The Flexion Rotation Exercise for Low Back Pain

Low back pain is a common problem, with as many as a quarter of the population experiencing it within the past three months, according to the National Institutes of Health. There are many treatments for low back pain and many things you should avoid doing if you have low back pain. Exercise has been proven to be an effective self-care treatment for many people with low back pain, sciatica, or other symptoms that come from the low back.

The flexion rotation exercise is a simple stretch that you can do if you have back pain. It is used mainly in the treatment of back pain that is located on one side of the back. If you have pain on the side of your back, in your buttocks, or down one leg, this exercise may be the one that offers significant relief.

Physical therapy spine guru Robin McKenzie called the flexion rotation exercise the million dollar exercise. Why? Maybe because it helps a lot of people, so it is a valuable exercise to keep in your therapy toolkit. Or perhaps he felt that if a chiropractor did this to enough patients, he or she would make a million dollars.

Remember, it is always best to check with your healthcare provider or physical therapist before starting any exercise program. Sometimes, simple diagnostic studies like X-rays are necessary before treating your own condition.


Starting the Flexion Rotation Exercise

Man performs flexion rotation exercise
Brett Sears, PT

While performing the flexion rotation exercise, monitor your symptoms. If your thigh or leg pain moves towards your spine, called centralization, then this is a good sign and indicates that you likely can continue the exercise. If your pain moves away from your spine, stop the exercise immediately.

To begin the flexion rotation exercise, lie on your side. Most often, you should lie on the painful side. For example, if you are feeling right-sided back and thigh pain, lie on your right side. Keep your bottom leg straight and slowly bend your top knee. Then hook your top foot behind your bottom leg.

If your pain is too severe to allow for you to lie on your side, try some more basic low back stretches before attempting the flexion rotation stretch.


Step Two

Man performs flexion rotation exercise
Brett Sears, PT

After you bend your top knee and hook your foot behind your bottom leg, grasp the knee with your hand. If you are lying on your right side, for example, your right hand will grab your left knee.

Place your top arm in the air and touch your top shoulder blade. Your hand ​of the top arm should be just behind your neck. If shoulder pain or lack of flexibility in your shoulder prevents you from reaching your shoulder blade, simply place your hand on the side of your head. Just do the best you can.


Step Three

Man performs flexion rotation exercise
Brett Sears, PT

Once your top hand is on your top shoulder blade, slowly rotate your upper body backward. The best way to do this is to try to touch your top shoulder blade to the floor. Your top arm should move with your shoulder blade and your top leg should remain bent and hooked behind your bottom knee. Hold the rotated position for one or two seconds.

Try to rotate as far as possible until a mild stretch is felt in your low back. If this exercise decreases or abolishes your low back, buttock, or leg pain, keep slowly moving into and out of the rotation stretch about 10 times, holding each stretch for one to two seconds.

Of course, if this stretch makes your symptoms feel worse, you must stop immediately and contact your healthcare provider or physical therapist to ensure that you are doing the exercise properly. While exercise can be a very effective treatment for low back pain, sometimes your problem may be too severe, and you may require more invasive treatments like injections or low back surgery.

The flexion rotation stretch should be performed at least three times per day, and it may need to be performed much more regularly for acute cases of low back pain. As long as the exercise helps to decrease or abolish your pain, keep performing it. If your symptoms persist for more than a week or two, a visit to your healthcare provider is a must.

Closing Thoughts

Low back pain can cause significant loss of function and can limit your ability to work or enjoy normal recreation. Exercises like the flexion rotation stretch can help offer you a self-care strategy to treat your problem. By incorporating exercises into your daily routine and by maintaining proper posture for your back, you may be able to prevent future episodes of pain.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Neurological Disorders and Stroke. Low back pain fact sheet.

  2. May S, Aina A. Centralization and directional preference: a systematic reviewMan Ther. 2012;17(6):497-506. doi:10.1016/j.math.2012.05.003

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.