Inflammation, DaVinci and Stretching

This past August 2022, I described an injury I sustained in November ‘21 and, as a result, developed an autoimmune disorder.

How does this and the subject of stretching go together?

Something that often happens when your body is battling inflammation is a loss of mobility. You might feel like you need to stretch because certain muscles feel tight, your movement seems restricted. What used to be easy to do is no longer so easy.

Well, that’s me. And even knowing what I do – not bragging here just facts – I am still tempted to stretch. That relationship of tightness and stretching is firmly entrenched in our culture. So I thought a short journey into the land of stretching might be helpful.

I’ll use back pain as an example partly because I’ve dealt with it for a long time.

Maybe, you begin your day stretching on the advice of your doctor and / or therapist. Over the past few months, your lower back has ached and you’re stiff as a 2 x 4 in the morning. The problem it seems, as you have been told, is that your hamstrings are too tight.

Dutifully, you gingerly get out of bed and straighten up slowly. If you move any faster, it feels as if your back will break in two. Finally, you’re up. But now you have to get on the floor in a doorway to stretch your hamstring. You walk to the bedroom door, hold on to the doorframe and ease yourself onto the floor. Once on the floor, you raise your leg which goes about 45 degrees and place it on the doorframe. Your job now is to slowly move yourself to the door forcing the leg up, which stretches the hamstring. You do this for 2-3 minutes on each leg every morning and evening. It’s been two months and it seems your hamstring is one stubborn muscle. Nothing has changed. At 40 years of age, you wonder if this is the way your mornings will be for the rest of your life.

Stretching of the hamstrings is one of the most commonly used interventions for lower back pain. But the question is why? Is it true that tight hamstrings cause lower back pain or is it that lower back pain causes tightness of the hamstrings?

Part of the answer dates back to 1509.

Leonardo DaVinci created a series of illustrations used in a publication in 1509 entitled “The Divine Proportion”. DaVinci recognized that the ideal human body could be divided into sections which when divided by each other equaled 1.618 also known as PHI (pronounced FEE). For instance, if you measure the distance from the floor to the top of your head and divide it by the distance from the floor to your navel you will get a quotient of 1.618 if your body is perfectly proportioned. Of course, few us are so perfectly built. This relationship exists everywhere in the human body: your finger joints, limb segments and even in how you move.

The relationship between the amount of motion in your hips and the amount of motion in your low back when you bend forward is very close to PHI: 1.6 (this is calculated as degrees of hip movement divided by the degrees of low back movement)^[1]Analysis of lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain. Esola MA, McClure PW, Fitzgerald GK, Siegler S Spine 1996 Jan 21:71-8. This is the ideal distribution of motion.

But, the human body is exceptionally good at getting the job done whether you don’t have enough motion or have too much motion. If you don’t move enough in your hips, in order to touch the floor when you bend forward, you borrow some motion from your lower back. In some cases, you borrow too much stressing the back beyond its capability. If you don’t have enough motion in your lower back, you may borrow from the hips and like wise push your hips beyond their means. Ideally, the two regions of the body should be in balance with the “Divine Proportion”. The closer you are to PHI, the easier it will be for you to move and with easier movement comes lower injury risk.

We know how much motion is optimal in the lower back when you bend forward: 50 degrees. Then your hips contribute 80 degrees for a relationship of 80/50 = 1.6. But what if your lower back contributes 100 degrees and your hamstrings contribute 40 (as in the case of one my clients)? In other words, you can touch the floor but most of the movement comes from your lower back. Are the hamstrings tight? YES. Do you have back pain? YES. Should you then stretch the hamstrings? MAYBE NOT.

To reestablish a more ideal or optimal movement ratio, PHI, by stretching the hamstrings, the hips would have to move nearly 162 degrees (162/100 = 1.62)! Your body will object strongly to that amount of motion. The answer is to first decrease the motion in your lower back to bring the ratio of hip motion to lumbar motion closer to PHI. This is accomplished by both strengthening the spinal structures and re-training your movement patterns.

The reason stretching your hamstrings to treat low back pain rarely works by itself is because the hamstring inflexibility is more of an expression of your back pain and rather than the cause of your back pain.

Having tight hamstrings with lower back pain is like having a fever with an infection. You can treat the fever, and in many cases this helps you feel better, but until you also address the infection, you’re still sick.^[2]https://pubmed.ncbi.nlm.nih.gov/12322811/

Hamstring tightness with lower back pain is most often secondary to an ongoing, low grade inflammatory reaction of either the spinal joints or intervertebral disc. As a general rule, when joints are inflamed, muscles get tight. If you tear your anterior crucial ligament in the knee, you have a limited time to test it and in many cases, the tear is missed because of the reactive muscle tension in the hamstrings.^[3]Frobell R.B., Lohmander L.S., Roos H.P. Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings. Scand J Med Sci Sports. … Continue reading

How do you know if this is the case for you? If you have stiffness and pain in the morning that lasts for 20 minutes or more, which is relieved by movement or a warm shower and worsens with inactivity, you can conclude that you very likely have a low grade inflammatory reaction in your spine. Stretching your hamstrings may be part of your solution but the choice to stretch should be based on PHI, and blended into an overall strategy to address the “infection”.

And what are the best, non-pharmaceutical, most empowering choices to address the low grade inflammation of your joints? One is movement.^[4]Does exercise reduce inflammation? Physical activity and C-reactive protein among US adults. E. Ford. Epidemiology., 2002, vol. 13, pp. 561–568 You need to move more than you need to stretch.

To start, keep your sitting times to no more than an hour. Get up and take a short walk (30-60 seconds) each hour. Once a day, take a power walk for 10-20 minutes (shorter if you have not moved much or regularly. A power walk is a fast paced, long striding type of walk).

And the other is found in your diet – what you eat and drink. I’ll explore this more in an upcoming post and share what I did to overcome joint inflammation and begin restoring mobility.

Like anything that’s worth achieving, it takes time. With some persistence, you’ll likely find that your early morning stiffness will improve. And the more consistent you become with this behavior, the better the result.

Thanks for reading.

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Doug Kelsey has been a physical therapist and human movement expert since 1981. He is formerly Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Sciences Center and the author of several books. He has conducted over 250 educational seminars for therapists, trainers, physicians, and the public and has presented lectures at national and international scientific and professional conferences. His professional CV is here.