• William Farrell

Back sore but bending backwards has no pain? = Clinical insight gained for low back pain diagnosis!


Lower back pain aggravated by spinal extension movement (bending backwards) can result from irritation of many underlying spinal pain-producing structures, including muscles, joints, and ligaments. Bending a patient's lower back backward is a key part of orthopedic testing used in offices for anyone who treats back pain, especially chiropractors. A solid clinical workup for lower back pain will perform this movement to test the range of motion in the lower back and provide insight into what structure is likely causing a patient's lower back pain. Understanding the spinal structures responsible for a patient's back pain is key to ensuring they are provided with the most appropriate treatment recommendations.


Backward bending is a sensitive test for lower back pain but is not specific to one tissue structure. However, one spinal structure called "facet joints" are aggravated almost 100% of the time when this test is performed if they are irritated.

Since facet joints represent the second most probable pain source for low back pain patients under 55 (spinal discs are number one), diagnostic thinking shifts away from facet joint pain when this test is negative (it does not produce pain). This observation has potentially great clinical value for back pain patients considering a facet joint injection as part of their therapy for back pain. A facet joint injection is less likely to provide much relief if you can bend backwards without pain. If you can bend back without pain, other spinal structures are more likely to be causing your back pain. If previous facet joint injections did not significantly benefit your pain and you can bend back without pain, other treatment targets should be considered.



Bending backward or "extension loading "of the lower back has the mechanical effect of offloading the disc structures in your lower back. For this reason, patients experiencing low back pain with a diagnosis of a herniated or bulging disc often find this position somewhat relieving. A common rehabilitation exercise program for low back disc pain, "Mackenzie Exercises," is based on spinal extension loading of the lower back for lower back disc pain relief. Of course, a diagnosis cannot be made on this observation alone. However, when made in conjunction with a thorough history and exam conducted by a trained professional, this observation can be key to directing treatment more appropriately to deliver a patient's low back pain relief!


If you've had low back pain that is not improving with treatment and spinal extension (back bend) was not tested in your assessment, it's time for a second opinion. Similarly, if a previous facet joint injection did not bring benefit and bending backward improves your pain or does not produce any, let one of our team members at the Radix Pain & Rehabilitation Centre conduct a review. Let's get to the root of the issue in your tissues!