One of the most confusing and controversial things to discuss with relation to back pain is the use of stretching and mobility work. When we feel pain or feel a lost range of motion when we move, our instincts tell us we need to stretch and that it is this lack of flexibility that is the cause of the problem. It seems logical right, a joint is stiff so I will loosen it and it will go back to normal. Unfortunately, this is very rarely successful with back pain if this is all you do. Often this stiffness is a reaction to poor movement and a lack of stability and is the only thing holding your body together. This is the body compensating to protect us from more serious damage. This is an example of our instincts betraying us and we must take a wider look at all the factors concerned to find a long lasting solution. Now this doesn't mean mobility work is not useful for it is an invaluable part of the rehabilitation process. However, the secret is with HOW it is used, and WHEN it is used, to get the results you are looking for. In this article, I will explain how I use mobility work correctly if you are a back pain sufferer.
The first thing I would like to say is that there is no template or one size fits all type of stretching program. Completing a general all over stretching program, doing more Yoga classes, or following someone else's stretching program will not help you. In fact, it will more than likely cause you more problems and more pain!
Only muscles that are tight or out of balance should be stretched.
If you do not address this, the tight muscles will inhibit the weaker muscles, resulting in disrupting the entire timing and firing of muscles needed in daily movements like bending over and walking. This disrupted timing will create instability and further weakness, resulting in more pain! You will need to strengthen the weak muscles, as much as you will need to weaken the tight muscles. And this is very important if you want to stop this merry go round from continuing. But the key is to weaken the neural message being sent to the tight overworking muscles FIRST.
This phenomenon is known as muscle inhibition.
In Vladimir Janda’s book “Assessment & Treatment of Muscle Imbalance” he explains great detail muscle inhibition and the difference between tonic and phasic muscles.
- In simple terms tonic system muscles are prone to tightness or shortness and are more concerned with stability, posture, and working for long periods. They are made up mostly of slow twitch fibres and are easily facilitated with constant repetitive movements.
- On the other side is the phasic system muscles who are prone to weakness or inhibition and more concerned with fast and powerful movements. They are predominately fast twitch muscle fibres and require specific movement to keep them functional.
The tonic muscles by way of their design begin to develop a method of overworking and dominating all movements and in essence “shut down” or "steal" the phasic muscles workload completely. This creates an imbalance within the body as muscles not capable to perform various movements continue to work developing trigger points and tightness, while at the same time other muscles are becoming weaker due to lack of work. The longer this stays this way the further the imbalance becomes and reaches a point of chronic pain. Which is why we MUST approach a muscular imbalance by identifying these tight muscles with tests and putting a plan in place to weaken their overworking nature. To strengthen the weak muscles first without weakening the tonic muscles is a waste of time, as the tonic muscles will continue to “steal” the workload within the movement pattern and exacerbate the problem.
It is clear that stretching is needed. But as mentioned at the beginning you cannot just use a one size fits all stretching program. You need to know what to stretch specifically to you, and to do that you need to complete some assessments. To know if you need to do a specific stretch, it should feel hard to do. If it is not hard to do it means don't do it! Remember we only stretch what needs to be stretched. If you stretch too much or something that does not need it, you will create more problems.
You will find a detailed mobility self assessment test you can do by going to this article - How to identify mobility restrictions that affect how you move
The two areas I really focus on are the HIPS and the THORACIC REGION.
Why?
Both of these areas are primarily concerned with providing the body with mobility to move and where they are located in the body, above the lumbar spine (thoracic), and below the lumbar spine (hips), explains how they can cause massive amount of trouble. The lumbar spine wants to remain in neutral and held stable. It does not want to be flexed or extended repeatedly or with loads for this causes serious damage to the discs and nerves. It relies on the hips and thoracic regions to do the movements required.
Without adequate hip mobility your lumbar spine has no choice but to bend and flex during movements that it should remain stable and in neutral.
The videos below give you some great ideas of how to mobilize these two areas.
You will also find tons of additional information and exercise ideas in the two articles below.
Be Careful Of Stretching That Flexes The Spine
Often people like to stretch the area they feel the pain in. While this appears to make sense to try and release what feels tight, what this is actually doing is making the back even more vulnerable to pain.
Constantly loosening the lumbar spine especially with stretches that pull the knees to the chest or round out the lower back aggravate your discs. And if you continue to do this repeatedly you are now a big step closer to developing chronic pain and a herniated disc injury! The stiffness in their back could be due to poor stability in the first place so continuing to weaken your stabilisers will only make you worse.
People tell me they feel good after they stretch. And while the stretch may give you some temporary relief via reducing the pain sensitivity in the nerves, it is setting you up for long term problems.
I remember a client who was suffering with a disc bulge for years and he would love to use Yoga poses and various stretches where he pulled his knees to his chest to try and stretch out his back in the belief this was doing him good. What was actually happening was this stretching routine was the catalyst for his back pain. It took me several months to convince him to stop doing this routine and let his back stiffen up.
Tight hamstrings are also blamed a lot for back pain people tell me they cannot touch their toes because of this. Poor toe touches will have more to do with hip mobility and the hamstrings are actually tightening up to protect you. The difference between hamstring muscles and the sciatic nerve is very important to differentiate. When the knees are locked out this is a nerve stretch and nothing to do with the muscles at all.
When people have trouble touching their toes, they usually blame it on having tight hamstrings, because that’s what they feel when doing the movement. But as we discussed earlier this is usually just a reaction to something else.
Watch the videos below to see a detailed explanation of stretches to avoid and why you cannot blame tight hamstrings for back pain.
How To Stretch?
To improve the flexibility I prefer to use contract relax stretching, but to weaken nerve signals I find long static stretching holding for 1-2 minutes with relaxed breathing is most effective. Some muscles respond better to the time, others need a more aggressive approach. But in ALL cases the timing of when you complete the stretch will make the most difference. Always warm up before stretching, trying to stretch a cold muscle is very risky and can cause more damage.
When To Stretch?
With regards to improving flexibility and the muscle length this is best done late at night right before bed!
This is due to your hormones secreting relaxing hormones to make you sleepy consequently making your muscles more responsive to stretching. Second to that is the fact that while you are asleep you will not do anything to undo your stretch. Your body will now have 8 hours of a new length tension time!
With regards to improving movement and eliminating compensation and movement dysfunction the stretches will need to be done during the workout. Remember at the beginning I told you tight muscles inhibit weak muscles. Well this is where you can change all of that and very quickly teach the weak muscles to fire up and be able to co-ordinate movement better than ever. A very important stage but it only works if you do the stretch first and instantly follow up with the movement you want to improve.
Watch the video below for an example of this.
PNF Stretching:
This is a very aggressive form of flexibility work and is best done during a workout or after a workout. You will need a partner to do this effectively and never do this stretching without warming up first.
To do this, take the muscle being stretched to its maximum length tension, and either using a rubber band or a partner push against the resistance for 5 seconds. Then relax for 5 seconds and gently take the stretch a little deeper. Repeat this process 3-5 times. By far the most effective at weakening tonic muscles and changing length tension of muscles quickly.
Trigger Points Release
Some muscles do not respond well to stretching and use of trigger point release with foam rolling and massage is more effective. Some people respond better to this approach too. You have to experiment to find what works best for your body. I often prefer to use foam rollers before a workout and during a workout and stretches after the workout. Again that is not a hard and fast rule with everyone, just a majority of people that tends to be the way I go.
The foam roller can be very effective at releasing fascia type muscles that do not respond well to stretching such as the Illiotibial band or thoracic spine. The reason I like to mobilize first is that I have found a significant improvement in the stretching of the other muscles once the fascia has been released. There is a mountain of research proving this, read "Anatomy Trains" by Thomas Meyers for more information on the role of fascia.
Below is a good video to watch about how to use foam rollers and trigger point tools.
Nerve Flossing
Those who suffer with sciatica symptoms a different form of stretching is required.
Excessive tension in the nerve is cause of sciatica. If a nerve root is impinged and cannot slide, it will increase in tension. So instead of moving it gets stretched. Further stretching creates more tension which creates more pain. Recently scientists have suggested that nerves have the ability to create their own pathways as long as they can move. This is where the idea of flossing comes from and it works by trying to pull the cord from one end while releasing from the other end and then switch directions and do the opposite.
I first read this in Stuart McGill’s famous book “Low Back Disorders” way back in 2008 and have used this strategy hundreds of times with great success. Some people had no real improvement where as others instantly found relief. I suggest trying it carefully yourself to see if it helps your Sciatic pain.
The video below shows you how this works. The video to the right gives you some additional exercises to relieve chronic pain.
How To Do It
Sitting on the edge of a bench or chair with your feet off the ground so your legs can swing freely.
1. Flex your neck so you are tucking your chin into your chest.
2. Then extend your neck by looking upwards and then behind you while simultaneously extending one of your knees so your feet point out in front of you.
3. This cycle is then reversed and repeated several times to create the flossing affect.
Technique Tips
Adopt a posture that relieves impingement just before trying flossing. For example, if you find relief from lying on your stomach do this just prior to doing the flossing. The motion should be slow and perfectly coordinated. Begin by performing 10 reps on each leg and do this several times per day.
Do You Need More Help?
There is obviously a lot of other things you will need to do for correcting your back pain problem. Before jumping straight into a corrective program make sure you have seen a qualified Health professional for an accurate diagnosis and assessment of your condition. I cannot stress this enough as self-diagnosing can potentially lead to more problems. We often refer out to Doctors, Chiropractors, and Physiotherapists before implementing our program to know exactly what we are dealing with. Being certain on where to start is crucial to the success of the program.
If you have seen a health professional and are now looking at implementing a series of exercises and stretches this article will provide you with many great ideas on how to do this. As many people struggle to implement this into a gradual progression I created a detailed step by step program called Back Pain Secrets that includes a 85 page Ebook and 90 minute video with exercises, stretches, mobilizations and in an easy to follow format. This can be done at home or in the gym and we cover everything about your condition in great detail from eliminating the cause to best strength exercises, even nutrition to speed up the healing process!
Click here or on the image below to get a copy.
Conclusion:
Now that you are familiar with what areas to stretch, how to stretch them and when to stretch, all you need to do now is put this into action. By following this simple step first you now give yourself every chance of completing the next 4 stages well which will involve the stability and strengthening stage. This is where the biggest benefits can be made, but also where the biggest risks and potential disaster awaits if this step is not completed correctly.
For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 200 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.
If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program. International readers can request a Zoom call. You can also subscribe to our FREE fortnightly newsletter by clicking here.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 16 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Movement - By Gray Cook
- Corrective Exercise Solutions - by Evan Osar
- Back Pain Mechanic - by Dr Stuart McGill
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Dr Stuart McGill
- Ultimate Back Fitness & Performance - by Dr Stuart McGill
- Core Stability - by Peak Performance
- Athletic Body in Balance - by Gray Cook
- Anatomy Trains - by Thomas Meyers
- Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek
- Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
- The Vital Glutes - By John Gibbons