Low Back Pain and Ergonomics

Most Low back pain has a direction bias that alleviates the symptoms. Usually, directional bias for decreasing low back pain can be either a position of lumbar flexion or lumbar extension. More complicated and less common cases may include lateral flexion and rotation. This strategy of treatment has shown to be more effective than nondirectional treatment or general exercise for low back pain with radicular symptoms (pain traveling down the legs from a nerve root compression) and non-radicular pain. 1,2,3,

Lumbar flexion may alleviate your symptoms if your pain is due to:

  • Facet joint irritation
  • Vertebral canal stenosis
  • Intervertebral foramen stenosis
  • Anterior longitudinal ligament sprain
  • Spondylolthesis
Flexing forward at the trunk without maintaining a neutral spine causes lumbar flexion

Lumbar extension may decrease your pain if you suffer from:

  • Lumbar disc herniation
  • Posterior longitudinal ligament sprain
  • Ligamentum flavum sprain
  • Supraspinous ligament sprain
  • Lumbar Paraspinal muscle strain
Pressing upwards with your arms while on your stomach increases lumbar extension

As you can see your low back pain can be caused by a variety of injuries and conditions. It is important that you visit a chiropractor to correctly diagnose the cause of the pain in order to ensure your treatment plan is effective. Chiropractors can also rule out red flags that may require immediate medical attention and can refer you to the correct medical professional if needed.

Low back Directional Preference and Standing

When standing up right with good posture will emphasize lumbar extension.

By placing one foot on an elevated surface while standing you can emphasize lumbar flexion on the left or right side of your lumbar spine.

Low back Directional Preference and Sitting

Sitting predominantly causes the lumbar spine to flex.

To increase the amount flexion of the lumbar spine you can place a stool under your feet.

To decrease the amount flexion of your lumbar spine you can place a lumbar support pillow at the low back region.

Low back directional preference while lying on your back

Lying on your back with your knees and hips flexed will increase lumbar flexion. You can also use a pillow and place it under your knees as well.

Lying on your back with your legs straight will emphasize lumbar extension.

Low back directional preference while lying on your stomach

Lying on your stomach will place the lumbar spine into extension. To increase the extension you can press your upper body upwards with your arms while keeping your hips in contact with the ground. Another alternative to increase lumbar extension is placing a pillow under the chest.

By placing the pillow under your abdomen while lying face down you are emphasizing lumbar flexion.


Understanding biomechanics of the lumbar spine are important if you experiencing low back pain. By knowing how to increases lumbar spine flexion/extension in common positions, you can better manage your low back pain and also avoid any stress that may provoke your symptoms. This blog post does not include compressive forces and I suggest you contact your chiropractor to better understand your low back pain and make forward progress in terms of your recovery.


  1. Audrey, L, Donelson, R, and Fung, T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 29 (23): 2593-2602, 2004.
  2. Austin N, Difrancesco LM, and Herzog W: microstructural damage in atrial tissue exposed to repeated tensile strains. J Manipulative Physiol Ther 33 (1): 14-19, 2010.
  3. Surkitt, LD, et al: Efficacy of directional preference management for low back pain: a systematic review. Phys Ther 92(5): 652 – 665, 2012.

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