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The Myth of Stretching to Improve Back Pain

This applies to both patients experiencing pain and those who are focused on prevention. The truth is, there has never been a study that correlates decreased flexibility of musculature with increased back pain. There is also little to no evidence suggesting that static stretching prevents injuries.

Clinically, this makes sense. Gymnasts, who are typically exceptionally flexible, have back pain that is just as severe as the pain experienced by patients with poor muscular length. In fact, many studies have been published that link static stretching to decreases in strength and performance. Genetics dictate our flexibility.

As a relatively inflexible male, I could stretch 10 hours a day for 10 years and would still not be close to achieving “the splits” with my legs. This is not to say that patients cannot improve flexibility by stretching; however, it does not correlate to pain relief or prevention.

It is true that stretching releases endorphins and “feels good” in areas where pain is present. People will try to bend and stretch in any way possible to get relief, particularly when experiencing back pain.

The key to prevention and treatment of back pain is strengthening. A combination of muscle strength and neuromuscular control in correct biomechanical planes of motion is essential. The most specific focus should be placed on gluteal and abdominal control. This control is the most effective way for your patients to achieve effective outcomes.

I disagree with this writer in that this article implies that what we could term muscle tightness, or shortening does not contribute to low back pain and therefore stretching is not a worthwhile intervention.  Many patients who experience low back pain have tight muscles such as the psoas (hip flexor) or in the low back such as the lumbar multifidi, which can contribute or be a factor in their low back pain. In other words, low back pain, especially when chronic can be “multi-factorial”.  Muscles that are tight can be treated manually with techniques such as trigger point therapy or myofascial release. This is why the most recent Cochrane Collaboration concluded that massage may be helpful in the treatment of chronic low back pain. You can see this for yourself in this excerpt from the Cochrane’s most recent systematic review involving massage for  Low Back Pain…

Low-back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society.  Seventy to 85% of the population will experience LBP at some time in their lives. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function.

Massage in this review is defined as soft-tissue manipulation using hands or a mechanical device on any body part. Non-specific LBP indicates that no specific cause is detectable, such as infection, neoplasm, metastasis, osteoporosis, rheumatoid arthritis, fracture, inflammatory process or radicular syndrome (pain, tingling or numbnness spreading down the leg.

Thirteen randomized trials (1596 participants) assessing various types of massage therapy for low-back pain were included in this review.  Eight had a high risk and five had a low risk of bias.  Massage was more likely to work when combined with exercises (usually stretching) and education. The amount of benefit was more than that achieved by joint mobilization, relaxation, physical therapy, self-care education or acupuncture. It seems that acupressure or pressure point massage techniques provide more relief than classic (Swedish) massage, although more research is needed to confirm this.

No serious adverse events were reported by any patient in the included studies.  However, some patients reported soreness during or shortly after the treatment. Some patients also reported an allergic reaction (e.g. rash or pimples) to the massage oil.

In summary, massage might be beneficial for patients with subacute (lasting four to 12 weeks) and chronic (lasting longer than 12 weeks) non-specific low-back pain, especially when combined with exercises and education.

After manual muscle techniques have been performed to relax/release tight muscles, it may be appropriate to instruct the patient in self-stetches.  After this is addressed, then, other factors contributing to pain can be addressed such as weak muscles with exercise to improve muscle strength and poor neuromuscular control with  activities to improve that factor.

This approach is called a multi-factorial approach to the management of low back pain.

I utilize this approach with patients when appropriate. Call us today to set up an appointment for an evaluation.

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