Dr. Paul Williams first published his exercise program in 1937 for patients with chronic low back pain in response to his clinical observation that the majority of patients who experienced low back pain had degenerative vertebrae secondary to degenerative disk disease (Williams 1937). These exercises were developed for men under 50 and women under 40 years of age who had exaggerated lumbar lordosis, whose x-ray films showed decreased disc space between lumbar spine segments (L1-S1), and whose symptoms were chronic but low grade. The goals of performing these exercises were to reduce pain and provide lower trunk stability by actively developing the "abdominal, gluteus maximus, and hamstring muscles as well as..." passively stretching the hip flexors and lower back (sacrospinalis) muscles. Williams said: "The exercises outlined will accomplish a proper balance between the flexor and the extensor groups of postural muscles..." (Williams 1965, Williams 1937, Blackburn 1981, Ponte et al.).

Williams' flexion exercises have been a cornerstone in the management of lower back pain for many years for treating a wide variety of back problems, regardless of diagnosis or chief complaint. In many cases they are used when the disorder's cause or characteristics were not fully understood by the physician or physical therapist. Also, physical therapists often teach these exercises with their own modifications. Williams suggested that a posterior pelvic-tilt position was necessary to obtain best results (Williams 1937).

Examples of Williams' Flexion Exercises

1. Pelvic tilt. Lie on your back with knees bent, feet flat on floor. Flatten the small of your back against the floor, without pushing down with the legs. Hold for 5 to 10 seconds.

2. Single knee to chest. Lie on your back with knees bent and feet flat on the floor. Slowly pull your right knee toward your shoulder and hold 5 to 10 seconds. Lower the knee and repeat with the other knee.

3. Double knee to chest. Begin as in the previous exercise. After pulling right knee to chest, pull left knee to chest and hold both knees for 5 to 10 seconds. Slowly lower one leg at a time.

4. Partial sit-up. Do the pelvic tilt (exercise 1) and, while holding this position, slowly curl your head and shoulders off the floor. Hold briefly. Return slowly to the starting position.

5. Hamstring stretch. Start in long sitting with toes directed toward the ceiling and knees fully extended. Slowly lower the trunk forward over the legs, keeping knees extended, arms outstretched over the legs, and eyes focus ahead.

6. Hip Flexor stretch. Place one foot in front of the other with the left (front) knee flexed and the right (back) knee held rigidly straight. Flex forward through the trunk until the left knee contacts the axillary fold (arm pit region). Repeat with right leg forward and left leg back.

7. Squat. Stand with both feet parallel, about shoulder's width apart. Attempting to maintain the trunk as perpendicular as possible to the floor, eyes focused ahead, and feet flat on the floor, the subject slowly lowers his body by flexing his knees.

References

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Ponte DJ, Jensen GJ, Kent BE. A preliminary report on the use of the McKensie protocol versus Williams protocol in the treatment of low back pain. J Orthop Sports Phys Ther 1984;6:130-9.

Williams PC: Lesions of the lumbosacral spine: chronic traumatic (postural) destruction of the intervertebral disc, J Bone Joint Surg 1937;29: 690-703.

Williams PC: The Lumbosacral Spine. New York, NY, McGraw-Hill Book Co, 1965, pp 80-98.