Disk herniation, tissue fluid stasis, diskogenic pain, and swelling from inflammation are conditions that may result from prolonged flexion postures, repetitive flexion microtrauma, or traumatic flexion injuries. Initially, symptoms may be exacerbated when attempting extension but then may be decreased when using carefully controlled extension motions. Several studies have documented that patients with a herniated nucleus pulposus who have symptom reduction with an extension approach to treatment respond favorably to conservative nonsurgical treatment.

Compression Fracture
Excessive axial compression loads usually cause end-plate or vertebral body fractures. Flexion and axial loading usually cause increased pain. Pain may occur without nerve root involvement, although there may be referred pain in the extremities.

Tissue Fluid Stasis
With sustained flexed postures in the spine, the disks, facet joints, and ligaments are placed under sustained loading. The intradiskal pressure increases, and there is compression loading on the cartilage of the facets and a distractive tension on the posterior longitudinal ligament and posterior fibers of the annulus fibrosus. Creep and fluid transfer occur. Sudden movement into extension does not allow for redistribution of the fluids and so increases the vulnerability of the distended tissue to injury and inflammation. Symptoms may be similar to those described for disk lesions because they lessen with repeated extension motions and respond to treatment.

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