There is WAY too much advice out there for people with back pain. I honestly wince sometimes when I see various fitness and therapy influencers on social media offering the “Have back pain? Try this simple stretch!” posts to impressionable people who are hurting and looking for solutions.
So – I get it. It’s understandable to feel confused and overwhelmed by the amount of back pain advice you find on the internet. It is perfectly natural to think that some of these attractive and well-credentialed individuals may have the perfect solution to the aching pain in your back. But my suggestion is to take all of these in with a healthy dose of skepticism.
Firstly, while many people do have similar problems, there is a wide array of issues that can be causing an individual’s low back pain. And knowing what is causing one (or more!) of them is crucial in determining how to treat this person. As much as we’d like this process to be straightforward, there simply isn’t a one-size-fits-all regimen that will resolve everyone’s pain. So there probably isn’t “one simple stretch” that’s going to “fix” everyone when it comes to their backs.
With that said, there are a few things that most people could stand to STOP doing – even if these activities aren’t bothering you now, they have the power to eventually cause you pain, and in my opinion, should be eliminated as part of a regular routine. In particular, I recommend that those with problematic disc issues and lumbar instability (which are often closely related) stay away from these stretches. Those with lumbar stenosis and arthritic conditions are likely to tolerate these better, though I will usually prescribe other activities when treating those types of patients.
- The “Knees to Chest” stretch
This is a popular go-to for some people, and can even provide some temporary relief. One of the problems with this stretch is that it will target the stretch reflex in the muscles of the lower back, and may temporarily feel good – BUT it will also be stretching other tissues like your vertebral discs and nearby nerves, and can keep a painful back in a sensitive condition. Both double-knee and single-knee to chest variations are pictured.
- The “Lumbar Rotation” stretch
This is another popular stretch, and the rationale for avoiding using this repetitively is the same as for the knees-to-chest stretch. You are likely sensitizing tissues other than muscles to stay painful, or eventually to become painful. This advice also applies to both single and double leg variations.
- The “Toe Touch” stretch
Everyone has seen and done this stretch, and some people enjoy showing off their ability to touch the floor, or even press their palms firmly into the floor to demonstrate their flexibility. Again, the rationale to avoid training the previous two stretches applies here: stop sensitizing your discs!. Unless you have a specific need to do this motion – and I can’t say I’ve heard too many good reasons for it – if your back hurts, I would advise against this stretch as part of a routine.
Please note that done gently, or occasionally, these may be fine for many people. Usually it is the case that doing a repetitive regimen of these on a regular basis, or pushing too deep into the stretch, that will get people into trouble. My goal here is to advise people that routinely doing these over and over again may be unknowingly keeping your back in a painful state, and that there are better alternatives to get your spine moving in a healthy and less provocative way.
It is probably also worth noting that most exercises, especially in therapy, should have a goal in mind. Getting a part of your body to be more flexible, or stronger, should ultimately have a functional purpose. These purposes can be as different as increasing endurance while working a physical job, tolerating sitting or standing longer, lifting heavier weights, getting faster or more explosive while running, or the ability to go up and down stairs easily – you get my point. Goals will be significantly varied and individualized for different people who are at different levels of ability and fitness.
There’s a general perception amongst the public that more flexibility is good for everyone, and it simply isn’t true. Some people, and more specifically, some parts of some people, may very well need more flexibility to prevent or recover from injury, or to function more optimally. But for some, more flexibility can actually increase the risk of injury. An unstable joint or body segment (this can be a shoulder, a hip, a spinal segment, etc.) will not respond well to more flexibility – in this case more stability is needed. This can be a much longer discussion, but I think it is helpful to appreciate that stability and flexibility (or more accurately, mobility) are better seen as a continuum with those attributes generally at opposing ends.
What should I do instead, you ask? The best and safest way to get your spine moving that I know is one you may know as a “Cat / Camel” – some refer to it as the “Cat / Cow”.
What is nice about this motion is that your spine is fully supported at four points: both knees, and both hands. My advice here is to slowly move the spine through a range of motion. Extremes of motion are not necessary; your goal is just to introduce some unloaded motion to your back.
There are two variations that I like:
- Cat / Camel – flexion / extension
Gently arch your back, all the way from your hips through your neck and look straight ahead or slightly upwards. Then, slowly bend your head down and look towards your stomach. Draw in your ribs upwards and push your upper back up towards the ceiling. Take 3-4 seconds to complete each cycle, avoiding trying to push an end range of stretch – this should be seen as a gentle way to loosen up after sitting or waking up, or a warm-up for other activities.
- Cat / Camel – sidebending
Instead of flexing and extending forward and back, you are now going to gently bend side-to-side. From the same neutral starting position, lead with the head and bend to the left, letting the rest of your back come along for the ride. Then bend to the right. The same principles from the regular cat / camel apply – take a few seconds to complete each cycle, avoid extremes of motion, and use these as a gentle activity to loosen up.
The cat / camel is an unloaded way to introduce some motion to your back without putting much force through the individual joints, and is a perfect way to warm up after waking or after a long period of inactivity (a long drive or work shift, for example). It is literally the first part of my everyday morning routine, other than grabbing a cup of coffee, of course.
I hope this is helpful for some of you feeling confused by the amount of advice you see plastered all over the internet. Please feel free to email or call if you have specific follow up questions.
Dr. Roland Alley, PT, DPT
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At Gunks PT, we can provide you with a comprehensive plan of care to address your specific type of back pain issues. Call us today at 845-579-5007 to schedule an appointment with us. You can also set up a free discovery visit via phone or zoom so we can discuss your options and goals: