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Classifying Low Back Pain

As a physical therapist, I often work with patients who are experiencing low back pain and radicular symptoms, which can be caused by a variety of factors including injury, poor postural variability, or underlying medical conditions. One of the key concepts that I discuss with my patients is the idea of extension bias versus flexion bias, which refers to the way that different movements can exacerbate or alleviate their symptoms.

Extension bias and flexion bias are terms used to describe the way that a patient’s low back pain and radicular symptoms are affected by certain movements. Extension bias is characterized by pain or discomfort that is worsened by activities that involve backward bending of the spine, such as standing up from a seated position or leaning back. Flexion bias, on the other hand, is characterized by pain or discomfort that is worsened by activities that involve forward bending of the spine, such as sitting or bending over to tie one’s shoes.

It is important to note that not all patients will exhibit a clear extension or flexion bias, and some may experience symptoms that are worsened by both types of movements. However, understanding a patient’s bias can be helpful in developing an effective treatment plan.

For patients with an extension bias, physical therapy may focus on exercises that involve forward bending of the spine, such as the cat-cow stretch or pelvic tilts. These movements can help to mobilize the spine and reduce tension in the lower back muscles, which can in turn alleviate pain and discomfort.

For patients with a flexion bias, physical therapy may focus on exercises that involve backward bending of the spine, such as the cobra pose or the upward-facing dog pose in yoga. These movements can help to stretch the muscles of the lower back and increase mobility in the spine, which can help to reduce pain and discomfort.

It is important to note that physical therapy for low back pain and radicular symptoms is highly individualized, and there is no one-size-fits-all approach. A skilled physical therapist will work with each patient to identify their specific symptoms and develop a customized treatment plan that takes into account their unique needs and goals.

In addition to exercise and stretching, physical therapy for low back pain and radicular symptoms may also involve other interventions such as manual therapy, and education on proper body mechanics and postural variability. By taking a comprehensive approach to treatment, physical therapists can help patients to manage their symptoms and improve their overall quality of life.

In conclusion, extension bias and flexion bias are important concepts to understand when working with patients who are experiencing low back pain and radicular symptoms. By identifying a patient’s bias and developing a customized treatment plan that addresses their specific needs, physical therapists can help to alleviate pain and discomfort and improve overall function and mobility. If you are experiencing low back pain or radicular symptoms, I encourage you to consult with a skilled physical therapist to develop a treatment plan that can help you to manage your symptoms and achieve your goals.

Dr. Daniel Komforti, Physical Therapist
AUTHOR
Dr. Daniel Komforti
PT, DPT, CIDN, SFMA-C
On a mission to help active adults change their narrative and stay active for a lifetime with more confidence.
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