Brazilian Journal of Pain
Brazilian Journal of Pain
Review Article

Mechanisms of muscle stretching exercises for reduction of low back pain: narrative review

Mecanismos de exercícios de alongamento muscular para redução de dor lombar: revisão narrativa

Luís Felipe Câmara-Gomes; Almir Vieira Dibai Filho; Renata Rodrigues Diniz; Poliane Dutra Alvares; Christiano Eduardo Veneroso; Christian Emmanuel Torres Cabido

Downloads: 7
Views: 717


BACKGROUND AND OBJECTIVES: Stretching exercises are present in physical training and muscle rehabilitation programs. Within the context of rehabilitation of patients with low back pain (lombalgy), there is still a gap about the mechanisms that these exercises should reduce pain and disability in these patients. The aim of this study was to investigate what are the possible mechanisms through which muscle stretching exercise could reduce pain in individuals with chronic low back pain.

CONTENTS: Pain in the lumbar region is one of the most disabling pains when it comes to limitations for daily functions, so it’s necessary to investigate alternatives that provide relief for these patients. As the cause of non-specific chronic low back pain is multifactorial, the treatment of the pathology occurs mainly to reduce the sensation of pain. As an alternative, the flexibility training through stretching exercises can be efficient because they generate biomechanical and sensory changes, which would result in an analgesic effect. Additionally, it’s still possible that these two effects occur together to explain the reduction in low back pain after performing stretching exercises.

CONCLUSION: There is theoretical basis in the literature to support the performance of stretching exercises as a non-pharmacological strategy for the treatment of chronic low back pain. Biomechanical and neurophysiological mechanisms can be pointed out to explain these benefits.


Low back pain, Muscle stretching exercises, Pain


JUSTIFICATIVA E OBJETIVOS: Exercícios de alongamento estão presentes em programas de treinamento físico e reabilitação muscular. Dentro do contexto da reabilitação de indivíduos com dor na região lombar (lombalgia), ainda existe uma lacuna sobre os mecanismos pelos quais esses exercícios reduzem dor e incapacidade nesses pacientes. O objetivo deste estudo foi descrever os possíveis mecanismos pelos quais o exercício de alongamento pode reduzir dor em indivíduos com lombalgia crônica.

CONTEÚDO: A dor na região lombar é uma das dores mais incapacitantes quando se trata de limitações para as funções no cotidiano. Por isso, é necessário investigar alternativas que possam proporcionar o seu alívio nesses pacientes. Considerando que a causa da lombalgia crônica não específica é multifatorial, o tratamento desta doença ocorre principalmente na tentativa de reduzir a sensação dolorosa. Como alternativa, o treinamento da flexibilidade por meio de exercícios de alongamento pode agir reduzindo a dor lombar por gerarem alterações biomecânicas e sensoriais que resultam em efeito analgésico. Adicionalmente, ainda é possível que esses dois efeitos possam atuar em conjunto para explicar a redução da dor lombar após a realização de exercícios de alongamento.

CONCLUSÃO: Existe suporte teórico na literatura para sustentar a realização dos exercícios de alongamento como estratégia não farmacológica para o tratamento da dor lombar crônica. Mecanismos biomecânicos e neurofisiológicos poderiam ser apontados para explicar tais benefícios.


Dor, Dor lombar, Exercícios de alongamento muscular


DeSantana JM, Perissinotti DM, Oliveira Júnior JO, Correia LM, Oliveira CM, Fonseca PR. Definição da dor revisada após quatro décadas. BrJP. 2020;3(3):197-8.

Shariat A. Musculoskeletal disorders and their relationship with physical activities among office workers: a review. Malaysian J Public Health Med. 2016;16(1):62-74.

Hayden JA, van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med. 2005;142(9):765-75.

Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation?. Phys Ther. 2010;90(3):438-49.

Chou R. In the clinic. Low back pain. Ann Intern Med. 2014;160(11):ITC6-1.

Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(3):23.

Vassilaki M, Hurwitz EL. Insights in public health: perspectives on pain in the low back and neck: global burden, epidemiology, and management. Hawaii J Med Public Health. 2014;73(4):122-6.

Reme SE, Shaw WS, Steenstra IA, Woiszwillo MJ, Pransky G, Linton SJ. Distressed, immobilized, or lacking employer support? A sub-classification of acute work-related low back pain. J Occup Rehabil. 2012;22(4):541-52.

Nepomuceno P, Schmidt LS, Glänzel MH, Reckziegel MB, Pohl HH, Reuter EM. Low back pain, anthropometric indexes and range of motion of rural workers. BrJP. 2019;2(2):117-22.

Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976). 2014;39(7):556-63.

Yang JH, Suk KS, Lee BH, Jung WC, Kang YM, Kim JH. Efficacy and safety of different aceclofenac treatments for chronic lower back pain: prospective, randomized, single center, open-label clinical trials. Yonsei Med J. 2017;58(3):637-43.

Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP. Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-83.

Lee JH, Kim TH. The treatment effect of hamstring stretching and nerve mobilization for patients with radicular lower back pain. J Phys Ther Sci. 2017;29(9):1578-82.

Keane LG. Comparing AquaStretch with supervised land based stretching for chronic lower back pain. J Bodyw Mov Ther. 2017;21(2):297-305.

Lawand P, Lombardi Júnior I, Jones A, Sardim C, Ribeiro LH, Natour J. Effect of a muscle stretching program using the global postural reeducation method for patients with chronic low back pain: A randomized controlled trial. Joint Bone Spine. 2015;82(4):272-7.

Puppin MAFL, Marques AP, Silva AG, Futuro Neto HA. Stretching in nonspecific chronic low back pain: a strategy of the GDS method. Fisioter Pesqui. 2011;18(2):116-21.

França FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. J Manipulative Physiol Ther. 2012;35(4):279-85.

Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011;171(22):2019-26.

Sousa FAEF, Pereira LV, Cardoso R, Hortense P. Multidimensional pain evaluation scale. Rev Latino-Am Enfermagem. 2010;18(1):3-10.

Chimenti RL, Frey-Law LA, Sluka KA. A mechanism-based approach to physical therapist management of pain. Phys Ther. 2018;98(5):302-14.

Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T. Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017:CD008609.

Cabido CE, Bergamini JC, Andrade AG, Lima FV, Menzel HJ, Chagas MH. Acute effect of constant torque and angle stretching on range of motion, muscle passive properties, and stretch discomfort perception. J Strength Cond Res. 2014;28(4):1050-7.

Ramos M, Cruz CA, Laurentino MF, Ashmawi HA, Santos FM, Chacur M. Effects of neural mobilization on individuals with chronic low back pain. BrJP. 2020;3(3):205-12.

Iwata M, Yamamoto A, Matsuo S, Hatano G, Miyazaki M, Fukaya T. Dynamic stretching has sustained effects on range of motion and passive stiffness of the hamstring muscles. J Sports Sci Med. 2019;18(1):13-20.

Wanderley D, Lemos A, Moretti E, Barros MMMB, Valença MM, de Oliveira DA. Efficacy of proprioceptive neuromuscular facilitation compared to other stretching modalities in range of motion gain in young healthy adults: a systematic review. Physiother Theory Pract. 2019;35(2):109-29.

Behm DG, Blazevich AJ, Kay AD, McHugh M. Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Appl Physiol Nutr Metab. 2016;41(1):1-11.

Konrad A, Stafilidis S, Tilp M. Effects of acute static, ballistic, and PNF stretching exercise on the muscle and tendon tissue properties. Scand J Med Sci Sports. 2017;27(10):1070-80.

Magnusson SP, Aagard P, Simonsen E, Bojsen-Møller F. A biomechanical evaluation of cyclic and static stretch in human skeletal muscle. Int J Sports Med. 1998;19(5):310-6.

Stathokostas L, Little RM, Vandervoort AA, Paterson DH. Flexibility training and functional ability in older adults: a systematic review. J Aging Res. 2012;2012:306818.

Gajdosik RL. Passive extensibility of skeletal muscle: review of the literature with clinical implications. Clin Biomech (Bristol, Avon). 2001;16(2):87-101.

McNair PJ, Stanley SN. Effect of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint. Br J Sports Med. 1996;30(4):313-8.

Gosselin LE, Adams C, Cotter TA, McCormick RJ, Thomas DP. Effect of exercise training on passive stiffness in locomotor skeletal muscle: role of extracellular matrix. J Appl Physiol. 1998;85(3):1011-6.

De Deyne PG. Application of passive stretch and its implications for muscle fibers. Phys Ther. 2001;81(2):819-27.

Wattananon P, Prasertkul W, Sakulsriprasert P, Laskin JJ. Effect of increased relative stiffness of the lumbar spine on hamstring muscle stretching in individuals with a history of low back pain suspected to have a clinical lumbar instability: a randomized crossover design. Clin Biomech (Bristol, Avon). 2020;75:104996.

Shamsi M, Mirzaei M, Shahsavari S, Safari A, Saeb M. Modeling the effect of static stretching and strengthening exercise in lengthened position on balance in low back pain subject with shortened hamstring: a randomized controlled clinical trial. BMC Musculoskelet Disord. 2020;21(1):809.

Hayes SG, Kindig AE, Kaufman MP. Comparison between the effect of static contraction and tendon stretch on the discharge of group III and IV muscle afferents. J Appl Physiol. 2005;99(5):1891-6.

Von Duvillard SP, Carvalho LP, Rodrigues SA, Cabido CE, Peixoto GH, Bell JW. Assessment of the maximal range of motion from initial sensation of stretching to the limits of tolerance. J Sports Sci Med. 2021;20(3):492-9.

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-9.

Brown CL, Gilbert KK, Brismee JM, Sizer PS, Roger James C, Smith MP. The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study. J Man Manip Ther. 2011;19(1):26-34.

Neto T, Freitas SR, Marques M, Gomes L, Andrade R, Oliveira R. Effects of lower body quadrant neural mobilization in healthy and low back pain populations: a systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;27:14-22.

Millesi H, Zöch G, Reihsner R. Mechanical properties of peripheral nerves. Clin Orthop Relat Res. 1995:76-83.

Pourahmadi M, Hesarikia H, Keshtkar A, Zamani H, Bagheri R, Ghanjal A. Effectiveness of Slump Stretching on Low Back Pain: A Systematic Review and Meta-analysis. Pain Med. 2019;20(2):378-96.

Guissard N, Duchateau J. Effect of static stretch training on neural and mechanical properties of the human plantar-flexor muscles. Muscle Nerve. 2004;29(2):248-55.

Ryan ED, Herda TJ, Costa PB, Defreitas JM, Beck TW, Stout J, Cramer JT. Determining the minimum number of passives stretches necessary to alter musculotendinous stiffness. J Sports Sci. 2009;27(9):957-61.

Submitted date:

Accepted date:

62859f9ba953956cc828b653 brjp Articles


Share this page
Page Sections