Understanding Flexion and Extension: The Key to Managing Back Pain

Why This One Distinction Matters So Much

At The Back Specialists, one of the first questions we ask isn’t, “Where does it hurt?” It’s:

“What movement makes it worse?”

The way your spine responds to flexion (bending forward) and extension (arching backward) tells us more than any MRI or X-ray ever could.

Here’s why:

• Flexion-intolerant backs get worse with movements like tying shoes, sitting too long, or picking things up off the floor.

• Extension-intolerant backs flare up with prolonged standing, walking, or arching the back during exercises like yoga or overhead lifting.

  
  

These movement patterns aren’t just symptoms—they’re the key to unlocking the solution.

What Is Flexion-Based Back Pain?

Flexion refers to bending forward at the spine. This is the motion you use when:

• Sitting at a desk

• Slouching on the couch

• Reaching forward to pick up a box

• Stretching your hamstrings (yes, that one too!)

  
  

Flexion-Intolerant Pain Often Feels Like:

• A deep, dull ache in the lower back

• Pain that increases when sitting too long

• Stiffness when standing up after sitting

• Sciatica-like symptoms down one leg (in some cases)

  
  

What’s Usually Going On?

In flexion-based pain, the spine’s posterior elements—discs, nerves, or ligaments—may be irritated due to repeated forward bending or poor spinal stability.

Stuart McGill’s research shows that too much flexion under load (like repeated bending, slouching, or improper lifting) increases stress on spinal discs. Over time, this can lead to:

• Disc bulges or herniations

• Nerve irritation

• Loss of core stiffness

  
  

The Wrong Approach?

Many people with flexion pain instinctively stretch more—especially hamstrings and lower back—because it “feels tight.” Unfortunately, this usually makes things worse.

What Is Extension-Based Back Pain?

Extension is arching the back, or the motion you use when:

• Standing tall or walking for long periods

• Reaching overhead

• Doing backbends or cobra stretches

• Performing exercises like deadlifts or back extensions

  
  

Extension-Intolerant Pain Often Feels Like:

• Sharp pain in the lower back when standing or walking

• Discomfort when lying on the stomach

• Tightness or burning in the lower back with overhead reaching

• Sometimes pain that eases when sitting down or leaning forward

  
  

What’s Usually Going On?

Extension-based pain can stem from compression or jamming in the back of the spine—often due to poor movement patterns or weakness in stabilising muscles.

Common contributing factors include:

• Weak deep abdominal control

• Tight hip flexors or lumbar erectors

• Poor glute activation

• Lack of thoracic mobility, forcing the lower back to overcompensate

  
  

How We Use This at The Back Specialists

We don’t treat pain blindly. We use advanced testing systems like SFMA (Selective Functional Movement Assessment) and the McGill Method to identify your unique movement signature.

Our Mini-Assessment helps answer:

• Are you flexion or extension intolerant?

• Is the pain coming from joint overload, nerve irritation, or movement compensation?

• Is your pain directional (worse in one movement, better in another)? If so—we can use that to your advantage.

  
  

We can then build a customised plan based on your movement diagnosis, not just your symptom description.

Real-World Example – Sarah’s Story

Sarah was a 38-year-old runner who came in with ongoing back pain that flared up after long walks or standing at work. She had been doing yoga backbends and bridges religiously, thinking it would “mobilise her spine.” But the real issue? She had an extension-intolerant spine—and every time she arched her back, she was feeding the fire.

Once we identified this, we removed the offending movements, stabilised her core, improved hip mobility, and taught her how to move without compressing her lower spine. Within three weeks, her symptoms had reduced by 60%, and she was running comfortably again by week six.

What You Can Do Right Now

Here are 3 quick checks you can try at home:

1. Toe Touch Test

Stand and slowly try to touch your toes.

• 🔺 Pain or tightness = Possible flexion intolerance

  
  

2. Standing Back Bend

Stand tall, place your hands on your hips, and gently lean backward.

• 🔺 Pain or jamming = Possible extension intolerance

  
  

3. Sitting vs Standing

• 🔺 Feels worse when sitting = Likely flexion-related

• 🔺 Feels worse when standing/walking = Likely extension-related

  
  

Important: These aren’t diagnoses—just clues. A full movement assessment is the gold standard.

What NOT to Do

If you’ve tried everything (stretching, massage, Pilates, injections) but nothing sticks, there’s a good chance you’re:

• Doing the right exercises—but for the wrong back pain type

• Treating pain generically—instead of based on your movement profile

• Missing underlying movement dysfunctions

  
  

We see this every day—and fix it.

Your Next Best Step

Want to know what type of back pain you have?

✅ Take our free 2-minute quiz to find out what’s likely causing your pain and get customised tips right away:

👉 https://www.thebackspecialists.ie/what-s-causing-my-back-pain

Or if you’re ready for expert guidance and a clear plan:

✅ Book your €49 Mini-Assessment with one of our Back Pain Specialists. Spots are limited each week.

👉 https://john-awicuhcq.scoreapp.com

Final Thought

Flexion vs Extension back pain is one of the most overlooked distinctions in the world of rehab and recovery. But once you know which pattern applies to you, you can stop guessing—and start progressing.

You’re not broken. You just haven’t been seen properly.

We got your back.

---wix---