Rehabilitation means returning to habitual state and function. So if the only ability you are lacking is flexibility, then stretching is all you need. For most people however, lower back rehab needs to address more than just stiffness. It needs to decrease pain, improve strength, endurance, flexibility and get you ready to return to work, sport or hobbies.
Contents
- Definitions compared
- Effectiveness data
- Structured rehab benefits
- Case study
Disclaimer:
You should consult with a healthcare provider before starting any new physical activity. This article is for educational purposes and is not meant to replace an assessment, diagnosis, or treatment from a qualified professional. Note; no doctor patient relationship has been formed.
Definitions Compared
Stretching is a very well understood concept. So we will not state the obvious, but we can discuss different forms, and the effects of each.
Static Stretching
This is when you hold a stretch for a period of time without any movement. Static stretching is great for improving flexibility but the magnitude and durability of the flexibility improvement depends on how you stretch. If you want to create a significant increase in flexibility that lasts, you will have to hold stretches for a long time at a point of significant discomfort. A quick stretch that is relatively comfortable will probably only produce transient changes in flexibility.
Dynamic Stretching
This is a stretch with movement. So you could slowly move into and out of a stretch, or hold a stretch while moving slightly, redirecting the stretch somewhat. This is a great practice for warming up, specifically for activities or exercises that require you to go deep into the ranges of motion that you are stretching.
Ballistic Stretching
This is like a dynamic stretch with lots of speed. Accelerating into the stretched position with a rapid rebound out of it. These are only useful as preparation for or warmup before specific athletic movements. Leg swings before running are a good example.
Lower Back Rehabilitation
As mentioned above, rehab means regaining your abilities. So rehab could include many different types of therapies including stretching, strengthening, endurance training, balance exercises, and much more. Strength training is an emphasis in many rehabilitation practices including LBPfix for a few reasons.
The first reason is because most people do not do any strength training, so having some strength training in a rehabilitation program will provide more benefit than something the patient is already doing. Second is because strength is more often a limiting factor than flexibility for work or chores.
Effectiveness Data
The most comprehensive look at different types of exercise for chronic lower back pain was done by Dr. Jill Hayden and colleagues in 2021. They looked at several different types of exercise including but not limited to; stretching, general strengthening, pilates, McKenzie exercises, core strengthening/motor control.
They compared the exercises individually and in combination to placebo and various different treatments including manual therapy, education, anti-inflammatories. They also compared the different forms of exercise together, giving us great insight into what works best.
They found that although stretching was effective at reducing lower back pain and improving function compared to minimal treatment, it was less effective for pain relief than core strengthening, Pilates, McKenzie exercises and Functional Restoration. Similarly, for functional limitation, core strengthening, general strengthening, pilates, McKenzie exercises and mobilizing were superior to stretching. (1)
The LBPfix program has McKenzie exercises, PIlates type exercises, core and general strengthening all built into the program so that you get the best of all worlds. There are also some stretches in the program, and if you want some more recommendations for stretches to add check out our other article about stretching for lower back pain.
Another large network meta analysis done by a different group of researchers showed similar results. They found pilates to be most effective for decreasing pain, and resistance training most effective for improving physical function and mental health. (2)
Structured Rehab Benefits
The benefits of a good rehabilitation program are all the things you want. You want to have less pain. You want to perform well at work, take good care of your family, and be able to do all of your favorite activities. Really this all comes down to having a better quality of life.
Having structure to your rehab helps you get it done consistently and helps you build good habits that will last long term. Being consistent with your exercise is important for your long term health, especially if you have lower back pain.
Other factors that are also very important for recovery which we touch on in the LBPfix Program are getting good sleep, eating a healthy diet and managing your stress levels. Building good habits and being consistent with these is very important. Do not underestimate these components just because they may not have immediately obvious benefits.
Case Study
Here is a case that I will never forget. It was early on in my career and the results were quick, the combination made it very memorable. A patient came in for chronic lower back pain. She had been having regular chiropractic treatment for many years. She got some relief from adjustments, but the pain either didn’t go away fully or came back quickly.
I asked her typical questions about health, lifestyle, activities etc. She loved running, but the lower back pain was getting in the way of that. She also had young kids, and had a fairly high stress burden. She stretched regularly, but didn’t do any strength training.
We did the adjustments that typically gave her relief, and I gave her two very simple exercises to start working on at home. She came back the next time, and had been pain free since starting the exercises. She kept coming in at her regular monthly interval for a couple more visits, probably out of habit more than anything.
Her lower back pain never came back for the duration of our time working together. She eventually stopped coming in, hopefully because she realized she did not need adjustments anymore. She was able to not only decrease, and ultimately eliminate the pain, but also keep it from coming back. All of that with some simple exercises.
Our Framework: How LBPfix Can Help
1. Identify Your Pain Driver: We classify your pain into one of four movement intolerance types
2. Prescribe the Right Movement Strategy: Once we know your pain type, we match it with corrective movements
3. Build Long-Term Resilience: As pain settles, we help you:
Move confidently without flaring up
Rebuild core control and lifting mechanics
Return to work, sport, or life without setbacks
Ready to Fix Your Low Back Pain?
Take our 2-minute quiz to find out if you’re a good candidate to our program – no strings attached!
References
- Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S, Yamato TP, Saragiotto BT. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother. 2021 Oct;67(4):252-262. doi: 10.1016/j.jphys.2021.09.004. Epub 2021 Sep 16. PMID: 34538747.
- Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H, Bowe SJ, Belavy DL. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020 Nov;54(21):1279-1287. doi: 10.1136/bjsports-2019-100886. Epub 2019 Oct 30. PMID: 31666220; PMCID: PMC7588406.
