Low back pain ranks second only to headache as a reason for medical office visits in the USA. The cost to the community in time lost from work, compensation payments and medical fees in is in excess of $100 billion/year. The most pathetic aspect of this statistic is that the major sources of low back pain: posture, stress, sedentary life style, obesity and tobacco usage, are amenable to individual control. 

So let's begin with a few words on posture. Good or bad are not useful terms in this context: what works and what doesn't is what it's all about.

Observed from the front or back, a golf ball dropped from the topmost point of the skull should evenly bisect the body, falling equidistant between the feet. The hips and shoulders should be level. From the side, that ball should pass through the center of the ear, the shoulder, the hip joint, the knee and the front of the ankle. This should result in a gentle curve (lordosis) to the front in the lower back, the same in the neck, and a curve posteriorly in the upper back (kyphosis).

This posture works, because with these relationships in place, very little muscle action is necessary to maintain the body in the erect position. As a matter of fact, with the optimal alignment described above, there is significant electrical activity principally, in the psoas major muscles and only to a slight degree in the calf muscles. Movement from this posture uses less energy and is therefor more efficient.

The psoas major is a deep and powerful muscle. It arises on each side from the sides of the lower back (lumbar) vertebrae and runs downward, across the front of the hip joints to insert into the back of the upper thigh. It acts to bend the trunk forward on the pelvis, pulls the lumbar spine into a swayed position and flexes the hips. 


Good posture depends on balance between the psoas major, rectus femoris and other trunk flexors on the one hand, and the abdominals, gluteals and hamstrings on the other.

The Psoas Dysfunction/Insufficiency Syndrome: Shortening or tightness of the psoas, associated with weakness of the abdominal muscles produces profound alterations in body mechanics and alignment resulting in excessive and inappropriate muscle exertion. The ensuing increase in the normal forward curve or hollow (lordosis) of the lower back is the most common postural defect producing low back pain. This is due to shortening and tightening of the muscles of the lower back, and to increased shearing forces on the intervertebral discs, the cushions between the vertebrae. At the same time, the small spinal (facet) joints) which are intended principally to guide movement, are forced into the abnormal function of weight bearing. As a result of these factors, the intervertebral discs degenerate and arthritic changes develop in the facet joints. The bottom line: back pain.

Treatment and prevention of low back pain depends, to a great extent, on exercises and stretches designed to correct these and other postural defects. The effectiveness of any such program, is, of course, dependent not on what you’re told to do, but rather, your actions. You should perform none of the following stretches or exercises without the full knowledge of your physician or therapist.

Gluteal muscles, hamstrings, the iliotibial bands on the outside of the thighs and the muscles of the lower back commonly requiring stretching. Abdominal, gluteal and lower back strengthening exercises are of major importance.

Aerobic activity such as stair climbing, step or low impact aerobics, walking, swimming, bike riding, etc. may be another key to prevention of low back pain. Aerobically fit people have significantly less low back pain, and they are able to better tolerate stress.

Stress may produce a state of chronic muscle contraction decreasing circulation and increasing the concentration of the toxic products (lactic acid and potassium ions) of muscle activity which stimulate nerve endings to generate low back pain. Deep breathing and progressive muscle relaxation exercises may serve to diminish this stress reaction. Participation in recreational sports such as golf, tennis, racketball, jogging, swimming, and even weight training etc. in the absence of contraindications, may further reduce stress levels.

Excessive weight, because of the increased muscle work requirement and because of the forward drag of a protuberant abdomen on the spine, increasing the lordosis, will generate and/or perpetuate low back pain. Weight reduction through dietary control and behavioral modification is another essential part of a back pain program in the presence of even moderate obesity.

Cigarette smoking or other tobacco consumption will decrease blood flow to the vertebrae, and promote disc degeneration. Additionally, smoker's cough increases the pressure on the small blood vessels around the spinal cord and its lining, and can generate back pain.

Stretches to counter-act psoas tightness are an essential part of the program: 

Iliotibial band stretch

  • Lie on your back, cross one knee over the other. 
  • Gently pull knees to chest. 
  • Hold stretch for 20 seconds 

Gluteal and Piriformis stretch

  • Sit at edge of chair. 
  • Cross ankle over knee. 
  • Keep hands on shin of upper leg. 
  • Keep back striaght. 
  • Gently lean forward. 
  • Hold 20 seconds. 

Psoas stretch

  • The left foot is placed forward, the knee and hip flexed to 90°.
  • The right leg is extended backward in a straight line with the back, weight on the ball of the right foot.
  • The stretch should be felt through the front of the right hip.
  • The stretch is then performed with the left leg back, then repeated on the right. 
  • Each is held for 20 to 30 seconds. 

Hamstring stretch

  • Sitting on chair.
  • Keep back straight.
  • Extend one leg out, heel on floor, toes up.
  • Slowly lean forward, keeping your back striaght.
  • Hold for 20 seconds.
  • Repeat on other side.


Although the exact cause of most cases of low back pain may be unknown, enough is known about the contributing factors described above to conclude that the incidence and severity of back pain attacks may be significantly reduced by adherence to a program such as outlined above. This program is incorporated into the treatment protocol at the Catskill Rehabilitation & Sports Medicine. So, if back pain is one of your problems, give us a call.