If you are like 80% of the human race, you’ve likely complained of back stiffness. That would seem to indicate that your back is need of stretching.
This seems to make sense on the surface, but recent research calls this into question.
As I often say, however, just because it’s logical, it doesn’t mean it’s physiological.
Just because you feel stiff, doesn’t mean you should stretch.
For years I’ve advised against always stretching your spine when it’s stiff based on spine anatomy and seeing the results in the clinic.
Some excellent recent research refutes the correlation to feeling tight, and actually having tightness in the back. Check it out here.
The Research
Stanton and colleagues studies a group of people with and without symptoms of back tightness. Specifically, each subject rated their degree of stiffness on a 0-100 scale.Then they objectively measured the actual stiffness of their spine by using a standard force to their vertebrae and measuring displacement.
They found that there was no correlation to perceived stiffness and actual stiffness.
The same researchers also found that those with perceived stiffness were also more sensitive to applied force. Also, when given an auditory cue while the force was applied, it altered their perception of how much force was applied. For example, when an increasingly high creaking noise was played while applying a force, those with back stiffness overestimated the perceived amount of force applied. In contrast, when a decreasingly loud creaking noise was played while applying force, they underestimated the force being applied.
This corroborates with other finding suggesting that pain is a multi-sensory experience.
So what does this all mean?
There are several key things these findings tell us we should do, or not do.
First, just because you feel tight, it doesn’t mean that you really are tight. Rather, it might mean that your tissues are sensitive and protecting.
Ok, so what?
Don’t go out of your way to go crazy things to “lengthen”, “stretching”, or “mobilize” your back. Because if you do, you might be, at best, barking up the wrong tree. There’s probably something else going on that you should turn your attention to:
- poor ergonomics (sitting too long, staying in awkward positions for too long),
- poor endurance (ie doing tasks that you’re poorly conditioned for, like gardening all day when you are poorly trained for that), or
- poor motor control (lacking the coordination to place your spine in positions to optimally distribute and produce force).
- hyper sensitive neural tissues; central or peripheral.
At worst, by stretching, manipulating, and mobilizing by chasing the stretch, you could be further irritating vulnerable tissues or further lengthening loose tissues. For example, the discs, ligaments, nerves, and facet joints of the spine are far less tolerant to stress than muscles, especially when irritated. Attempts focused on mobilizing tissues that aren’t really stiff may be making things worse. Surprisingly sometimes the negative symptoms people feel when stretching are falsely justified as necessary to “loosen” the “stiff” muscles or joints. (more on this below).
But it feels so good to stretch!
Just because it feels better doesn’t always mean you should do it. Scratching an itch may feel better now, but doing so increases the histamine response so it keeps itching, and picking the scab delays healing.
Stretching your back certainly isn’t always bad. In fact, in many cases it can help greatly. However, it doesn’t need to be done aggressively or for prolonged periods. In cases when stretching seems to help back issues, it’s not always because it is reducing stiffness. Rather, it can help because it may provide the brain with positive afferents that alter pain reception and inhibit guarding, all things that help some types of back pain. This is also a mechanism by which joint manipulation works. This explains how joint manipulation can reduce pain in some cases, even though it is proven NOT to “realign” any joints.
Also, in the case of mobilization, it can improve water concentration in the discs, associated with improved health, pain reduction, and function of the spine.
The key is to determine whether your spine is truly stiff or not, which is best done with both an examination and proper history, preferably by someone who isn’t biased with a certain treatment approach (ie chiros that manipulate everyone, surgeons that advocate surgery for most before therapy, pain specialist that inject everyone). If it truly is stiff, then apply gentile mobilization, manipulation, and stretching techniques. And if you have to do this all the time, it probably isn’t working.
LOOK FOR THE CAUSE
I’m alarmed by how many people with back issues, and even more so clinicians, focus on just treating symptoms. What is the point if you don’t find the cause? They just keep coming back.
Improving symptoms are important, but keeping them from returning is even more important. And that means looking for the cause. That should be the goal.
Common causes
The primary causes of most back pain are:
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Prolonged sitting,
prolonged any position,
doing tasks that you aren’t properly conditioned for.
In people with known back issues, the following are the most common causes I see based on my clinical experience and research.
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reaching, bending and twisting repeatedly beyond your base of support, especially with heavy loads,
poor torso muscle endurance,
poor lumbopelvic motor control,
poor hip mobility,
poor general strength and fitness,
poor self-management strategies (pain reduction, stress reduction), and
fear avoidance/pain catastrophication
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