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Dr. Joseph Horrigan

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When Is Stretching Not a Good Idea for Back Pain?

Posted: 04/16/2013 4:11 pm

Low back pain is a very common problem affecting millions of people at any given time. The economic toll of chronic low back pain (three months or longer) has been estimated to be between $12 to $90 billion from loss of work productivity, cost of treatment, and disability payments, according to the American Academy of Family Physicians.

Most patients who develop low back pain have a vague memory that stretching is helpful for the low back and try to fix the problem by doing stretches that target that area. However, if the cause of the low back pain stems from an injured intervertebral disc, stretching can exasperate the injury and cause even more pain.

The intervertebral disc provides space between the bony vertebrae and functions as a shock absorbing structure. In some cases, injury to this disc can inflame the exiting spinal nerve root and cause pain, tingling, numbness and weakness, or any combination thereof, down your lower extremity. Patients often refer to this as sciatica. Health care providers usually describe these symptoms as radiculopathy, or inflammation of a specific spinal nerve root (e.g. L5 radiculopathy).

When low back pain begins, the patient may put a stretching program into action by stretching the hamstring muscles in the back of their thighs. This stretch can be beneficial for cases of uncomplicated, mechanical low back pain. However, if the patient has pain radiating down the back of their legs from an inflamed nerve (radiculopathy), then the stretching may not be a wise idea.

Patients who have a lower lumbar disc injury and have inflamed the L5 or S1 nerve roots will have increased pain from a straight leg raise maneuver during an examination. The reason for the increased pain is because the inflamed nerve is being stretched. This straight leg raise, which is identical to a hamstring stretch, usually increases the patient's pain. The problem is that when the hamstring muscles are stretched, the L5 and S1 nerve roots are stretched as well. The end result from stretching the hamstring in these patients is the nerve pain is perpetuated. This lack of improvement in symptoms causes patients to seek other opinions and care elsewhere.

When I evaluate patients who have described this very scenario, I ask them to stop stretching the hamstring muscles for at least two months. The purpose of this request is to stop aggravating and inflaming the nerve roots every day. Typically, once the patient stops stretching the hamstrings, there is noticeable improvement within a week. Once all of the pain radiating down their legs has stopped and their back feels better, I will then recommend hamstring stretches be resumed.

Other forms of stretching, such as pulling the knees to the chest and opposite shoulder while lying on their back, can be performed throughout their low back pain and radiculopathy episode. The muscles in the front of the thigh (quadriceps) can be stretched as well, unless disc injuries have occurred in the mid to upper region of the low back. If this happened, then the L2, L3 or L4 spinal nerves can be inflamed. Stretching the quadriceps muscle will also stretch these nerves and perpetuate pain in the front of the thigh.

Stretching can be beneficial when performed at the right time. If you find that you often feel worse after stretching, you need to stop and seek advice from a health care professional.

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