As the body weight is shifted forward and before the foot can be planted flat on the ground, lengthening contraction of the quadriceps muscle especially that of rectus femoris muscle occur. Lengthening contraction of the tensor fascia lata which is also a knee extensor muscle also occurs. This is the other phase of stance where falls can occur if there is pain and or spasm or weakness of the rectus femoris (L3, L4) and tensor fascia lata (L5, S1) are present.
Most patients with lower back pain are prone to be sedentary and tend to have tightness or shortening of the hip and knee flexor muscles. Thus a hip flexion contracture will also cause significant tightness of the rectus femoris and the tensor fascia lata muscle at the hip. Since sedentary positions especially that of sitting where hip and knee flexion are involved, constant flexion of the knees make the rectus femoris and tensor fascia lata muscles to be stretched out at the knee.
Additionally, hamstring muscles are tight at the knee and stretched out at the hip which aid the hip and knee instability during the stance phase of ambulation.
Training for balance is very important for patients with chronic lower back pain to prevent falls. Within the home in a clutter free environment, patients can also practice walking backward. When doing these exercises, they should hold onto a wall to prevent falls in case of loss of balance.
Patients should also practice walking on the toes and heels. They must practice walking in a straight-line with the heel of one foot following the toes of the other foot as in the drunken test.
Train oneself to be able to stand on one foot while moving the unsupported limb in flexion, extension, abduction, adduction, internal and iexternal rotation movements with knee in flexion as well as knee in extension.