Flexion-Intolerant Low Back Pain

If tucking is painful, the person may be moving the lumbar spine with the pelvis instead of separating pelvic motion from low-back motion. The first principle is to find a position the person can tolerate before progressing exercise demands. If exhaling causes back pain, the exhale should be slowed, softened, controlled, and not forced. Lumbar support or prone breathing can be used when flexion-sensitive positions are not tolerated. Excessive rectus abdominis use during a drill may be addressed by tilting the head into OA extension. A full exhale may be inappropriate initially if it pushes the person into a painful end-range position. The discussed flexion-intolerant cases include herniated nucleus pulposus or disc bulge presentations, radicular symptoms, and worsening with posterior pelvic tilt during full exhalation. Flexion-intolerant back pain is a presentation in which lumbar flexion provokes symptoms.