The back and neck together are built like a spring system. The neck and lower back have similar curves. The upper back or thoracic spine curves in the opposite direction of the neck and low back. Together, these curves distribute force every time a person takes a step to protect the individual units of the back and the amount of force going into one’s head. Stiffness can throw this entire system off course.
If any section of the back becomes stiff, then it starts to cheat on the job; it creates a system in which the sections of the back that are more flexible/mobile take more load. These overloaded segments of the back will eventually give out just like a person in a work environment who is not permitted to take sufficient breaks will burn out.
Stretching is often the first line of defense against nonspecific low back pain. If the origin of the pain is stiffness, then, most likely, the patient’s low back curve has become stiff and inflexible. This means the curve does not reverse. Every curve in the back works like a spring; this means it must be able to reverse position. For example, the low back while walking looks like a capital “C” curve. Then, when a person bends forward, the low back should look like a capital C backwards or a smooth hump, like a little hill. These people often have pain with walking because the back is pulled even more into an extreme C position with the buttocks in a pushed out position secondary to core weakness.
In some cases, a patient will present with the reverse (these specific stretches are not addressed in this particular article). This means the back is stuck in a backwards C position with difficulties resuming the natural C position. These patients have more difficulty sitting for prolonged periods of time. All back pain becomes more complicated if associated with leg pain and is beyond the scope of this particular article.
In terms of stretches, the most common stiffness deficit of the back is when a person walks with the exaggerated C curve and has difficulties reversing this C curve when bending forward. Instead of reversing when bending forward, the curve stays the same. If a person is able to tolerate a quadruped/crawl position, then it is most recommended to perform repeated and pain free arching of the back while bringing the chin towards the chest multiple times per day (see Angry cat stretch below).
If a person has painful knees and is unable to assume a quadruped/crawl position, then the best stretch for this person would be in sitting and pulling the back into an arched back cat position. Holding the knees while pulling the back into an arched position and bringing the chin to the chest provides a stable position from which to stretch one’s back (see alternative below).
Alternative:
When this particular movement, quadruped cat position/Angry Cat, becomes more tolerable and smooth, then progress towards a Child’s Pose position (see below). With the feet in a pointed position, sit back on the heels from the quadruped position. The single most important step with this position is to hold one’s head. If the 8-10 pound head is hanging in the hair, the back turns on/has to engage in order to sustain it there, and this will prevent a stretch. Sit back on the heels and hold the head with the hands or on a block/books/pillows. Hold this position prior to getting out of bed and nightly 1-3 minutes (set a timer).
Child’s pose is a sustained hold or low load prolonged stretch and, in this Physical Therapist’s opinion, is the most effective method for self mobilizing one’s own low back to be able to reverse appropriately with activity.
Again, if there is any knee pathology, a person could attempt this position with a pillow between the knees in order to improve tolerance. If this position still causes pain in the knees, do not do it. An alternative (see below) would be rolling a ball out while sitting in a chair or sliding a pillow case along the kitchen table while sitting in a chair to maximize the space between one’s head and one’s tail.
Alternative:
In summary, the spine works like a spring system to distribute load and requires that every curve in the back is able to reverse position. Most often stretching for nonspecific low back pain requires reversing the natural low back curve for extended periods of time into a rounded or cat-like position. If low back pain persists, then, most likely, there is a strength deficit involved, as well. Assessing and providing appropriate treatment regarding stretching and strengthening is what Physical Therapy is all about.
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I believe in the warmth of coffee and tea and community. This is a place where we are integrating yoga and physical therapy to meet RVA's needs to heal from an injury then work to prevent reinjury, together.
~Leah Johnson, PT, DPT, OCS, Cert. DN
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