Is stretching good for lower back pain?
If you have chronic lower back pain, it’s important to first understand what is causing your pain before starting any treatment program, including stretches or yoga. If your doctor has diagnosed you with SI joint dysfunction, and this is what’s causing your lower back pain, stretching and strengthening your muscles in your core and pelvis may be one of the first steps in your non-surgical treatment plan. Three or more positive provocative tests may indicate your SI joint is the cause of your lower back pain. If you don’t have a doctor who is trained in SI joint care or isn’t experienced in SI joint diagnostic tests, you can find one here.
After a full physical evaluation, your physician or physical therapist may recommend specific exercises and stretches to strengthen and lengthen muscles that directly or indirectly attach to your sacrum and ilium. Your SI joints are located on each side of your sacrum. Your sacrum is a bony structure that is at the base of your spine and is centered in your pelvis. Your ilium is the largest part of your hip bone (the part you rest your hands on, when you put your hands on your hips).
Typically, your SI joints have minimal movement (no more than 2 mm to 4 mm in any direction125). With SI joint dysfunction, these joints move too much or too little, which can cause pain in the lower back, legs, buttocks, and groin. Weak, shortened, tense, or imbalanced muscles may contribute to or worsen SI joint pain, but they are not likely the cause. SI joint dysfunction is caused by trauma and/or degeneration (see examples).
What do we mean by imbalances in the surrounding muscles? Some examples of patients with this issue may include those that suffer from:
- A lack of full internal rotation of the hip, which will also prevent a short muscle on one side of the joint from affecting joint position and/or motion. (reference: rehabilitation)
- Shortened or tight quadriceps (muscles on the front and sides of the thigh) and quadratus lumborum (the deepest muscle in your abdomen, close to the back) (reference: patient stories), which can contribute to SI joint stress and lower back pain
- Weakened core muscles, which can put added strain on the lower back (reference: patient story Bob)
Remember, these are just individual examples. Your body is unique, and only your doctor or physical therapist can help you understand what might be causing your SI joint pain and which stretches may help relieve your lower back pain.
Best lower back stretches to ease pain related to the SI joint
Although there are no published clinical studies that evaluate the effectiveness of yoga or stretching for lasting improvements in SI joint dysfunction or pain, one study has suggested that stretching can be an important part of an overall non-surgical treatment plan by helping strengthen ligaments and muscles that support the SI joint.125
So, which stretches relieve lower back pain caused by the SI joint? Here are three popular stretches your physical therapist or doctor may recommend:132
Knee to chest stretch: While lying comfortably on your back, bring your knee to your chest and hold the back of your thigh. Hold for 30 seconds. Breathe deeply. Release slowly and repeat with the other leg.
Bridges: While lying on your back, knees bent and feet flat on the floor, slowly raise your hips to the ceiling, hold for a few seconds, then slowly bring your hips back to the floor and rest for a few seconds. Repeat a few times. Remember to breathe and stop if it hurts.
Open clamshell: While lying on your side, knees bent, and your head comfortable in your arm or on a pillow, raise your top knee up toward the ceiling while keeping your ankles together. Slowly release. Repeat a few times. Roll over to do the other side.
Remember, move slowly and stop if it hurts. Before attempting these stretches, be sure to ask your doctor if they are right for you. If your doctor is unaware of stretches that are specific for lower back pain related to the SI joint, consider contacting a physician in your area that has been trained in SI joint care.
Should I stretch my lower back if it hurts?
Do not do stretches that cause or worsen your back pain.
Some stretches can feel good, and some stretches can provide a level of discomfort that feels different for different people. But pain is not the goal. Your physical therapist will likely suggest that you remember to breathe deeply when stretching, and if it begins to hurt, ease off or completely stop that stretch.
When you’re doing stretches, if anything hurts, stop, and discuss your exercises with your doctor.
If your doctor has recommended stretching as part of your SI joint treatment plan, ask how each stretch should feel and discuss your level of comfort (and discomfort!). Your doctor may have critical modifications for you that help the exercises become not only more comfortable, but also protect you from further injury and pain.
Should you stretch your lower back if you are pregnant?
If the SI joint pain in your lower back is due to pregnancy, talk to your doctor about your options before trying any stretches to relieve the pain. A back brace or SI joint belt may be a better option. “Belts applied to hold the sacroiliac joints in place have equal benefit as a home exercise program or a structured clinical exercise program in pregnancy-induced sacroiliac joint dysfunction”.125
SI joint back braces are not just for pregnancy. An SI belt or lower back brace, which is a non-elastic strap placed temporarily around the pelvic joints, may reduce the feeling of abnormal movement and may help to relieve symptoms of lower back pain51,52 in anyone with SI joint dysfunction.
Next step: talk to your doctor about the best lower back stretches for you and your treatment plan as a whole
If you have followed a non-surgical treatment plan for your lower back pain caused by SI joint dysfunction for six months or more, and your pain has not improved or worsened, consider talking to a trained physician about SI joint fusion.
Additional resources for lower back pain relief
- True patient story: Barbara is prescribed stretching to help ease pain related to SI joint dysfunction
- Abnormal muscle length balance: rehabilitation for SI joint pain
- How to prepare for SI Joint physical therapy that may include stretches for lower back pain
- Is your lower back pain sciatica?
- Stretching for post-partum pelvic girdle pain in the lower back