Does Stretching Help With Back Pain?

Each joint in the body is designed to move through a specific range of motion. Almost all joints allow for movement in more than one plane of motion (i.e., forward and backward, side to side, rotating movement).

When our muscles and other soft tissue structures tighten due to inactivity or injury, the joint range of motion is impaired and can result in pain. Motion is “lotion” for the joints, and stiffness and pain often arise from lack of use. Age-related diseases, such as osteoarthritis and spinal stenosis, can also limit the range of motion due to changes in the joint surfaces or joint spaces.

A daily stretching routine does in fact help to prevent back pain and other musculoskeletal pain by helping to maintain normal range of motion in our joints. Stretching increases the flexibility and length of muscles, tendons, ligaments, connective tissue, and scar tissue. It can even help nerves to glide more easily throughout the body and reduce radicular (nerve) pain (3). Greater flexibility allows for more joint movement throughout the day and limits compensations (overuse of a part of the body that works well to make up for an injured body part) at other joints throughout our body.

Stretching can also reduce lingering chronic back pain. One study looking at the effects of exercise programs in people with chronic low back pain found that stretching the hamstrings and lumbar spine significantly reduces pain (2).

Strengthening exercises can further amplify the benefits of stretching. Strength gains are greatest when the muscle has full flexibility and can move throughout the entire anatomical range of motion. A physical therapist will work with you to restore mobility and range of motion prior to addressing strength deficits. Regular endurance or cardiovascular training can also help to maintain flexibility gains by keeping your joints in motion.

The spine is made up of many small joints, each with multiple planes of movement. As the body ages, the soft tissue structures in the back (muscles, tendons, ligaments, spinal discs, and more) lose flexibility and elasticity. As a result, the water content of the soft tissues decreases, reducing elasticity and flexibility. Loss of flexibility makes it more difficult to maintain a healthy range of motion in the many joints of the spine. When muscles are tight, movement at joints can be restricted, triggering muscular imbalances, wear and tear on joints, and back pain.

Many studies show that stretching back, hip, and leg muscles can relieve back pain in the short term and the long term and improve function (2, 4, 5). Stretching has many positive effects on our bodies that combine to reduce pain.

First, stretching increases range of motion while reducing stiffness. Maintaining a consistent stretching routine is especially important as you age, since your body becomes less flexible with the natural aging process. Restoring full range of motion to joints allows the muscles to work more effectively and strengthen. Full range of motion also prevents pain and stiffness from developing.

Stretching can also improve blood flow and nutrient delivery to our musculoskeletal structures, further contributing to joint health and pain reduction. In particular, dynamic stretching can help improve circulation while simultaneously lengthening muscles. Dynamic, or active stretching, involves moving a limb through its full range of motion and repeating several times rhythmically or sequentially (6). This form of stretching is a great way to warm up the body prior to an activity or static stretching. Dynamic stretching has also been shown to improve muscle power generation and jumping performance and can serve as an effective cool-down activity, to enhance muscle recovery and decrease delayed onset muscle soreness (DOMS) (7, 8).

Stretching can also improve posture and body mechanics by restoring healthy range of motion. With poor postureWhen we have poor posture, some muscles become tight because they’re overworked or overcompensating for other postural muscles that are weak (9, 10). Two examples of this are tightness in the upper trapezius muscle and pectoralis muscles (“pecs”) that many of us experience as a result of poor posture (forward head and rounded shoulders) (9, 10). These muscles are tight because the muscles that oppose them are often long and weak (the deep cervical flexors oppose the trapezius, and the rhomboids and lower trapezius oppose the pecs) (9, 10). Instead of contributing equally to help maintain good posture, one group of muscles is overworked, i.e., tight, while the other group can barely turn on, i.e., long and weak. When tight muscles are stretched, it allows When we stretch the tight muscles, we’re helping to improve our posture so all muscles can work at maximum efficiency within their expected range of motion and improves posture. As mentioned earlier, stretching should always be accompanied by a strengthening program designed by a physical therapist in order to address muscular imbalances.

Additional benefits of regular stretching include improved balance, reduced risk of injury during activity, improved physical performance, and stress relief (11). Stretching is often accompanied by deep breathing and mindfulness, which have calming effects on the body. Taking the time to focus on your body while you stretch can help to clear your mind.

Stretching serves as a natural pain reliever especially when combined with other forms of physical activity and can help reverse chronic pain. Movement is the best medicine for pain, especially when we are afraid to move due to years of chronic pain patterns and fear has prevented movement in the past. Regular movement, including stretching, helps to lower the pain threshold by reteaching the brain that movement can, in fact, feel good.

The first step in developing a stretching program that is right for you is to talk to a healthcare professional and seek a referral to a musculoskeletal expert. Always consult with a musculoskeletal expert to determine if a new stretching or exercise routine is appropriate for you.

Physical therapists and PM&R physicians are particularly well-placed to manage your care when it comes to new exercise routines. After obtaining a thorough history including present symptoms and prior interventions, a physical therapist will clinically assess any movement restrictions associated with your back pain. They’ll then design an effective stretching and strengthening program that is tailor-made for you.

There are three main types of stretches that a physical therapist may include in your stretching program. These are static stretching, dynamic stretching, and proprioceptive neuromuscular facilitation, or PNF stretching.

Static stretching is performed with the limb in an end-range position, where the muscle is maximally stretched or lengthened, and is held for a certain amount of time, usually 30 to 60 seconds (6). This form of stretching is what we think of as traditional stretching and is most effective after physical activity or a dynamic warm-up when the muscle is “warm”.

As mentioned earlier, dynamic stretching, or active stretching, involves moving the limb through the range of motion to end range in a repetitive manner (6). Unlike static stretching, this is an active form of stretching and does not involve holding one position for an extended period of time. Another form of dynamic stretching is ballistic stretching, which involves ‘bouncing’ at the end range (6). Ballistic stretching is no longer recommended as it has been shown to increase the risk of injury (6).

Proprioceptive neuromuscular facilitation, or PNF, involves alternating between a muscle contraction, of either the muscle being stretched or a muscle that directly opposes it, and a muscle stretch (6). The theoretical mechanism behind PNF stretching is rather complex, however, it uses a neurological reflex to reduce muscle tension and allow for a greater stretch of the muscle (12).

A physical therapist can educate you on these three types of stretching and how to incorporate the most effective types for you into your daily routine. If you do not believe a physical therapist is the right fit for you, you may consider a visit to the chiropractor or massage therapist to seek advice on stretching for your back.

Outside of the traditional healthcare system, there are a number of forms of exercise which can offer pain-free stretching techniques. These include Yoga, Pilates, Tai Chi, and aquatic classes. Participating in exercise classes such as these may help you get an idea of what feels good for your body and what helps relieve your pain. However, you should always obtain clearance from your healthcare professional before participating in a new exercise program.

Remember that stretching alone does not relieve back pain and should always be part of a well-rounded rehabilitation plan that involves strengthening, endurance training, and lifestyle modifications developed with the help of a healthcare provider.

There are a number of basic stretches for the back, hips, and legs that can offer relief for back pain. Some of these stretches include:

• Knee-to-chest (lying on back)
• Lumbar twists (lying on back
• Hamstring stretch (lying on back)
• Lunge
• Quad stretch
• Open books
• Child’s pose
• Cat-cow

As you begin a regular stretching program under the supervision of a healthcare professional, keep a few important things in mind.

First, never stretch a muscle that is cold. Always stretch after you exercise or after an active warm-up that is 5-10 minutes long. An active warm-up should include low-intensity exercises that support and prepare you for stretching or for your physical activity. A basic active warm-up may include walking mini lunges, mini squats, jumping jacks, cat-cow repetitions, or simply, a brisk walk. An active warm-up increases blood flow to the area to be stretched, allowing the muscles to tolerate more stretch and avoid injury. Static stretching can make an excellent cool down after a bout of physical activity.

On average, you should hold a static stretch for 30-60 seconds. You can repeat the stretch for 3-5 repetitions. Avoid ballistic stretching, or bouncing, at the end range of the stretch. Use your breath to ease into the stretch instead of bouncing. Try to stretch every day for 5-10 minutes even if you are not exercising on a given day.

Always stretch in a pain-free range. You may feel discomfort but should not feel pain. Hold the stretch at an end range that is tolerable and use your breath to move deeper into the stretch. In general, stretching should be an enjoyable experience. Stop if you experience pain and consult with your healthcare provider.

Always stretch both sides of your body. Range of motion should be equal on both sides of the body. When there is a limitation in a joint on only one side, this is a recipe for injury as the body will use surrounding joints or the opposite side of the body to compensate for the lack of mobility on the impaired side.

If you have a history of recent injury or surgery, consult with your physical therapist or physician regarding the safest stretches for you. Keep good form in mind and never stretch a muscle that is strained or is actively healing from an injury.

Stretching can offer solace to your mind as you look inward and focus on your body. Deep breathing and mindfulness can help make stretching a relaxing daily ritual for you. Listen to uplifting music or perform with a friend to enhance the experience further.

Research shows that stretching is an effective way to reduce back pain and improve function, when used in combination with a strengthening and endurance program. The risks of stretching are relatively low when performed with vigilance, especially when executed under the guidance of a healthcare provider.

When it comes to stretching, consistency is key. Don’t be discouraged if your new stretching program is mildly uncomfortable at first. With time, your flexibility will improve and stretching will become an enjoyable daily routine. Try to spend 5-10 minutes stretching every day after a brief warm-up or bout of physical activity. If you can’t manage to stretch every day, start with 3 times a week to still see benefits. It may take weeks or months to improve your flexibility, however, stretching is scientifically proven to increase flexibility and reduce back pain.