The reduction of cLBP through control of early morning flexion Snook SH, et al Spine 1998 Dec.

Conclusions: “The treatment group was given instructions in reduction of morning flexion; the control group was given six exercises shown to be ineffective for LBP. Significant reductions in pain intensity were found in treatment group vs, control. After similar instructions to the control group the response was similar reductions in pain”.

Dr. Kennedy comment: this is a consistently cited study and we’ve discussed the implications at the seminars for years…the natural disc swelling after sleeping imposes ligament tension changes which reduce the neutral-zone in flexion (and rotation). With instruction and specific efforts to dramatically reduce flexion (as well as rotation) soon after arising (and my experience suggests this “control of flexion is always a prudent idea throughout the day) most patients with cNSLBP (the majority of us) can be well served and have days & weeks of disability reduced or eliminated. Interestingly the sham-exercises served no apparent benefit even though they are the most often prescribed for LBP. McGill has referred to such exercises: knee-to-chest, hip side-to-side rolls, toe touches, side bends and the like as “silly and pointless”.

There appears to be less efficient “disc-fluid-reduction” in some patients with cLBP and reduction of flexion for several hours (not just the first hour after arising) serves them even better.