Flat back syndrome is a term used to describe lack of curvature in the low back. Sometimes people are told that flat back syndrome is the reason for their chronic low back pain. Having a flat back is a symptom of low back pain but not a cause. A healthy low back does have natural curvature. And people lacking lumbar curvature will commonly indicate pain on or near their sacrum. Flatback syndrome involves numerous muscles in the lower body being overly tight. Gaining curvature of the lumbar spine entails lengthening lower body muscles. The psoas muscle, in particular, must be lengthened to bring curvature to the lumbar spine. Active Isolated Stretching (AIS) is highly beneficial for flat back syndrome. Flat back syndrome is associated with spinal stenosis, lumbar disc herniation, disc degeneration, arthritis, and chronic low back pain.
Flat back causes
Tightness in the lower body muscles causes the lumbar region to lose its natural curve. Loss of curvature in the lower spine can be of varying degrees. The lower spine does not need to be completely straight for people to experience low back pain. The psoas, gluteal (buttocks), and hamstring muscles are almost always involved in flat back syndrome. Other muscles are involved, but these three are almost always a causal factor. Athletes will lose flexibility in these muscles through repetitive motion activity. And psoas, glute, and hamstring muscles will become tight from numerous hours of sitting. Frequent flying (airline travel) will further tighten psoas, glutes, and hamstring muscles because people are sitting on planes. And the high altitude compounds tightness to these lower body muscles. Unfortunately, industrialized society requires long hours of sitting to perform our occupations. This is a major reason why low back pain is so prevalent throughout the world.
Laying on a foam roller to correct flat back syndrome
Some therapists incorrectly advise laying and rolling on a foam roller to gain curvature in the lumbar region. Rolling the low back on a foam roller does not cure flat back syndrome. A tightened psoas muscle causes the lumbar spine to flatten. And the psoas cannot be affected by rolling pressure to the low back. The psoas is underneath the belly. And even if you roll the foam roller on your stomach, it will not release the psoas because the muscle is too deep to release by applying rolling pressure of a foam roller.
Massage therapy for flat back syndrome
Some modalities like deep tissue massage, Rolfing, and Active Release Technique claim that their method can open the tightened psoas muscle through their form of manual manipulation. The psoas cannot be opened through massage or manual therapy because there are too many points of attachment to be released through direct pressure. Self-stretching techniques will not open a psoas to optimal length. The psoas must be opened through assisted stretching. Afterwards, self-stretching techniques can help maintain an open psoas. Chiropractic adjustments would be more effective after AIS treatment because chiropractic does not address psoas tightness in their procedure. PNF stretching uses the wrong position for psoas stretching, which can cause herniation to the discs around the L4, L5, S1 region. Active Isolated Stretching is most effective at opening the psoas muscle, which is essential for restoring the natural lumbar curve.
Muscles attach to bones. Tightness in the psoas, hamstrings, and gluteal muscles will put excessive strain on the pelvis and spine. This muscular tightness will pull on the pelvis bone and cause the lower spine to lose its natural curve. Inflammation will result around the spine from muscular tightness which causes spinal stenosis – the narrowing of the spinal canal. Low back discs around L4, L5, S1 will often become strained to the point in which they herniate, bulge, or degenerate. Spinal stenosis and lumbar disc disorders can also be restored with AIS therapy because the cause is excessive muscle inflexibility. A spinal canal can widen when muscular inflammation is ceased. A herniated, slipped, or bulging disc can return inside the vertebral column when muscular pressure is discontinued. Similarly, AIS therapy will cure spinal nerve pain because pinching on spinal nerves is caused by muscular inflammation.
Weakness in the lower body muscles also contributes to flat back syndrome. Rehabilitation from flat back syndrome entails doing lower body strengthening exercises to maintain the natural curve in the low back. After the psoas muscle is lengthened, it needs to be strengthened. Correct abdominal exercises are an important part of rehabilitation. Unfortunately, many people perform abdominal exercises incorrectly which worsen flat back syndrome. For example, full sit-ups are when the hands are interlocked behind the head and the person performs a full ab crunch to the point in which their elbows touch their bent knees. This is the wrong way to practice abdominal exercises! Full sit-ups or full ab-crunches will tighten the psoas muscle, which will decrease curvature of the lumbar spine.
Spinal stenosis, lumbar disc herniation/degeneration, and chronic low back pain will often be linked to flat back syndrome. Flat back syndrome is not the cause of these disorders. Flat back syndrome is an indicator of tightened lower body muscles. Active Isolated Stretching can reverse flat back syndrome because the first course of treatment is to restore flexibility. Conventional stretching, PNF stretching, yoga, and Thai massage have failed to grasp key mistakes they are making in their procedure. Active Isolated Stretching can restore lumbar curvature while other forms of stretching cannot. One-to-one AIS treatment is the kick start to gaining curvature in the lumbar spine. At-home AIS exercises are what maintain correct posture.
(The following comments were not written by the administrator, Anthony Ohm, of this website. The following words do not represent the views of Anthony Ohm).
Jennifer, I have to respectfully disagree with your conclusion that Flat back is only caused by spinal fusion and distraction rods. These may be some symptoms of FBS, but certainly not the cause. Physiologically speaking, the spine doesn’t just randomly fuse itself into hypolordosis; There is some force/tension in/on the body that brought it to and maintained it in an unhealthy position.
In most cases, the onset of FBS begins with excessive forward/downward tilting of the head. Depending on how far the head is tilted forward, the weight of the head can effectively increase from an average weight of ~7 lbs to ~30 lbs due to gravity. This additional weight can lead to lengthening of the upper back muscles that are intended to keep the head from falling too far anteriorly. On the other side of the body, the front neck muscles responsible for turning, bending, and flexing the neck, are now kept in a shortened position which over time becomes the new neutral position for the muscle, thus limiting it’s range of stretch.
Over time in this new neutral position, the weight of the head begins further pulling the body downward, and rounding the thoracic spine. As the hyperkyphosis continues, the rib cage rotates inward and down, causing the abdominals and Psoas muscles to enter into a shortened state. As this shortened state becomes the new neutral position for these muscles, the lumbar spine is straightened by the now shortened Psoas muscle.
To clear up previous Psoas involvement issues, it originates on the TVPs of lumbar vertebrae 1- 5 and it inserts on the lesser trochanter of the femur. It’s fibers run in an up-down diagonal fashion which shows its line of pull. In a fixed position, feet planted on the ground, it flexes the lumbar spine. Flexion of the lumbar spine means a straightening of the lumbar spine, thus a tight Psoas is at least a common symptom if not an advocate of FBS.
To defend stretching as a tool to reducing FBS, I have had personal experience with clients suffering from FBS and have had some profound and positive results from massaging, stretching, and strengthening muscles affected by the condition. Massaging the overly tight muscles allows them to be stretched into a closer-to-normal position. Massage while in this stretched position retrains the muscle to relax in a more lengthened position. This tactic, in addition to strengthening/ shortening the overly stretched muscles, has led to several reversals of FBS in age groups ranging from 30-70.
There is no one treatment for FBS, but surgery is certainly a last resort. If you suffer from FBS, get an x-ray, get a postural assessment done, and see a massage therapist along with a physical therapist. Though not all cases may be treatable in this fashion, if you catch the condition in the early stages, the better your chances are that these recommendations will work for you!
To Jo perry,
Yes, tight hamstrings are a critical area that reduces curvature in the low back. Additionally, excessive tension in the psoas muscle will pull the body forward. A tight psoas even pulls the shoulders forward. When the psoas is tight, curvature in the lumbar spine is decreased because the mid section and upper body are being pulled down and forward. When the psoas muscle is lengthened, the angle between the quadriceps and abdomen is increased. This results in greater curvature of the lumbar spine. Anterior tilting of the pelvis decreases lumbar spine curvature. And the cause of anterior tilting of the pelvis is a shortened psoas muscle. In the future (but not so quickly, because I am a one-man operation), I will post videos on my website documenting the immediate changes that can occur after experiencing AIS psoas lengthening.
I understand that most textbooks are not mentioning that a tight psoas is a principle factor in causing a flat back. That’s why I write these articles and put them on the web. I’ve got something new to add. Millions of people around the world are searching for answers to their physical pain problems and medical professionals are giving answers that are limiting at best. The information I present is ignored by the majority of healthcare practitioners. And its the average person with low back pain for whom I present this information. The average low back pain sufferer is depressed and feeling as if they are running out of viable options. Pharmaceutical companies and surgical companies have corrupted the medical profession’s analysis of physical pain and dysfunction.
The simple answer is that the muscular system affects the nervous and skeletal system. By using the most thorough form of assisted stretching, the body can recover from numerous physical pain issues. This approach has been overlooked by the healthcare community because the old way of assisted stretching (PNF) is not detailed enough to correct musculoskeletal problems. I hope you’ll get a chance to learn more about Active Isolated Stretching. The developer, Aaron Mattes, is still alive and he is teaching seminars in Sarasota, Florida.
Thanks for visiting,
Anthony Ohm
I am a physiotherapist and still do not understand how a tight psoas causes flat back syndrome?? surely it is tight and strong hamstrings and long and weak hip flexors which causes posterior rotation of the pelvis flattening the lordosis?! This is often what I’ve found in clinical practice and in any textbook I have read
Hi Demi,
I totally understand that you have a flat back and you do not have any harrington rods in your back, nor have you had fusion surgery in the L4, L5, S1 region.
As I stated in my article, a flat back is a sign of extra muscular tension in the muscles that affect the low back region. Definitely, people who have rods in their back will have a lack of curvature. But millions of people without rods are lacking curvature in their low back and those that are missing curvature usually experience low back pain too. Gaining curvature is possible through AIS treatment sessions. After one or two sessions, an improvement in curvature is noticeable. Some people are angry and limited in their views. Its important not to let them inflict their negativity onto us as much as they punish themselves.
Best wishes,
Anthony Ohm
I have severe flat back and I have NEVER had rods or fusion surgery. I have degenerative disc disease, herniated discs, myelopathy, etc. I’ve suffered from lower back pain for years and just found out that I have flat back. I’ve noticed changes in my lower back and that my posture is ‘forward’. It’s definitely muscle related as a result of DDD. Most people and even some doctors seem to think like you. I’m living proof!!! I’m 55 and have suffered for about 15 years now. I have had C5, C6 and C7 fused, but no surgeries below the neck. I’ve been on disability now for three years and a pain and spine doc just last month diagnosed flat back and chronic muscle spasms from neck to lower back. I’ve never been overweight and was always active until three years ago, when I finally gave in and stopped working.
Hi Darwin,
You will have to tell me the page that you are referring to in Kendall’s textbook. I don’t have a copy of it, but I’ll try to take a look at it.
Having said that, keep in mind that my thesis is not widely acknowledged by the health/medical community. A tightened psoas will decrease curvature in the lumbar spine. And AIS treatment is the most effective way that I’ve seen that addresses lengthening the psoas muscle.
The tightened psoas causes a forward lean that can pull the shoulders and chest forward. A tightened psoas is “part of the reason” that so many elderly people are hunched over or bent over. It plays a role in forward head posture. Look at all the elderly people with forward head posture (those that are bent over). Do these people demonstrate a lordosis? Heck no. They’ve got no lumbar curve. The tightened psoas pulls the body forward and in the process it decreases the lumbar curve. People with a flat back are showing signs of a tightened psoas.
Anthony Ohm
“The psoas muscle, in particular, must be lengthened to bring curvature to the lumbar spine”
“A tightened psoas muscle causes the lumbar spine to flatten”
Wouldn’t a facilitated/tight Psoas muscle increase lumbar curvature? Anatomically, I don’t see how a tight psoas muscle would cause the lumbar spine to flatten. According to Kendall (Muscles Testing and Function with Posture and Pain, 5th ed.), “The psoas major, acting bilaterally with the insertion fixed, will increase the lumbar lordosis…”
Just wanted to see if I’m missing something. Thanks for sharing your information.
In response to Jennifer S.’s comment:
The majority of people suffering from low back pain have lost curvature in their low back. Regaining that curvature is attainable with Active Isolated Stretching (AIS) treatment. I suggest you try a few sessions in AIS (with an advanced practitioner) and see for yourself. You can wait for scientific studies to come out before you try something different, but those studies are way behind in providing useful news. Just a few months ago, a study came out that said that massage is beneficial for low back pain. That study could have been released forty years ago and maybe then would it have been useful information.
You write: “You can not stretch your way out of Flatback syndrome.” I would accept your statement if you wrote: “You can not cure flat back syndrome by using conventional stretching, PNF stretching, Bob Anderson’s form of stretching, yoga, or Thai massage.” Active Isolated Stretching is not to be lumped together with those modalities. AIS can resolve flat back syndrome.
I feel for those that accepted advice to use Harrington rods or spinal fusion surgery. Read any forum on chronic back pain and you will read multitudes of accounts of people who were made worse by accepting back surgery as a way to improve their condition. Was it a good decision for people to accept their physician’s advice and get back surgery and become implanted with harrington rods? Are there many cases where a person with harrington rods says that they are happy with their surgery? Even in those cases, where the client is suffering from pain caused by distraction rods, spinal fusion, and degenerative conditions; AIS can provide a great improvement to their overall condition. The stipulation to this claim is that the client must be treated by an advanced AIS practitioner. Worldwide, there are only about twenty therapists in this category.
I was diagnosed with flat back syndrome. I saw over forty specialists (physicians, surgeons, physical therapists, chiropractors, acupunturists, massage therapists, etc.) to treat this condition and I didn’t get the help I needed until I was treated by Aaron Mattes, the developer of AIS. Providing true hope for those suffering from chronic back pain or flat back syndrome is a distinguishing mark of AIS therapy.
PLEASE!!!! If you suffer from Flatback Syndrome DO NOT accept anything that’s written in this idiotic, non-scientific bit of content obviously written by someone without any knowledge of the condition.
You can not stretch your way out of Flatback Syndrome. It is caused by distraction rods and spinal fusion (or sometimes some degenerative conditions) that change the very shape of your spine. The symptoms of FBS occur because of this structural anomoly and a loss of lordosis (the “good” curve that causes a healthy spine to curve out on top and in at the bottom), which destroys the ability of your spine to distribute weight evenly, causing undue wear and tear.
This is an unbelievably irresponsible article that gives false hope to any reader hoping their case might be dealt with differently…