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Back Pain: To Stretch or Not to Stretch?

Friday, July 29, 2016 7:36 AM

After 10 years of working as a physical therapist in adult orthopedics, Elsa Gould, DPT, Outpatient Rehab Services at NorthShore, has been known to say that yoga keeps her in business. Are you shocked? Surely being more limber is a good thing, right?


The truth is not that simple – especially if you are experiencing joint or low-back pain. This is because the body has a carefully balanced system of flexibility and stiffness – yes, beneficial stiffness - that is meant to maintain correct joint alignment during any activity you may do during your day. The problem is that real life often gets in the way of this delicate balance. We get jobs that require us to sit all day, making the core weak and the hips stiff. Pregnancy causes ligaments to relax to accommodate the baby and a growing mid-section tips the pelvis forward causing a rise in the stiffness of our hip flexors.

The end result of these situations is the same: joint pain. Our brains often interpret this discomfort as stiffness-related and we decide that stretching is the answer. But stretching an unstable joint, especially in the wrong direction, is only going to make the problem worse. And stretching a muscle that might already be too long will only further upset the balance. In many cases, the solution is stabilization exercise. Stabilization exercise is different than what many people view as traditional strengthening – though make no mistake – stabilization exercises will absolutely make you stronger.

Elsa shares some easy core stabilization exercises that are a starting place for someone with low-back pain:

  1. Lie on your back with your knees bent. Take a breath in through your nose and then blow out slowly through your mouth. At the end of the breath, pause and gently pull your belly button in toward your spine. You should not draw in hard enough that you can’t breathe and you should not cause any movement whatsoever in your back or pelvis. It’s a very slight movement, akin to the feeling you may get when trying to zip up a pair of pants that are too tight. Practice holding that gentle contraction for 10 seconds while breathing, and then relax.
  2. Lie on your back with your knees bent, fingertips on the bones at the front of your pelvis on each side. Start by drawing in the belly button toward the spine as in the first exercise. Then, slowly lift one knee in a marching motion. If you’re doing this correctly, you should not feel any movement in the pelvis under your fingertips. Alternate sides until you’ve done 10 each side.
  3. Still lying on your back with your knees bent and your fingertips monitoring for pelvic movement, slowly tip one knee out to the side. Only go as far as you can before you feel movement at the pelvis, then return to center. Alternate sides for 10 each side.

These exercises are not the same as sit-ups, but they are more important and they have a bigger effect on pain because of the fact that they target the corset of muscles that surround and protect your spine. And they’re functional, meaning they mimic the way the body should function: a stable mid-section and mobile extremities.

Your physical therapist is the best person to formally evaluate what form of stabilization exercise may benefit you the most and take you through the appropriate progression over time. A physical therapist carefully assesses your alignment, strength and flexibility, and the internal mobility of your joints. From there your physical therapist can tailor an exercise program to target your areas of weakness and restore the necessary balance between stiffness and flexibility.

Elsa wants you to remember that the next time your back goes out, run to your physical therapist before you run to your yoga class!