Whenever I see a new client with a history of low back pain I ask specific questions about their stretching, exercise and self care routine. Many folks have symptoms/injuries spanning several years, they also have 
worked with numerous practitioners who prescribe exercises. In fact I will have them demonstrate for me exactly what they do. I often find that the exercises or stretches are actually contributing to the back pain.
The science of back pain treatment, injury rehab and strengthening has changed a lot over the past ten years. Low back stretching, like the knee to chest stretch (pictured left), used to be a staple of low back pain management. It is also part of most general fitness stretching programs. Current research highlights the role of muscle activation and spinal stabilization over stretching as a means of reducing spinal pain. I’ve treated several patients that over – stretch their low back as part of their Yoga/Pilates/fitness training practice.
Pain is a neurological signal that will shut down muscle function (inhibition) this leads to muscle atrophy and weakness. Muscle control is the first line of defense against joint injury. If someone stretches a lot on top of decreased muscle function deeper tissues like ligaments and discs will become compromised. It’s a domino effect.
Here is a picture of a client’s low back who has a long history of low back pain. They also practiced yoga and regularly stretched their low back. In this picture you can clearly see the vertebrae sticking out and the lack of muscle mass. The usual lumbar curve (lordosis) is absent as well. In a healthy/non injured lumbar spine the vertebrae in the low back are usually not visible because of the spinal curve and the mass of muscle tissue on each side of the spine.
Stretching of the spine needs to be carefully considered for those who have a history of back pain and injury. Everyone has a unique collection of genetic/anatomical considerations including health status and injury history. Added to this are athletic and functional considerations that all play a role in spinal health and care.
