Back Pain Treatments

Controlling Lumbar Flexion to Reduce Low Back Pain

This study attempted to reduce patients' nonspecific low back pain without medication, manipulation, or surgery. They tested the prolonged effects of controlling lumbar flexion (forward bending) movement in the morning.

The authors emphasized to the subjects that the first two hours after rising were the most important—they should not bend, sit, or squat—and to attempt to keep a straight back during that time of the day. Squatting or kneeling was permissible for the remainder of the day, but bending was to be avoided.

The authors compared the results to a control group. The control group was advised to perform six commonly prescribed exercises, such as pelvic tilt, hamstring stretch, and side leg raise, which have been found ineffective in reducing low back pain.

Subjects in both groups were asked to keep a daily dairy that answered the following questions:

  1. How would you rate your back pain today on a 0 to 10 scale in which 0 is "no pain" and 10 is "pain as bad as it could be"?
  2. Did back pain prevent you form performing your usual work activities today (work, school, or housework)? Yes or No?
  3. Did back pain prevent you from participating in any recreational, social, or family activities today? Yes or No?
  4. Did you take any medication today (including over-the-counter medication)? Yes or no? If so, what kind?

Each week participants mailed in their responses. The questions were designed to measure pain intensity, disability, impairment, and medication usage.

The study began with 116 subjects, but due to the demanding regimen many participants dropped out; when they entered phase two, 85 subjects were involved. The treatment group had 24 subjects, and the control group had 36 patients.

Thirty�five percent of the subjects in the treatment group reduced their pain by 50% after six months of flexion control. The following chart shows the percentage decrease the patients experienced.




Pain Disability



Days in Pain






Medication Use



Overall the findings were successful, and patients who continued for six additional months reduced pain further. One additional benefit of the exercise was that it was effective for both men and women and for patients older (46-60) and younger (30-45). Also:

�"Perhaps somewhat surprising, but also encouraging, is the finding that subjects with high psychological overlay benefited as much as those with low psychological overlay, and subjects with leg pain benefited as much as those without leg pain. The only subjects who did not benefit as well were those who performed heavy physical work."

Snook SH, Webster BS, McGorry RW, et al. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. Spine 1998;23(23):2601-2607.