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Williams Back Exercises Cite this Page

Alexander M. Dydyk; Amit Sapra.

Author Information and Affiliations In this Page

Last Update: May 1, 2023. Definition/Introduction

Issues of Concern
Definition/Introduction Go to:
Clinical Significance
Williams back exercises, also known as Williams flexion or lumbar exercises, are exercises for
Review Questions
people with low back pain. Williams back exercises are recommended for people with low back
References
pain to help improve lumbar flexion and strengthen the gluteal and abdominal muscles. The
exercises were first developed for men younger than 50 years of age and women younger than
age 40 who had moderate to severe lumbar lordosis and whose plain radiological films revealed
Bulk Download
diminished disc space between the lumbar segments L1-S1. Also, these patients had chronic low
Bulk download StatPearls data from FTP
back pain that was mild to moderate in nature.

These exercises were introduced to teach the patient how to avoid lumbar extension, which
worsens low back pain. Williams's back exercises are a non-surgical option for people to Related information
improve low back pain. These exercises came into being for people who do not want to undergo PMC

low back surgery. In the last two decades, Williams back exercises have seen a broad application PubMed
for people with various types of low back pain, even in the absence of a formal diagnosis. Also,
both physicians and physical therapists have developed many variations of these exercises.
Similar articles in PubMed
In comparison, the McKenzie method emphasized motion with increased lumbar extension. The Review Low back pain in young athletes. A practical
McKenzie extension exercises and William flexion exercises were both founded in the 1930s. approach. [Sports Med. 1991]
The Mckenzie method is also known as the Mechanical Diagnosis and Therapy method (MDT); [Exercise program for chronic low back pain based on
the goal of the McKenzie exercises to retain lumbar lordosis. Furthermore, full motion of the common clinical characteristics of patients].
[Lijec Vjesn. 2014]
spine is recommended with a combination of flexion and extension exercises. Limited studies Electromyographic activity of back musculature during
have been done showing the efficacy of the Williams or McKenzie exercises compared to Williams' flexion exercises. [Phys Ther. 1981]
placebo or versus each other in direct comparison.[1] The Mckenzie method has been shown to Spine stabilization exercises are not superior to flexion
improve motion in muscle energy techniques for osteopathic manipulative therapy. No such exercises for ultrasound-detected
[Acta
muscle
Ortop
thickness
Mex. 2022]
studies have taken place for the Williams exercises.[2] changes in patients with chronic low back pain and
Review The relationships between low back pain and
lumbar lordosis: a systematic review and[Spine
meta-J. 2017]
There are different classifications or syndromes for the origin of back pain in the McKenzie analysis.
method. Postural, dysfunction, and derangement syndromes are the most common. Treatments See reviews...
are often based on the position of ease, which reduces the patient's back pain.[3] Thus if the See all...
patient's pain is relieved in flexion, then flexion exercises will be performed. Multiple studies
have shown the McKenzie method to be superior to other exercise regimens for subacute and
Recent Activity
chronic low back pain. However, the limited difference has been seen in the acute setting.[4][5]
Turn Off Clear

A series of exercises seen for Williams back pain exercises include pelvic tilt, single knee to Williams Back Exercises - StatPearls
chest motion, double knee to chest motion, partial sit up, hamstring stretch, hip flexor stretch,
and squat. The purpose of Williams back pain exercises is to reduce pain and restore function. Clubfoot - StatPearls
Furthermore, the prevention of future injury and the development of chronic pain are critical. In
an eight week study that compared Williams back pain exercises to a no-treatment control, the Increased intervertebral space
experimental group was found to have decreased back pain, as well as an increase in the MedGen

flexibility of their hamstring muscles, hip flexors, lumbar extensor muscles. They were also See more...
found to have increased abdominal muscle strength.[6]

Issues of Concern Go to:

The main issue of concern is whether the William back exercises were superior or inferior to the
McKenzie protocol. Researchers have compared the Williams and McKenzie protocols for back
pain. Decreasing pain and return of lumbar motion were the variables examined. In the
comparison of the two groups, patients who underwent the McKenzie protocol improved
function to a significantly greater extent than patients in the Williams protocol group, as well as
achieved this results in a significantly decreased period. EMG activity at four lumbar vertebrae
was examined in patients performing posterior and anterior pelvic tilt exercises of the Williams
protocol. The results showed the positions of pelvic tilt, curl up, knees to chest, and hamstring
stretch, when completed with posterior tilt, minimized the electromyographic activity in both the
lumbar and sacral regions. Furthermore, the use of anterior tilt positions should be avoided to
minimize electromyographic activity in the lumbar and sacral regions. Lastly, the
electromyographic activity the four lumbar vertebral levels respond independently of each other
while the performance of Williams' flexion exercises.[7]

Generally speaking, patients with acute mechanical low back pain do not get referred to physical
therapy or a home exercise program, but select populations at increased risk for developing
chronic back pain could benefit.[8] Some studies have shown there to be modest efficacy to
starting exercise therapy for back pain less than four weeks in duration, while multiple
systematic reviews have not shown them to be superior to conservative therapy.

Although some studies do prove that there is a significant efficacy of exercise therapy in selected
cases of acute low back pain (less than four weeks).[9][10] However, systematic reviews have
not demonstrated a treatment benefit of exercise therapy compared with conservative
management.[11] Separately the evidence does support the use of exercise therapy for patients
with subacute and chronic low back pain.[9][10][11]

Clinical Significance Go to:

Before the availability of more advanced treatment modalities for low back pain, the Williams
exercises were the standard of care for this problem. The exercises can be performed in the
supine position on any flat surface. The first maneuver of importance is to grab the legs and pull
the knees to the chest and hold them for several seconds. Williams felt that this helped open the
intervertebral foramen, stretched the ligaments, and distracted the apophyseal joints.

Williams originally designed these exercises for chronic low back pain secondary to low-grade
lumbar disc disease seen on X-ray. The theory was that when pressure is placed on the posterior
aspect of the lumbar vertebral with extension, disc herniation can occur. In theory, this is due to
increased lumbar lordosis; lumbar lordosis would decrease by limiting the pressure placed on the
posterior aspect of the lumbar vertebra. The decrease in pressure would improve by improving
the flexion of the vertebral disc, leading to decreased disc herniation, thus reducing the incidence
of chronic low back pain. The exercises proposed to open the intervertebral foramen to provide
additional lumbar stability. The McKenzie exercises have their basis on the belief that humans
are constantly in a flexed position; this, in turn, causes the nucleus of the lumbar disc to move
posteriorly. The posterior motion of the lumbar disc then causes back pain.

When patients perform the exercises regularly, they reduce pain, improve the stability of the
lower pelvis, and increase the range of motion. The seven variations of Williams’s exercises
include: 1) the pelvic tilt, 2) the single knee to chest, 3) double knee to chest, 4) partial sit-up, 5)
hamstring stretch, 6) hip flexor stretch, and 7) squatting.

The Williams back pain exercises are repeatable as well as done for various lengths of time. The
recommended duration for the exercise is every day for 10 to 20 minutes. Exercises are done
with the patient lying supine on a flat surface and completed at home. Then the patient would
flex their legs by pulling their knees to their chest and holding this position. The patient would
relax and repeat the motion. An example of the various exercises appears below.

The posterior pelvic tilt position is performed with the patient lying on their back with
their hands at their side and their knees bent. The patient is then told to tighten the muscles
of their abdomen, as well as their buttock muscles, flattening their back against the floor.

The single knee to chest motion is done with the patient lying on a table or bed. They are
then instructed to let a leg fall off the table or bed, bend their other leg and wrap their
hands around the bent knee, and pull the bent leg toward their chest.

The double knee to chest stretch is also done with the patient lying on their back. The
patient is instructed to bring both their knees, one at a time, to their chest. With their hands
held together, the patient pulls their knees towards their chest and curls their head forward.
While performing the motion, the patient is instructed to keep their knees together and to
have their shoulders flat on the floor. The patient then lowers one leg at a time.

The lumbar flexion position with rotation is completed with the patient lying on their back
with their hands at their sides and their knees bent. The patient is then instructed to rotate
their knees towards the direction of pain.

The seated lumbar flexion exercise starts with the patient sitting upright in a chair. The
patient is urged to slowly bend forward until they feel the tension in their back. In
contrast, the standing lumbar flexion exercise starts with the patient standing upright with
their feet spread shoulder-width apart. The patient slowly bends forward, sliding their
hands down to their legs until they feel the tension in their back.

The partial sit-up exercise is completed with the patient lying on their back with their
hands at their sides and their knees bent. The patient is instructed to use their abdominal
muscles to raise their upper back off the floor while exhaling. The patient is supposed to
rise only enough to get their shoulder blades off the floor. Furthermore, the patient is not
supposed to thrust themselves off the floor or to lift their heads with their arms. While
performing this motion, the patient is supposed to keep their knees bent and their feet flat
on the floor. The patient should feel the muscle contraction only in their abdominal
muscles. The patient is then instructed to gently lower their upper body in a smooth and
relaxed motion.

The partial diagonal sit-up is completed with the patient lying on their back with their
hands at their sides and their knees bent. The patient is instructed to use their abdominal
muscles to raise their upper back off the floor while exhaling. The patient raises their
upper body off the floor with one shoulder higher than the other. The patient is not
supposed to thrust themselves off the floor or to lift their heads with their arms but to keep
their knees bent and their feet flat on the floor. The patient should feel the contraction only
in their abdominal muscles. This motion is supposed to move smooth and relaxed while
gentle lowing their upper body.

Mechanical back pain is one of the most common complaints seen in a primary care clinic. It
often resolves with conservative management and time. Home exercise programs such as the
William flexion exercises and the McKenzie extension exercises are two of the most common
home exercises used. The William flexion exercises are designed to improve flexion of the
lumbar vertebra while limiting lumbar extension. Performing these exercises, we aim to
strengthen the gluteus and abdominal muscles. These exercises have been recommended for
patients with a variety of low back pain complaints since the 1930s.

Most of the evidence is either level III or IV. Few recent studies have been completed on the
Williams back exercises despite being the standard of care previously. Health care
professionals, which include physicians, therapists, and nurses, must have active conversations
regarding home exercise programs with patients experiencing mechanical back pain. Home
exercise programs can be considered part of the standard of care for mechanical back pain, along
with other conservative treatment options.

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References Go to:

1. Garcia AN, Costa Lda C, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, Costa LO.
Effectiveness of back school versus McKenzie exercises in patients with chronic nonspecific
low back pain: a randomized controlled trial. Phys Ther. 2013 Jun;93(6):729-47. [PubMed]
2. Szulc P, Wendt M, Waszak M, Tomczak M, Cieślik K, Trzaska T. Impact of McKenzie
Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective
Parameters Related to Spine Function in Patients with Chronic Low Back Pain. Med Sci
Monit. 2015 Sep 29;21:2918-32. [PMC free article] [PubMed]
3. Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms--a systematic
review. Man Ther. 2004 Aug;9(3):134-43. [PubMed]
4. Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM. Effectiveness of
the McKenzie Method of Mechanical Diagnosis and Therapy for Treating Low Back Pain:
Literature Review With Meta-analysis. J Orthop Sports Phys Ther. 2018 Jun;48(6):476-490.
[PubMed]
5. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of
exercise for low back pain. Spine (Phila Pa 1976). 2004 Dec 01;29(23):2593-602. [PubMed]
6. Fatemi R, Javid M, Najafabadi EM. Effects of William training on lumbosacral muscles
function, lumbar curve and pain. J Back Musculoskelet Rehabil. 2015;28(3):591-7.
[PubMed]
7. Blackburn SE, Portney LG. Electromyographic activity of back musculature during
Williams' flexion exercises. Phys Ther. 1981 Jun;61(6):878-85. [PubMed]
8. Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main
CJ, Mason E, Somerville S, Sowden G, Vohora K, Hay EM. Comparison of stratified
primary care management for low back pain with current best practice (STarT Back): a
randomised controlled trial. Lancet. 2011 Oct 29;378(9802):1560-71. [PMC free article]
[PubMed]
9. Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE. Identifying subgroups
of patients with acute/subacute "nonspecific" low back pain: results of a randomized clinical
trial. Spine (Phila Pa 1976). 2006 Mar 15;31(6):623-31. [PubMed]
10. Fritz JM, Delitto A, Erhard RE. Comparison of classification-based physical therapy with
therapy based on clinical practice guidelines for patients with acute low back pain: a
randomized clinical trial. Spine (Phila Pa 1976). 2003 Jul 01;28(13):1363-71; discussion
1372. [PubMed]
11. Faas A. Exercises: which ones are worth trying, for which patients, and when? Spine (Phila
Pa 1976). 1996 Dec 15;21(24):2874-8; discussion 2878-9. [PubMed]

Disclosure: Alexander Dydyk declares no relevant financial relationships with ineligible companies.

Disclosure: Amit Sapra declares no relevant financial relationships with ineligible companies.

Copyright © 2024, StatPearls Publishing LLC.

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Bookshelf ID: NBK551558 PMID: 31855385

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