Non-Specific Low Back Pain Extension Mobility Dysfunction

Where is Non-Specific Low Back Pain Extension Mobility Dysfunction painful? (Body Chart)

Low Back Pain Extension Mobility Dysfunction

What are the classical features of Non-Specific Low Back Pain Extension Mobility Dysfunction?

Age: Can be all ages. Greater prevalence in the older sedentary population. 

Gender: No difference was reported in the literature 

Activity: sitting, driving, hairdressers, bending, labouring, lifting

24-hour pattern: Stiffness following flexion biased activities 

Where is Non-Specific Low Back Pain Extension Mobility Dysfunction painful?

– Localised back pain

– Well defined limits but vague // patient might describe a region of stiffness 

– More commonly has an ipsilateral bias but can be central and bilateral 

– Can refer in the buttock and leg but uncommon

Characteristics of symptoms for Non-Specific Low Back Pain Extension Mobility Dysfunction

– Aching, Throbbing, Annoying pain 

– Stiffness 

– Episodic in nature 

– Mechanical 

– Low intensity (VAS 1-3/10)

– High frequency as often behavioural // ie sitting 

– No neurological symptoms

Typical activity capability/restriction for clients with Non-Specific Low Back Pain Extension Mobility Dysfunction

– Patient is often still highly active as symptoms are not intense enough to seek intervention  

– Will worsen if continually provoked // ie worse at the on a Friday after sitting for 10 hours a day for 5 days during the week 

– Patients may describe a warm-up effect // ie hurts on the first hole at golf and then be able to finish around without concern

– Commonly report stiffness/restriction following activity leading patients to become more sedentary

Behaviour of symptoms for Non-Specific Low Back Pain Extension Mobility Dysfunction


– NSAIDs, analgesics, repeated extension based activities, walking, standing sit to stand desk use, laying down 


– Sustained lumbar flexion, initially painful into extension however symptoms will resolve with repeated, sitting, bending, lifting 

24-hour pattern

– Activity dependant, likely to get better with prolonged extension 

Typical history of a client with Non-Specific Low Back Pain Extension Mobility Dysfunction

– Participation in activities with sustained flexion moment // sitting for long periods of time throughout the day/week

– Previous episodes of similar pain or pain that come and goes  

– Mechanical in nature 

– Commonly has a progressive onset // ie an increase in sustained sitting or a reduction in extension based activity (walking)

– Warm-up effect when starting extension based activity (ie walking)

– Stiffness/restriction after flexion based activity 

– Enquire about activity preceding incident if no clear mechanism

Pathobiological mechanisms behind Non-Specific Low Back Pain Extension Mobility Dysfunction

– Need to triage and rule out specific pathology prior to using movement patterns 

– If clear then evidence supports the category of non-specific lower back pain

– Movement patterns are considered as a subcategory of non-specific lower back pain

– Only use as a pattern if nociceptive dominant 

– If chronic then considers it as an impairment however inadequate to use as a primary diagnostic label. Management should then be implemented as a nociplastic dominant presentation

Proposed pathology underlying Non-Specific Low Back Pain Extension Mobility Dysfunction

– Triage completed and specific pathology excluded (non-specific lower back pain)

– Compressive load on the posterior tissues of the spine (ie PIV)

– Tensile load on the posterior tissues of the spine (ie Disc pathology) 

– The lower back is considered to be passively constrained 


Note: Evidence supports that pathology observed on imaging does not necessarily correlate to pain/disability 

Physical impairments & associated structure/tissue sources (ie P/E findings)


– Hypomobility into extension // with PPIVM

– Hypomobility into extension // AROM

– Symptoms with lumbar movements (extension + unilateral bias)

– Symptoms reduce with repeated movements into extension // centralise 

– Reduced lumbar lordosis in sitting 

– Reduced motor control into extension // unable to get into extended position without external force 

– Reduced lumbar body schema 

– Reduced two-point discrimination 



– Hip flexor weakness

– Glute max tightness 

– Increased extension range in thoracic spine and/or hips

– Reduced independent control into flexion in spine and hips



– Deconditioning 

– Reduced muscular endurance 

– Slouched posture 



– Oswestry Low Back Pain Disability Questionnaire validated measurement tool

Typical contributing factors to Non-Specific Low Back Pain Extension Mobility Dysfunction

– Weight

– Genetics

– Physical fitness 

– Hypomobility in the lumbar spine

– Participation in high-risk activities 

– Technique 

– History of low back pain 

– Smoking 

– Stress/anxiety 

Relevant precautions/ contraindications to P/E and treatment

– Severity and irritability 

– Need to exclude specific pathology when considering a non-specific diagnostic umbrella 

– Cordea equina 

– Clear neurological signs/symptoms if clinically indicated

Relevant diagnostic imaging for Non-Specific Low Back Pain Extension Mobility Dysfunction

– Can be used to rule out serious pathology when indicated // note that referral for lower back pain in itself is insufficient, need to have evidence of specific pathology or neurological symptoms to consider. If non-specific back pain evidence to support patients do better without the scan 

– Presence of pathology is normal and not indicative of pain/disability if the patient comes with imaging // always conduct an unbiased assessment and then compare patient presentation to the clinical findings 

– MRI goal standard

Typical prognosis for Non-Specific Low Back Pain Extension Mobility Dysfunction

– Often resolved within weeks

– Favourable if the first incident, with recurrence the prognosis worsens

– With the increase in psychosocial flags the prognosis worsens 


High-level evidence 

– Quicker return to work when positive outcome expectation

Management/treatment selection for Non-Specific Low Back Pain Extension Mobility Dysfunction

Phases of rehabilitation

– Stage 1: Symptom management 

– Stage 2: Reloading phase

– Stage 3: return to full function and sport



– Joint play techniques (high-level evidence) // patient group likely to respond very well to manual therapy, should get immediate relief, if not consider an alternative diagnosis 

– Mobilise into extension // PA PAIVMs and reinforce with exercise into an extension

– Muscles control into extension // start with extension biased position and progress into flexion biased positions 

– Pacing to progressively increase loading 

– Lumbar external support 



– Abdominal strengthening ( mid-level evidence for TA activation)

– Increase mobility into flexion in thoracic and hips 

– Muscle control into flexion and performance 



– Rest contraindicated (high-level evidence) 

– Increase physical activity (high-level evidence) 

– Consider biomechanics and technique // are we able to redistribute the load somewhere else

– Postural correction into lumbar extension (ie sitting posture) 

– Address contributing factors and cardiovascular fitness

– Equipment // patient population respond well to lumbar support 

– Consider work set up

– Ergonomic optomisation 


Pharmacological (high-level evidence) (refer as required) 


– Analgesics

– Muscle relaxants

Differential diagnosis for Non-Specific Low Back Pain Extension Mobility Dysfunction

Spondylolisthesis // bilateral pain, neurological symptoms 

Disc pathology (especially if herniation) // flexion pattern and pain that crosses the midline

Spinal cord injuries // positive neurological or neurological symptoms 

Cord equina // B&B, saddle anesthesia, bilateral symptoms

Muscle strains // dynamic assessment

Central canal stenosis // neurological symptoms, bilateral symptoms

Nerve root // positive neurological or neurodynamic findings 

Cancer // subjective special questions 

Ankylosing spondylitis // inflammatory special questions


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