Lumbar Extension and How It Helps Back Pain

Lumbar extension is the bending backward of the spine. Lumbar extension exercises are used to increase range of motion (ROM) in people with lower back pain due to lumbar spinal stenosis, a narrowing of the spinal canal that pinches nerves and can limit walking and other activity.

A man doing his stretches for his spinal stenosis
RgStudio/Getty Images

Physical therapy (PT) can help people with lumbar spinal stenosis improve strength and ROM and relieve symptoms. While it typically involves spinal flexion, or the forward bending of the spine, lumbar extension can also help relieve symptoms.

Research shows PT can be as effective as surgery for spinal stenosis, with fewer dangerous side effects.

This article discusses the standing lumbar extension, a basic lumbar extension exercise. It also explains exactly how lumbar extension works to relieve back pain.

How Lumbar Extension Helps

Lumbar extension places stress and pressure on the backside of your intervertebral discs, those soft, squishy shock absorbers in your spine.

By bending backward and pressing against the discs, you may be able to slightly press them away from your spinal canal and nerves. This can give your spinal nerves a little more room and may relieve spinal stenosis symptoms.

Historically, all patients with lumbar spinal stenosis were prescribed lumbar flexion exercises to help open up the spinal canal and relieve pressure off of spinal nerves.

While many patients with spinal stenosis benefit from flexing their spine, others benefit from bending it backward.

The Standing Lumbar Extension Exercise

The standing lumbar extension exercise is typically used by physical therapists trained in the McKenzie Method of Mechanical Diagnosis and Therapy.

If you have spinal stenosis, this exercise is one you might try first (after checking with your healthcare provider).

Here is how to do a standing lumbar extension:

  • Stand with your feet about shoulder-width apart.
  • Place both hands behind your back just above your hips.
  • Slowly bend yourself backward. You can lean back against a kitchen counter for stability if necessary.
  • Hold the bent back position for up to 60 seconds, and monitor your symptoms as you are bending backward.
  • After 60 seconds, return to the upright position.

While performing the standing lumbar extension exercise, monitor your symptoms. Initially, you should feel increased back pain and leg pain or tingling.

As you hold the position, continue monitoring your symptoms to see if these symptoms decrease or centralize to your back.

Less pain? A decrease or centralization of your symptoms is a good sign and means that you should continue the exercise a few times a day to maintain your ROM and control of your symptoms.

More pain? If your symptoms continue to hurt in your low back and your legs continue to tingle, stop the exercise and proceed with your physical therapy flexion exercise program. Standing lumbar extension is not appropriate for you.

The Bottom Line

Lumbar spinal stenosis can be a difficult diagnosis to manage. It can make walking challenging and limit your ability to work or enjoy recreational activities.

If you have stenosis, you may be tempted to engage in only flexion-based exercises for your condition. Some people may benefit from performing a standing lumbar extension to quickly get pressure off the spinal nerves and rapidly reverse symptoms. This can allow you to get back to your normal activity quickly and safely.

A Word From Verywell

Check-in with your healthcare provider to make sure you get an accurate diagnosis for your condition first, and then visit your physical therapist to learn the correct exercises to perform for your specific condition.

Your PT can help you move better and feel better so you can get back to your normal, active lifestyle.

Frequently Asked Questions

  • Why do we need lumbar extension?

    Lumbar extension exercises improve range of motion, increase lower back strength, and help relieve pain and stiffness in people with arthritis in the lumbar spine.

  • What muscles are involved in lumbar extension?

    Lumbar extensions work the lumbar extensors, a group of muscles that include the erector spinae and multifidus. Extensions also work the gluteal and hamstring muscles. 

  • What does physical therapy for spinal stenosis involve?

    Components of physical therapy for spinal stenosis may include:

    • Exercises to improve your spinal ROM
    • Exercises to increase core and hip strength
    • Therapeutic modalities to help decrease pain
    • Mobilization techniques to help improve your spinal mobility
    • Education for postural correction techniques

6 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. Lurie J, Tomkins-lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234. doi:10.1136/bmj.h623

  2. Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162(7):465-473. doi:10.7326/M14-1420

  3. Padmanabhan G, Sambasivan A, Desai MJ. Three-step treadmill test and McKenzie mechanical diagnosis and therapy to establish directional preference in a patient with lumbar spinal stenosis: a case report. J Man Manip Ther. 2011;19(1):35-41. doi:10.1179/2042618610Y.0000000002

  4. Tousignant-laflamme Y, Longtin C, Brismée JM. How radiological findings can help or hinder patients' recovery in the rehabilitation management of patients with low back pain: what can clinicians do? J Man Manip Ther. 2017;25(2):63-65. doi:10.1080/10669817.2017.1309345

  5. Mann SJ, Singh P. McKenzie back exercises. StatPearls [Internet].

  6. Lee HS. Enhanced muscle activity during lumbar extension exercise with pelvic stabilization. J Exerc Rehabil. 2015 Dec 31;11(6):372-7. doi:10.12965/jer.150249

Additional Reading
  • McKenzie, R., & May, S. (2003). The lumbar spine mechanical diagnosis and therapy. (2nd ed., Vol. One). Waikanae: Spinal Publications New Zealand.

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