Williams Flexion Exercise

Original Editor - Shreya Pavaskar

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Description[edit | edit source]

Williams back exercises, also known as Williams flexion or lumbar exercises, are a series of exercises that were founded in the 1930s for people with low back pain. In comparison with the McKenzie back exercises that based on lumbar extension, it aims to improve lumbar flexion and strengthen the gluteal and abdominal muscles to avoid from the pain getting worse. [1]

Indication[edit | edit source]

Lumbar flexion exercises is an exercise technique that aims to correct posture, relax muscles, increase endurance, stretch and increase lordosis.[1]

  • To avoid lumbar lordosis
  • Non-surgical option to improve low back pain
  • Improve stability of lower back
  • Decrease pain

Procedure[edit | edit source]

Williams exercises include:

  1. The Pelvic Tilt: 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.
  2. The Single Knee To Chest: 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.
  3. Double Knee To 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.
  4. Partial Sit-Up: 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.
  5. Hamstring Stretch: The patient is in supine lying with hands on the side. With one knee bent and other knee straight, the paint is asked to pull the foot of his straight leg towards himself. He is then asked to raise his leg till he feels the stretch at the back of his thigh.
  6. Squatting: Stand with feet just wider than hip-width apart, toes pointed slightly out, clasp hands at chest for balance. Send hips back and bend at knees to lower down as far as possible with chest lifted. You can swing your arms back for momentum. Press through heels back up to explode up, jumping vertically in the air.
  7. Hip Flexor Stretch: Kneel on your affected leg and bend your good leg out in front of you, with that foot flat on the floor.. Keeping your back straight, slowly push your hips forward until you feel a stretch in the upper thigh of your back leg and hip.
  8. Lumbar Flexion With Rotation: 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.
  9. Seated Lumbar Flexion: 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.

In the video below, Dr Donald A. Ozello demonstrates how to do Williams flexion exercises which are listed below:

  • Stretching Exercises: Supine Single Leg, Knee to Chest, Supine Double Leg, Knees to Chest, Hip Flexor Stretches, Hamstrings Stretches
  • Strengthening Exercises: Supine Pelvic Tilt, Crunches, Bodyweight Squats


The Williams back pain exercises can be repeated several times. 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. Then the patient would perform the exercise and repeat.

Evidence[edit | edit source]

A randomized controlled study involving individuals over the age of 50 with chronic low back pain and degenerative spondylolisthesis found that lumbar flexion exercises produced positive results similar to lumbar stabilization exercises in terms of pain control and disability improvement. [3]

Resources[edit | edit source]

Lumbar Flexion Exercises by Orthopaedic Specialists of North Carolina (OSNC)

References[edit | edit source]

  1. 1.0 1.1 Dydyk AM, Sapra A. Williams Back Exercises.
  2. Ccedseminars.Williams Flexion Exercises for Lumbar Spine. Available from: https://www.youtube.com/watch?v=757ucsakxoc[last accessed 1/9/2023]
  3. Nava-Bringas TI, Romero-Fierro LO, Trani-Chagoya YP, Macías-Hernández SI, García-Guerrero E, Hernández-López M, Roberto CZ. Stabilization exercises versus flexion exercises in degenerative spondylolisthesis: a randomized controlled trial. Physical Therapy. 2021 Aug 1;101(8):pzab108.