Flexion-Intolerant Low Back Pain

Low back pain can be caused by a variety of different factors. Discogenic pain, lumbar
spondylosis, facet joint dysfunction, and sacroiliac dysfunction are all common structural
diagnosis that are seen with low back pain sufferers. Unfortunately, what is contributing
functionally to their back pain is what often goes undiagnosed. It is important for patients to
understand both structurally and functionally where their pain if coming from.

Flexion-intolerant low back pain is a common presentation. Simply put, it is back pain that is
made worse with too much flexion or bending forward. Flexion-intolerant low back pain is
characterized by symptomatic pain with movement, and possible referral pain into the buttock
or down one side of the leg (sciatica).  Pain is worsened with sustained or repeated flexion.

Cues That Someone Is Flexion-Intolerant:

  • Pain upon waking in the morning
  • History of sudden onset of pain during lifting or bending
  • History of sciatica, buttock, or leg pain
  • Discomfort or pain getting out of a car or chair
  • Discomfort during tasks that require bending such as tying as shoes
  • More pain in sitting than standing
  • Prolonged sitting during the day
  • Relief with extension-based exercises


How Is It Treated?

In the office, our goal is to restore proper movement. Joint manipulation, soft tissue
mobilization, and exercise are all proven modalities to provide fast, long-lasting relief for back
pain. This includes those that are flexion-intolerant.

At home, it is important to remove motions and positions that may be contributing to low back
pain. For example, flexion-intolerant back pain sufferers may think they are helping their cause
by performing such flexion exercises as stretching their hamstrings, or pulling their knees to
their chest, however other than only a perception of relief for a short time, they are causing
more cumulative damage leading to a cycle of pain and stiffness.

When a patient’s symptoms can be made better or worse by adopting various positions, this is
important to take note of as this can help determine better treatment options, including at home
self-treatment, for them. This is often the case when back pain is made worse from too much
flexion. For this reason, we prescribe extension-based exercises for our patients to continue at
home. Particularly if nerve irritation is present.

Watch the video below as Dr. Donahue reviews an exercise, we often prescribe for low back

Abel Shaw

Abel Shaw


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