Michael Lee: A Neurophysiological Perspective on Chronic Low Back Pain
Michael Lee, Co-Founder of KinaPT, Physical Therapist at Kaiser Permanente, shared a post on LinkedIn:
”Let me make a clinical argument that the ‘stretch your back pain away’ prescription is doing patients more harm than good – not because stretching is harmful, but because it addresses the wrong target.
Every day, patients with chronic low back pain are told to stretch.
Stretch the hamstrings.
Stretch the hip flexors.
Foam roll the glutes.
Release the tension.
It feels productive. The research on what’s actually happening is more complicated.
Muscle tightness in chronic LBP is not primarily a structural problem. The tissue isn’t short. The nervous system has created increased tone as a protective response to perceived threat – whether that threat is tissue damage, fear of movement, psychological stress, or all three. The muscle is doing exactly what the brain is telling it to do.
Stretching that tissue produces temporary local relief. But it doesn’t modify the threat perception driving the response. The tightness returns because the signal driving it was never addressed.
The evidence based intervention for protective muscle tone is not passive lengthening. It’s graded movement exposure, load tolerance training, and the accumulation of safety signals that gradually down regulate the threat response. That’s a fundamentally different approach -and a more demanding one- than a daily stretching routine.
Why do we keep prescribing structural solutions to a neurological problem?”
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