Spinal Flexion and Low Back Pain

Whether you're exercising, gardening, playing with your kids, or doing housework—any of these bending movements have specific names based on the direction that your spine goes while performing them. There's flexion, or bending forward; extending, which is an arching back type movement; side bending, also known as tilting; and rotation, or twisting.

Let's explore perhaps the most frequently performed spinal action of all: flexion. A familiar movement for most of us, spinal flexion is the act of bending forward. It's what you're specifically told not to do when lifting heavy items, gardening, and other manual tasks. Understanding how flexion works and its effects on the body may help manage your back pain.

Woman holding her back, having lower back pain from PID
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Spinal Flexion and Herniated Disc Risk

Too much spinal flexion, or spinal flexion that is loaded—either because you're carrying something with a substantial amount of weight, or you're twisting your spine as you bend—may negatively affect your intervertebral discs. It may even cause a herniated disc injury.

A herniated disc occurs when the outer covering of a spinal disc, which is known as the annulus fibrosus, frays or breaks, and the disc's liquid center (nucleus pulposus) leaks out. If the nucleus pulposus happens to land on a spinal nerve root, as it often does, you'll likely experience pain and/or other nerve symptoms, which are collectively known as radiculopathy.

Herniated disc injuries sometimes get better without surgery, but this can take a year or so. With conservative care only, symptoms tend to dissipate once the disc material is resorbed into the body. Physical therapy can help manage the pain while you wait, should you decide to go this route. 

But many people who sustain a herniated disc want a quicker fix, so they opt for a discectomy surgery.

Flexion of the Spine and Deformity

We're all subject to the force of gravity, which can compress the spine incrementally over time. In turn, this may lead to a chronically flexed spinal position, called kyphosis. Unless you are very mindful about your posture, you may not even notice your kyphosis until it becomes extreme or results in pain. 

Sitting at the computer, driving, and carrying children are examples of activities that may lend themselves to spinal flexion postural misalignment.

Along with kyphosis, spinal flexion as a daily habit over time may contribute to scoliosis or swayback. In these conditions, the chronic spinal flexion position is called the "saggital" component. Saggital refers to movement, in this case of the spine and trunk, that goes in forward or backward directions.

Spinal Flexion and Spinal Stenosis

In some cases, extraspinal flexion is desired. For example, if you have spinal stenosis, you may experience the classic symptom of neurogenic claudication. Generally, getting your spine into a flexed position helps relieves the pain and cramping associated with neurogenic claudication.

It's always wise to consult with your healthcare provider and physical therapist for the best positions and exercises given your individual condition.

You may want to consider acupuncture, as well. A March 2018 study published in the journal BMC Complementary and Alternative Medicine compared medication, exercise, and acupuncture for managing lumbar spinal stenosis. Of the three treatments, acupuncture resulted in the most improvement—both for symptoms and physical functioning.

Preventing Back Problems Related to Spinal Flexion

The easiest way to prevent back problems that arise from chronic spinal flexion is to keep your core, which includes your ab and back muscles, both flexible and strong. 

A back exercise program should help you do this. In particular, yoga and Pilates not only strengthen muscles, but they also develop your spinal alignment. With these systems, you'll exercise your back in all the directions your spine can move. Plus, their emphasis on balanced action and whole-body alignment may help re-establish an erect posture. 

Strength exercises are often done with your back arched or twisted. Because arching, and to some degree twisting, are opposite actions to spinal flexion, exercises in these positions may counter habitual tendencies toward spinal flexion, which in turn, may reduce associated risks to your back.

A Word From Verywell

There are some spinal conditions, such as arthritis, facet joint problems, and others, that may be irritated by arching or twisting your back. Twisting may irritate a herniated disc, as well. If you are unsure about what to do given your symptoms, ask your healthcare provider or physical therapist which back exercises to avoid and which are safe for you to perform.

3 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.
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  2. Oka H, Matsudaira K, Takano Y, et al. A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study). BMC Complement Altern Med. 2018;18(1):19. doi:10.1186/s12906-018-2087-y

  3. Eliks M, Zgorzalewicz-stachowiak M, Zeńczak-praga K. Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art. Postgrad Med J. 2019;95(1119):41-45. doi:10.1136/postgradmedj-2018-135920

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.