Flexion vs. Extension Intolerant Back Pain

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Of the individuals that participate in either the Ruthless Performance Ex Phys Interventions or our Posture Restoration & Injury Prevention Training, there is no across-the-board origin of pain or movement dysfunction at the hip or low back; in fact, client training histories run the gamut in activity level, training history, limb length, and so on.

So what is the common denominator among individuals with low back pain?

In short, there isn’t one singular origin, but rather there are two.

The more frequent of which is extension intolerance. This is common among what we in the Strength & Conditioning world refer to as ‘desk jockeys’, or any individual who is regularly in a resting position of spinal flexion. This includes desk workers, individuals with extended work commutes, TV watchers, and so on… Given our societal predisposition to these patterns, it should be relatively straightforward as to why this is so common.

In opposition to this is flexion intolerance. This is common among highly active individuals such as weightlifters, american football players, backpackers, manual laborers, and so on.

Assessing which category you fall in can usually be done simply with the above information, however there are some easy to perform physical tests as well. A hip extension machine is a great tool for diagnosing the more common extension intolerant back pain. Simply perform a standard hip extension, from here take notice to your range of motion and comfort levels. To assess flexion-intolerant back pain, perform several repetitions of the traditional sit-up or crunch. From here, reevaluate pain, comfort, and ROM.  If a hip extension machine is unavailable, any exercise in which spinal extension occurs (or spinal flexion for the flexion intolerant assessment) can be used.

These tests in congruity can determine a great deal about the cause and symptoms of any dysfunctions or abnormalities in the spine. Oddly enough the solution for both of these issues starts with the same series of correctives…

To gain more mobility in the requisite spinal segments (for extension and flexion), start with rotational spinal mobility to help ensure that as these capacities develop, the movement is coming from the correct areas of the spine (primarily thoracic rather than lumbar). Some exercises and drills which may assist here are quadruped t-spines, cross-over stretch, russian med ball twists, and so on.

From here you can progress into more specific drills to focus on your specific type of intolerance (i.e. focusing more on adding range to spinal extension drills or vice versa).

Spinal health can be simplified into a system of mathematical averages; to regain extension, flexion, or even to maintain a more neutral spine, adequate steps need to be taken to pull the posture in that direction.

For more information on our Posture Restoration & Injury Prevention Training or the Ruthless Performance Ex Phys Interventions, send us a message at RuthlessPerformance.com/contact.


2 thoughts on “Flexion vs. Extension Intolerant Back Pain

    […] Flexion vs. Extension Intolerant Back Pain By John Matulevich via Ruthless Performance […]

    Gwen said:
    January 16, 2019 at 8:24 pm

    I am a 47 year old female and I am really frustrated because I lost all movement at my waist to bend or twist in 2007. At the time it started was when I had really bad MRSA that reached my soft tissue/bloodstream and unfortunately the ER missed it and sent me home on oral antibiotics. It took 3 months to finally recovery, but for some reason I never regained mobility. I can bend slightly back, but forward I cannot bend at all. Bending tests always end up the same with the doctor asking me to bend forward and then repeating his request to go ahead and I usually end up in tears explaining that “that is my attempt to bend” and I am standing straight up! I usually end up with a startled confused look and the response usually is, “that is all you can do? that is odd”. And I just end up leaving disappointed and frustrated. It seems to me that obviously there are certain muscles/ligaments/bones that work together for range of motion of the hip, so it seems that would narrow it down for diagnosis. Would your advice on here help me regain mobility at my waist? Honestly, it is those little things we do everyday without thinking about it, but the loss of mobility really makes those small task like showering, getting dressed and putting shoes very difficult. Any advice would be greatly appreciated!

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