Doing back exercises like the forward-bending back stretches (e.g. pulling knees to the chest or toe touches) first thing in the morning is a very common routine reported by our patients, but for those with back pain we generally do not recommend doing forward-bending back stretches first thing in the morning. According to Dr. Stuart McGill @backfitpro, professor emeritus at the University of Waterloo, the reason is because the intervertebral (spinal) discs are highly hydrated when you first wake up in the morning and the increased fluid in the disc can cause two issues: (1) it makes the top and the bottom of the disc less tolerable to compression, and (2) it increases the stress on the outside wall of the disc. Stretching your back this way at this time of the day can provide a false sense of symptom relief that lasts for a short period of time simply because the sensory receptors in the back are stimulated, and more importantly, doing this over a long period of time can cause back instability. This explains why some patients with back pain would find it more painful to put the socks on in the morning than to take them off at night. Research studies have shown (as old as in the 90s!) that removing forward bending activities in the morning can improve patients with back pain. If we prescribe forward-bending back stretches as therapeutic home exercises, we recommend our patients to perform them in the afternoon and evening on a regular basis, just not first thing in the morning.

Richard Kung, Registered Physiotherapist
Doctor of Physiotherapy, Bachelor of Science (Kinesiology)

Cohesion Physiotherapy
Stouffville, Ontario