. have demonstrated that spinal flexibility has little predictive value for low back troubles. Whereas, Hides et al. and Saal clearly reveal that the most successful low back rehabilitation programs emphasize stabilization through exercise with the spine in a neutral position.

The short term relief one feels when doing a double knee to chest or single knee to chest exercise is a stretch receptor relaxation response called the autogenic inhibition reflex.

What is that? It’s a sudden relaxation of muscle when placed under high tension so the muscle doesn’t tear. Essentially what’s happening is the muscle is being told to shut down.

Negative Impact:

1. We want our spine muscles working to protect our spine. Doesn’t that make sense for someone with low back pain?
2. We dampen the nervous system with this inhibitory reflex. We want to facilitate our neuromuscular system, not impede it.
3. Intervertebral discs herniate and posterior spinal ligaments strain at end range spinal flexion. Guess what bending over and touching your toes does: takes your spine to the end range of spinal flexion. The fact is this, acute low back pain patients WILL become chronic back pain suffers with these stretches. Don’t become a low back pain lifer!

Spine Range of Motion: The Solution

In Part 1, we discussed the negative impact full flexion range of motion has on the spine and the rehabilitation process. So what can you do if my back feels tight or stiff? The arch and sag motion while on all fours is a great exercise to spare the spine of damaging end range consequences as well as providing the spine with vital nutrients and reducing spine viscosity (stiffness). The objective is to enhance active flexibility with controlled motion. Note that this motion exercise is just that, a motion exercise, not a stretch. The emphasis is on motion (flexion/extension) rather than pushing to end range. Certain individuals can add side bending to the range of motion repertoire. Stop the motion before pain is felt. According to McGill, six to ten cycles is sufficient enough to reduce viscosity. More cycles do not reduce the viscous friction any further.

Quadruped Arch and Sag

Quadruped Sidebending

When should I perform my spine sparing range of motion exercise?

Individuals with low back pain should NOT perform range of motion exercises immediately after rising from bed. During bed rest intervertebral discs absorb water causing them to plump up. (Yes, it’s true. You are taller in the morning than you are in the evening). With this expansion of the discs, spine bending is more restricted placing stress on discs and ligaments. The good news is that discs lose 90% of their water content within the first hour upon rising from bed. Feel stiff in the morning? Now you know why. Snook et al. demonstrated that low back pain sufferers noticed a reduction in symptoms by simply removing spine flexion exercises from their morning routines. So, the best time to perform active range of motion exercises is about an hour AFTER rising from bed.

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