Muscle flexibility, strength, endurance, and chronic back pain

How can you tell if your flexibility is affecting your back pain?

There is an easy test to see if your lack of flexibility is contributing to your back or buttock pain. Simply sit in a chair and cross one leg over the other and bend your trunk forward. If this produces some of your pain, there is a high likelihood that improving your muscle flexibility may decrease your pain.

Do this with your other leg and see if there is a difference. If there is a noticeable difference from side to side, it may mean the muscles on your painful side are substantially shorter than the muscles on your non-painful side. If you hurt on both sides, or even your “good” side, this indicates improving your flexibility may reduce your pain.

Next, muscles must have the strength to be able to generate enough force to control our joints. Our gluteal (buttock) muscles must generate force to control our pelvis while standing on one leg. This concept is something we all learned when we were learning to walk. We figured out that if we can stabilize our hip, we can put all of our weight on that one leg. If we stabilized the other hip, we could take another step. By repeating this process, we learned how to walk.

What happens when a skeletal muscle is starved of oxygen or nutrients?

Frequently the muscles make lactic acid, which further starves them of vital oxygen and nutrients. Muscles then develop localized trigger points that can be felt just under the skin and fatty tissues. Some people are even sensitive enough that they feel these areas swell or enlarge temporarily. It is easy to become alarmed when these feelings happen.

However, you really should just think of these trigger points as occurring because the muscle doesn’t have sufficient flexibility, strength, or endurance to perform required work. Any change or problem with a particular muscle’s flexibility, strength, or endurance can cause pain receptors to start firing and signal to the spinal cord that something is wrong. The best way to minimize these signals is to improve your overall flexibility, strength, and endurance. Muscles repair and rebuild themselves through a consistent and rigorous exercise program.

First, muscles must have enough flexibility or “stretchiness.” One way to think of muscles and tendons is to compare them with rubber bands. When we are young, muscles and tendons have natural elastic properties. That’s why children and teenagers do not usually have chronic pain. As we get older, we lose these elastic properties and some flexibility. The stretching exercises taught in physical education classes are intended to encourage a lifelong habit of stretching and maintaining flexibility.

When a short, tight muscle is stretched, pain receptors within the muscle naturally respond to alert the spinal cord. Some experts believe these sensors are calibrated incorrectly or are responding to faulty information, therefore causing chronic pain.

Weight gain’s effect on your muscles and back pain

Another important thing to remember is that our muscles are accustomed to moving our current weight. If you gain an extra 50 pounds, those buttock muscles have a much harder job controlling your hip and are more prone to being strained or injured by sudden or unexpected activity. Even slight gains in weight may lead muscles that were previously able to compensate without back pain to become painful.

Knee pain, foot pain, and even neck pain are not uncommon as people gain weight. Going up stairs requires your muscles to propel your entire body weight vertically and increases the demand on other joints and muscles. Many patients also have knee pain along with their back pain. Keep an eye on your weight and do what you can to maintain a healthy weight and a regular exercise program.

Endurance and your muscles

Muscles must have sufficient endurance, or the ability to contract repeatedly over a period of time. Standing for 15 seconds activates the same muscles as standing for two hours. So, if you can stand for 15 seconds, you have sufficient strength. If there is no way you can stand comfortably for two hours, then the only difference is explained by endurance.

Usually if a person does not have enough flexibility or strength to start an activity, then having the endurance to continue the activity is even less likely. Consider discussing a regular cardiovascular or aerobic exercise program with your provider.

Exercise to relieve your back pain

It doesn’t matter whether you walk, run, swim, or bike—what matters is a consistent record of activity. Your muscles only understand recent activity. This is like a “bank” of energy that your muscles need to use whenever you move your body. A heavier body requires you to make more withdrawals. You can’t keep borrowing from this bank without contributing to it on a regular basis.

Many people with chronic back pain tell us they are already exercising. In that case, what your back pain is telling you is your exercise program is still not sufficient to control your body’s muscles and current weight requirements. We recommend you increase your exercise regimen even more for another 6 to 12 weeks and see if you still have pain. If you do, then you’ll likely need to do even more exercise. Talking with a physical therapist or physician at that time may be a reasonable plan.

Last reviewed: 
April 2018

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