Lower back pain and leg stretches

By Antonino Balistreri (LSSM, MISRM)

Back pain can often be prevented or managed with the right kind of stretches.

Have you ever had lower back pain? Even if you haven't, you will find that keeping your hamstrings and glutes in a good, loose condition will help your lower back stay happy.

All you need is some discipline to do the right stretches regularly. You don't even need much time for example, you can do some of this work waiting at the luggage belt at airports, for example. In fact, that would be a particularly good place to do it, since you are about to rip your 22.9kg suitcase from the belt! For a very brief moment you will put your back under extreme pressure and every little bit of flexibility in your bum and legs will help, but let's have a quick look at the science before I show you what stretches are good for you.

Stretching is an important way to help prevent injuries as it keeps the muscles flexible and allows the joints to move through their full range of motion. Unfortunately it is often neglected and not included into training routines.

This article will explain how proper stretching of hamstrings and gluteal muscles can prevent and manage lower back pain.

Almost half of us suffer at some stage

Back pain is very common. According to a survey published in 2000*) almost half the adult population of the UK (49%) reported lower back pain lasting for at least 24 hours, at some time in the year, and 80% of all the population have experienced back pain at some stage in their life. One of the reasons for the onset of back pain is because the majority of us spend a large part of our day seated at work. In this position, the muscles that suffer more stress are the hamstring group and the gluteals group.

The hamstrings (semitendinosus, semimembranosus and biceps femoris) are along the back of your thighs. They work directly with your lower back, allowing you to walk, run, sit and stand. The gluteal are formed by three muscles: the gluteus maximus - its main function is to extend the hip; the gluteus medius which lies under the gluteus maximus and holds the pelvis upright when walking especially when you run; the gluteus minimus which lies under and assist the gluteus medius in most movements, especially in rotating the hip joint inward such as when you bring your knees together.

The culprit: sitting at the desk all day

In a constant seated position the hamstrings are constantly put in a shortened state and the gluteal lose part of their tone because they get squashed by the body weight. This recurring seated position, with repetitive daily exercises can often cause the hamstring muscles to adapt to a shortened or tight state, and the gluteals to lose their strength in keeping the hip in a proper position. Eventually this faulty position can lead to back pain because the muscles lost their optimal mobility. Mechanically shortened hamstring can contribute to lower back pain for the fact that they can cause a backward rotational pull on pelvis and hip bones which in turn strain the muscle located at the base of iliac crest. This change in the pelvis’ neutral position can irritate the nerves that originate from the lumbar-sacral part of the pelvis. The sciatic nerve in particular can become irritated from the shift in the pelvis position. However this adaptive shortening is not permanent and proper muscle flexibility can be restored via a proper stretching training.

Performing hamstring flexibility exercises can reduce overuse injuries such as shin splints or lower back pain. Flexibility training increases the hamstrings and gluteals range of motion and improves their performance. Also with increased flexibility the posture improves and overall stress on body decreases.

How to stretch your hamstrings safely and effectively

Wolfgang likes to call this the "Ancient Egyptian Stretch" :-) I guess, he wants to emphasize that you need to ensure that you move your legs and body in only one plane, so it looks kind of two-dimensional. Here's what you need to do - see the photo series at the end of this mail for an illustration:

• Start with standing straight wit the weight distributed evenly between both feet.
• Put one leg forward - this is the leg we are going to stretch.
• Make sure that your body weight is evenly distributed between both feet again.
• Put your hands upon your hips.
• Slowly pivot from the hips forwards, always making sure that you keep your lower back straight and that you don't start twisting to the side, it is especially tempting to do so from the hips.
• Slowly you should start feeling a good stretch in your hamstring on the leg that you have kept straight.
• Stay in the stretch for at least 30 seconds, then slowly come out of it and stretch the other leg.

There are many different stretching techniques: static stretching, dynamic stretching and proprioceptive neuromuscular facilitation to mention some. Static stretches are those in which you hold a stretch for an extended period. Dynamic stretches, such as high-knees and buttocks kicks, increase the tension in your muscles. Proprioceptive neuromuscular facilitation combines passive, relaxed stretches with isometric, resistant stretches to increase your flexibility. Combining these three techniques is beneficial as long as you avoid bouncing motions.

*) Palmer KT, Walsh K, et al. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years BMJ 2000;320:1577-1578.