Spinal Flexion and Low Back Pain

Woman holding her lower back because of pain
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Believe it or not, the movements you take your spine through when exercising, minding your garden, playing with your kids, doing housework and so many other things, have names. These names are based on the directions into which your spine goes. They are: 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 — that of flexion. Doing so may help manage your back pain.

A familiar movement for most of us, spinal flexion is the act of bending forward. It's the position that brochures and websites about lifting heavy items, gardening and other manual tasks tell you not do. 

Spinal Flexion and Herniated Disc Risk

The reason for this cautionary note is that 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) squirts 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, 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, and gravity has the tendency, incrementally over time, to compress the spine. In turn, this may lead to a chronically flexed spinal position, called kyphosis. Unless you are very astute about your posture, you may not even notice your kyphosis until it becomes extreme, or it results in pain. 

Sitting at the computer, driving and carrying children are examples of activities that may lend themselves to this type of 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. That said, it's best to consult with your doctor and/or physical therapist for the best positions and exercises given your individual condition.

And 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. 

Prevent 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. 

Obviously, 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 and/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.

NOTE: There are some spinal conditions such as arthritis, facet joint problems and others that may be irritated by arching and/or twisting your back. And twisting may irritate a herniated disc, as well. If you are unsure about what to do given your symptoms, ask your doctor or physical therapist which back exercises to avoid and which are fair game.

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