In our previous blog post, we discussed common pain generators of the spine and their relation to the four main patterns of low back pain.  Those 4 main pain generators are the intervertebral disc, the facet joints, the nerve root, and the surrounding musculature. With this information, we discussed the four main patterns of low back pain. They are:

  • Flexion Intolerant Low Back Pain: pain coming from the disc causing flexion intolerant back pain
  • Extension Intolerant Low Back Pain: pain coming from the facet joints causing extension intolerant back pain
  • Radiculopathy: pain coming from compressed nerve roots causing flexion intolerant back pain with sciatica
  • Spinal Stenosis: pain coming from spinal stenosis causing extension intolerant leg dominant pain

To go into more details on the above information, click HERE to read our post on patterns of low back pain.

As previously discussed, these patterns of low back pain demonstrate a directional preference. This means that moving the spine in certain directions will relieve the pain, while moving it in other directions will aggravate the complaint. Chiropractors use this knowledge to provide the most effective treatment for your back pain. Lets take a look at the treatment for each of these back pain patterns.

PATTERN 1: Flexion Intolerant Low Back Pain

Since pain is coming from the intervertebral disc, we must position ourselves in such a way that removes pressure on that disc. Typically this is done by putting your low back into extension. This can include the Cobra position or the McKenzie protocols.

Light aerobic activities, such as short frequent walking, should be included to ensure to body is staying active and healthy. You should try to avoid prolonged activities in a flexed position, such as sitting or driving. If you are in these positions, an extension roller can be useful to put your back in more of an extended position. A short course of medications such as acetaminophen and NSAIDs (non-steroidal anti-inflammatory drugs) can be considered if needed. Once pain is under control, it is important to address any underlying muscle dysfunction or imbalances through a focused exercise program.

PATTERN 2: Extension Intolerant Low Back Pain

Positions of relief for this pattern of low back pain are ones where less stress is put on the facet joints. This include flexion based exercises such as the happy baby pose. Sitting or standing with a foot stool can also help increase flexion in the low back to take stress off of those irritated joints of the low back.

Back Flexion

You should try to reduce motions that involve backwards bending or reaching high above the head since these can irritate those joints, especially during the acute (early) stage of the complaint. Acetaminophen and NSAIDs can be considered for further pain relief, similar to flexion intolerance low back pain. Once the pain is manageable, regular exercise should improve overall body function as long as it targets major back and leg muscles.

PATTERN 3: Radiculopathy

The best position for potential short-term pain relief is a “Z-lie”. This can be achieved by laying on your back with the back of your feet on a chair and knees bent at 90 degrees. The chair can be moved closer to help bring your knees towards your chest, as needed.

Light aerobic activities, such as walking within symptom tolerance, should be maintained. Sometimes a wait-and-see approach might be useful until the pain calms down, but for more severe cases, epidural steroid injections may be considered after discussing with your family doctor. A short course of acetaminophen or NSAIDs with the option of stronger pain medications might be needed in acute stages. Make sure to have this discussion with your family doctor. Once the acute inflammation has reduced, regular exercise including neural mobilization might be helpful in addressing residual symptoms. This movement-based treatment is thought to relieve nerve related symptoms by mobilizing the nerve relative to its surrounding.

PATTERN 4: Spinal Stenosis

If you are experiencing pain due to spinal stenosis, it is important to avoid prolonged extension and try to be in a more flexed position during activities such as walking and standing. This can be achieve by taking sitting breaks or using a walking aid, such as a walker or cane, to reduce symptoms.

Like the previous patterns of low back pain, acetaminophen and NSAIDs can be considered if needed. Interestingly, rehabilitations programs has been developed specifically for individuals with spinal stenosis, such as the stenosis bootcamp. This is a series of exercises designed to help manage the pain specifically from spinal stenosis.


These are brief introductions to some of the common treatment options for these four patterns of low back pain. As much as we like to simplify it for understanding, everyone is a little bit different and there is unfortunately no exact cookie cutter approach to treatment for everyone. If you are experiencing back pain, get it checked out by a trusted professional who can guide and coach you on the best way to manage it.

Interesting in learning about low back pain protocols? Click HERE to read out blog post on the use of x-rays and other imaging techniques for low back pain.

Looking to book an appointment with one of our chiropractors or registered massage therapists? Click HERE to book in with us.