Back pain is a very complicated topic, but for purposes of this post, let's break down just a few potential back pain possibilities. Extension Intolerant Low Back Pain - this means it hurts for you to extend the lumbar spine mostly. Sitting will feel better in this instance.
- Two tissues we look at stretching in this case (There is more than just these two) will be the Hip Flexors and Thoracic Spine. The hip flexors are important because of the Psoas attachment to the lumbar spine. Due to how it attaches, when it's spastic due to casting a painful spine, it will compress the posterior joints in the back making things more sensitive. The thoracic spine is important because when it's stiff, it will cause the low back to compensate by increasing it's range in extension especially when doing anything overhead.
- A common mistake with stretching the hip flexor as part of the rehab process is shifting the center of gravity to far forward. Starting with the center of gravity over the knee on the floor, simply posterior tilt the pelvis to start and this will decrease the need to shift forward to the point where the lumbar spine is being compressed in extension.
- A common mistake when stretching the thoracic spine is not controlling where the motion is coming from. Often times the stretch is done with the whole spine in extension. However, if you sit into your heels and clasp the hands behind the neck, you can sink into and an out of the stretch without the low back and neck moving into excessive extension.
Flexion Intolerant Low Back Pain - This means it hurts for you to bend forward. Standing will typically be better.
- Two tissues we often look at stretching in this case (there may be many more than just these two) are the hamstrings and posterior hip muscles which include the piriformis.
- A common mistake with hamstring stretching is doing so with excessive low back flexion as well. Bending over to "stretch the hamstrings" will actually put the back in all out flexion first and reinforce an unwanted movement pattern which is "move from the back, not from the hips". Instead, try performing a stretch with a bent knee (which will prevent sciatic tension) and an erect posture while using a hinge pattern as the movement instead of flexing forward.
- For the posterior hip, I often see people try to stretch in a pigeon pose as they try to lean over the hip. This pose again will create lots of low back flexion. Try instead to sit more in a "shin box" position and lean towards the wall in front of you instead of leaning down towards the leg.
Don't take these cues an absolute. No doubt, the spine should have the ability and capacity to move through a wide range of motion without being irritated. However, when digging yourself out of a hole, you need to be a bit more precise and calculated with which tissues are being stretched. These tips will allow you to be more targeted with your approach until the pain subsides. At which point, you can begin to add in a variety of movements and loads as you begin to work on your conditioning of the low back.
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