You begin your day stretching on the advice of your doctor and therapist. Over the past few months, your lower back has ached and you’re stiff as a 2 x 4 in the morning. The problem it seems, as you have been told, is that your hamstrings are too tight. Dutifully, you gingerly get out of bed and straighten up slowly. If you move any faster, it feels as if your back will break in two. Finally, you're up. But now you have to get on the floor in a doorway to stretch your hamstring. You walk to the bedroom door, hold on to the doorframe and ease yourself onto the floor. Once on the floor, you raise your leg which goes about 45 degrees and place it on the doorframe. Your job now is to slowly move yourself to the door forcing the leg up, which stretches the hamstring. You do this for 2-3 minutes on each leg every morning and evening. It's been two months and it seems your hamstring is one stubborn muscle. Nothing has changed. At 40 years of age, you wonder if this is the way your mornings will be for the rest of your life.
Stretching of the hamstrings is one of the most commonly used interventions for lower back pain. But the question is why? Is it true that tight hamstrings cause lower back pain or is it that lower back pain causes tightness of the hamstrings? The answer is two fold and part one dates back to 1509.
Leonardo DaVinci created a series of illustrations used in a publication in 1509 entitled "The Divine Proportion". DaVinci recognized that the ideal human body could be divided into sections which when divided by each other equaled 1.618 also known as PHI (pronounced FEE). For instance, if you measure the distance from the floor to the top of your head and divide it by the distance from the floor to your navel you will get a quotient of 1.618 if your body is perfectly proportioned. This relationship exists everywhere in the human body: your finger joints, limb segments and even in how you move.
The relationship between the amount of motion in your hips and the amount of motion in your low back when you bend forward is very close to PHI: 1.6 (this is calculated as degrees of hip movement divided by the degrees of low back movement)*. This is the ideal distribution of motion. But, the human body is exceptionally good at getting the job done whether you do not have enough motion or have too much motion. If you do not move enough in your hips, in order to touch the floor when you bend forward, you borrow some motion from your lower back. In some cases, you borrow too much stressing the back beyond its capability. If you do not have enough motion in your lower back, you may borrow from the hips and like wise push your hips beyond their means. Ideally, the two regions of the body should be in balance with the "Divine Proportion". The closer you are to PHI, the less risk of injury you will have and the easier it will be for you to move.
We know how much motion is acceptable in the lower back when you bend forward: 50 degrees. Then your hips contribute 80 degrees for a relationship of 80/50 = 1.6. But what if your lower back contributes 100 degrees and your hamstrings contribute 40 (as in the case of one client I recently saw)? Are the hamstrings tight? YES. Does the client have back pain? YES. Should you then stretch the hamstrings? NO. Why? To get to PHI by stretching the hamstrings, the hips would have to move nearly 162 degrees (162/100 = 1.62)! Your body will object strongly to that amount of motion. The answer is to first decrease the motion in your lower back to bring the ratio of hip motion to lumbar motion closer to PHI (watch for suggestions on how to decrease motion in your back in our Library).
You may be asking yourself, if you have low back pain and have been stretching your hamstrings, should I be doing this or not? Good question. Maybe. The reason stretching your hamstrings to treat low back pain rarely works by itself is because the hamstring inflexibility is an expression of your back pain not the cause of your back pain. Having tight hamstrings with lower back pain is like having a fever with an infection. You can treat the fever, and in many cases this helps you feel better, but until you also address the infection, you will feel sick. Hamstring tightness with lower back pain is most often secondary to an ongoing, low grade inflammatory reaction of either the spinal joints or intervertebral disc. As a general rule, when joints are inflamed, muscles get tight. How do you know if this is the case for you? If you have stiffness and pain in the morning that lasts for 20 minutes or more, which is relieved by movement or a warm shower and worsens with inactivity, you can conclude that you very likely have a low grade inflammatory reaction in your spine. Stretching your hamstrings may be part of your solution but the choice to stretch should be based on PHI, and blended into an overall strategy to address the "infection". And what is the best, non-pharmaceutical, most empowering choice to address the low grade inflammation of your joints? Movement**. You need to move more than you need to stretch.
To start, keep your sitting times to no more than an hour. Get up and take a short walk (30-60 seconds) each hour. Once a day, take a power walk for 10-20 minutes (shorter if you have not moved much or regularly. A power walk is a fast paced, long striding type of walk). Once your early morning stiffness subsides, consider having your hip to lumbar motion ratio checked. This will help you avoid spending time and energy on something you may not need to do, like stretching, and direct you toward your "Divine Proportion".
Make today count.
Doug Kelsey
Author. Teacher. Therapist.
*Analysis of lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain. Esola MA, McClure PW, Fitzgerald GK, Siegler S
Spine 1996 Jan 21:71-8
Correlations of hip mobility with degree of back pain and lumbar spinal mobility in chronic low-back pain patients. Mellin G. Spine 1988 Jun 13:668-70
Relationship between mechanical factors and incidence of low back pain.
Nourbakhsh MR, Arab AM. J Orthop Sports Phys Ther 2002 Sep 32:447-60
**Does exercise reduce inflammation? Physical activity and C-reactive protein among US adults. E. Ford. Epidemiology., 2002, vol. 13, pp. 561--568
