What kind of back pain is this?
Not all lower back pain is the same, and the wrong stretch makes the wrong kind worse. Three quick questions to figure out what's going on, then a routine matched to the answer.
Stop and see a doctor if any of these apply
- · Numbness or pins-and-needles in the groin or saddle area
- · Loss of bladder or bowel control, or trouble starting urination
- · Sudden severe weakness in one or both legs (foot drop, can't lift toes)
- · Fever along with back pain
- · Unexplained weight loss along with new back pain
- · History of cancer with new back pain
- · Pain that started after a significant trauma (fall, car accident)
These can be signs of cauda equina syndrome, infection, fracture, or tumour. Go to A&E or call NHS 111. Do not try to stretch through these.
Does the pain shoot down your leg below the knee?
No, pain stays in the back
Likely non-specific mechanical low back pain — the most common type. Usually paraspinal or QL involvement. The 5-minute beginner routine is the right starting point.
Yes, it goes below the knee
Possible nerve root involvement — most often a disc bulge irritating L4, L5, or S1. Go to Question 2. The wrong stretch here makes it worse.
What makes it worse: sitting, or standing?
Sitting hurts, walking helps
Classic disc-bias pattern. Flexion (sitting, bending forward) compresses the disc. Extension (standing, walking) decompresses it. Try the McKenzie extension routine and watch for centralisation.
Standing hurts, sitting helps
Possible facet joint or spinal stenosis pattern (more common over 60). Avoid extension exercises. The acute and beginner routines are safe. See a physiotherapist if it persists past 4 weeks.
The centralisation principle (Robin McKenzie, 1981)
The single best biofeedback signal for disc-related back pain. As you do an exercise, watch where the pain lives.
- · If pain moves UP toward the spine — good. That stretch is helping.
- · If pain moves DOWN further into the leg — bad. Stop. Try the opposite direction or see a physio.
- · If pain stays the same — neutral. Continue but don't push intensity.
In Long, Donelson & Fung's 2004 trial (n=312), patients matched to extension-bias vs flexion-bias protocols using centralisation as the signal showed significantly greater improvements in pain and disability, plus a roughly threefold reduction in medication use, vs patients given mismatched or generic exercises.
How long has it been hurting?
Under 48 hours
Acute. Tissue is still reactive. Use the 4-minute acute routine — gentle decompression only.
48 hours to 6 weeks
Subacute. The acute phase has settled. The beginner routine is appropriate. Daily is more important than long.
Over 12 weeks (chronic)
Chronic. Get an assessment if you haven't. Then the maintenance routine daily, plus address the load chain (hip flexors, glutes).
Tightness vs strain vs DOMS
| Sensation | Worse when | Better when | What to do |
|---|---|---|---|
| Tightness Dull, achy, sticky | After sitting; first thing in the morning | After moving; after stretching | Stretch. Daily routine. |
| Strain Sharp, specific spot | Specific movements (twist, bend, lift) | Avoiding the specific movement | Acute routine for 48-72 hrs, then beginner |
| DOMS Diffuse muscle soreness | 24-72 hrs after unusual exercise | Light movement, blood flow | Beginner routine, hot bath |
| Nerve Burning, electric, pins-and-needles | Sitting (often); coughing | Standing; specific positions | See physio. Centralisation test first. |