If your friend ever asks, “I hurt my back! What’s a good stretch I should perform?” Your immediate response should be, “Don’t you dare stretch your injured back!”
Here’s Why You Should Never Stretch an Injured Back
Spinal stiffness (passive resistance to stretching) and spinal stability (ability to resist unwanted movement) are the keys to a healthier back, not spinal flexibility (capability to be bent). The stiffer a spine, the more load it can carry without buckling under heavy force. Spinal stability acts as a protective measure from vulnerable and deteriorating spinal components. Imagine a bunch of avocados stacked on top of one another; they would collapse without a toothpick connecting each one together for stability. Similarly, the spine has bony protrusions and facets coming off the vertebrae that attach to the muscles. If the muscles are too flexible they become lax and are more likely to crumble from shear forces.
Studies have shown a correlation between increased spinal flexibility and future back problems. For example, imagine the spine as a paper clip; the more it bends back and forth, the weaker it becomes until it breaks or a disc herniates. Every individual has a different amount of cycles (bends) until an injury occurs. Mobility (the ability to produce desired movement) within joints is still relevant, however, too much mobility in the spine leaves room for instability which can lead to decreased performance in many sports.
Beyond athletes, occupational workers have little relationship between increased spinal ranges of motion leading to a successful return to their job. After a back injury, emphasis must primarily be placed upon stabilizing the spine rather than the wide misconception and popular obsession on increasing flexibility. At first, participating in yoga or Pilates may be counterproductive and can cause more pain for the spine. The constant bending will pull apart the healing tissues. By eliminating lower back stretches, the nerves causing pain are given time to desensitize and can eventually regain pain-free range of motion.
But, you might be saying “Hold on for a second, my back feels better when I stretch it.” Initially, this may be correct due to the stretch reflex caused by certain stretches. This reflex will supply 15-20 minutes of pain relief making it feel as though it helped until the pain returns once again and possibly becomes worse from the aggravation of the stretch. This is especially true for rotational and forward flexion stretches that place overloaded exacerbation on spinal fibers. Excessive stretching of the lower back will eventually dissipate the stretch reflex, whose purpose serves to protect the spine, therefore setting it up for future disaster. The focus of stretching should be shifted over to improving spinal stability through maintaining proper spinal hygiene such as good posture and hinging at the hips to pick things up.
Should You Stop Stretching All Together?
No! Flexibility is still very important, but it is specific, joint to joint. The best performing weightlifters have more flexibility in the shoulders, hips and ankles, not their backs. However, elbows, feet and knees are joints where stability takes precedence over flexibility. Although these assumptions generally hold true, one cannot generalize for the bulk of the population for stability and flexibility work on a continuum. An individual may have an excess of mobility in the hip and may need to work on stability or vice versa. Independently, try to work on stabilizing the joints that need stabilization and mobilizing the joints that need more range of motion, but don’t treat all joints the same. Some studies have revealed the most successful athletes have relatively tight hamstrings. The tightness acts like a spring, which is why a lot of basketball players can jump so high. It is also worth noting that there is no link between hamstring tightness and back pain, although asymmetrical flexibility between each leg can be associated with back pain. Immobility from back pain is usually a result of inhibited and tight glutes and psoas (hip flexors), not the hamstrings.
Once spinal stability is reinstituted, certain spinal flexibility movements can be reintroduced into your rehabilitation or training program. Static joint flexibility does not correlate to dynamic performance. So we must approach flexibility training for the joints and muscles that need mobilizing in an intellectual way. This includes active flexibility: training the joints under a load while progressing through a range of motion, similar to the situations endured in your sport of choice. Knowing that your muscular system should be used as springs, you should never stretch your muscles beyond the range of motion demanded for the event. On the other side of the spectrum, athletes with inadequate range of motion, will also be inhibiting their athletic performance and can benefit from an increase in flexibility training.
Even before spinal stability can be achieved, you must primarily regain correct movement patterns. After all, you can do all the stability exercises in the world, but if you continue to reopen the “scab” through poor movement habits then your healing process will be stunted or you will quicken the pace towards re-injury.
The most common cause of low back pain is due to prolonged incorrect postural positions. This topic is extremely relevant for students studying hours on end, as well as individuals who have careers that force them into poor positional postures for extended periods of time. Posture neglect can cause a host of lifelong problems. If you obtain a slouched sitting position at your job for a prolonged period of time, this will eventually lead to disc distortions in the spine. You can get away with the bad positioning, only until you can’t. It will eventually catch up to you, which is why you should make it a priority to perfect good posture!
Illustrated in the above photos (figure 1-3), the spine, including the neck, is in a correct neutral position. The last photo (figure 4) shows a rounding back fault, which can be corrected simply by retracting the shoulder, bracing the core, and bringing the book up to head height. Many individuals may find themselves assuming this flexed neck position while looking down to read.
No static sitting position is the most ideal, because eventually abdominal, back extensor, and hip flexor fatigue will ensue. Some individuals obtain back discomfort or pain from sitting or standing for an extended period of time. In order to diminish this problem, alternate your position periodically so weight bearing loads redistribute onto other tissues. Additionally, a cushion placed behind the lumbar spine, tends to support the spine’s natural curve, therefore preventing the rounding of the lower back.
The most important concept for postural positions and movement patterns is abdominal bracing which is the act of contracting your core by pushing your stomach walls outward. This will cause an immediate increase in spinal stability by activating all of the core muscles synergistically. Whereas, hollowing, the act of contracting the core by sucking your stomach in, has been shown to decrease stability. Once you are in a seated or standing position, you should contract your core at about 20% tension. The best way to prevent fatigue or slumping would be to alternate between sitting, standing, and kneeling with an organized spine every 15-20 minutes.
The correct standing position includes screwing your feet into the ground, squeezing your glutes (butt muscles), bracing the core, and setting your head up and shoulders back.
Once the static positions of sitting and standing are mastered, you can move onto perfecting the hip hinge. The hip hinge is widely misused throughout the day and must be correctly emphasized in order to prevent expenditure of the spine.
As shown in the photo above, Gabriella is rounding her back as she demonstrates a hip hinge. This movement can be corrected by setting the shoulders down and back, initiating movement at the hips, keeping the spine rigid, squeezing the butt, bracing the core, and pushing the hips back.
Corrective exercises that can be used to fix this fault are the lat pull-down, straight arm pull-down, dying bugs, and lying leg raises.
If a lower back overextension occurs, it can be corrected by digging the rib cage down and in, bracing the core, and focusing on not pushing the chest too far out.
Corrective exercises that can be implemented to fix this fault are planks and dying bugs.
Very nice! Once the hip hinge has been perfected, you can move on to another prominent movement pattern which is the box squat and it can be performed every time you sit or stand throughout the day.
The picture above shows Gabriella’s neck slightly overextending. This fault can be corrected by keeping the head in line with the rest of the spine while imagining you are holding an avocado between your neck and chin.
In this example above, Gabriella’s knees are collapsing in. This can be corrected by screwing the feet into the ground to create torque in order to force the knees outward while squeezing the glutes (butt).
Corrective exercises that can be implemented if the cues do not work are the X-band walk, banded squat, and banded glute bridge.
The above photo is an example of a correctly executed box squat. The feet are slightly wider than shoulder width. Push the hips back as you bend the knees until the hamstrings reach the bench. To stand up, Gabriella would then push the knees out and drive the hips forward and up.
I hope the information in this article has helped you learn more about the proper course of action if you have experienced a back injury. Try to ingrain these correct movement patterns into a daily routine and you will be that much closer to regaining a pain-free back!