Williams Flexion Exercise (WFE)

What is a Williams flexion exercise (WFE)?

Williams flexion exercises (WFE) — also called Williams lumbar flexion exercises or simply Williams exercises is a set or system of related physical exercises intended to enhance lumbar flexion, avoid lumbar extension, and strengthen the abdominal and gluteal musculature in an effort to manage low back pain non-surgically.

It also stretches the erector spinae, hamstring, and tensor fasciae latae muscles and iliofemoral ligament. The system was first devised in 1937 by Dr. Paul C. Williams, then a Dallas orthopedic surgeon.

Williams’s back flexion exercises are a non-surgical treatment option for that patient who wants to improve low back pain. These exercises are an effective way to resolve back pain permanently who do not want to undergo low back surgery. Over time, Williams’s back flexion exercises have been prescribed to patients with various conditions related to low back pain, even in the absence of a proper diagnosis. This exercise is mostly prescribed by orthopedics, physicians and physical therapists have also developed many variations of these exercises.

As compared to the McKenzie method of exercise where motion will increase lumbar extension. The McKenzie method of extension exercises and William’s Back flexion exercises were both founded in the 1930s. The Mckenzie exercise is also called the Mechanical Diagnosis and Therapy method (MDT). There are limited studies that have been available showing the efficacy of the Williams flexion exercise or McKenzie extension exercises compared to each other in direct comparison.

History of Williams flexion exercises (WFE)

The WFEs were developed out of the Regen exercise (also called “squat exercise”), advocated in the 1930s by Eugene M. Regen, a Tennessee orthopedic surgeon, and which consists in squatting and emphasizing the convexity of the lumbar area. Williams first published his own modified 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.

These exercises were initially developed for men under 50 and women under 40 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.

Rationale

Williams believed that the basic cause of all pain is the stress induced on the inter-vertebral disc by poor posture. He theorized that the lordotic lumbar spine placed strain on the posterior elements of the intervertebral disc and caused its premature dysfunction. He was concerned about the lack of flexion in daily activities in the accumulation of extension forces that hurt the disc.

Goals of Williams flexion exercises (WFE)

The goals of these exercises are to open the intravertebral foramina and stretch the back extensors, hip flexors, and facets; to strengthen the abdominal and gluteal muscles; and to mobilize the lumbosacral junctions. And also reduce pain and provide lower trunk stability.

Mechanism of WFE

Williams said: “The exercises outlined will accomplish a proper balance between the flexor and the extensor groups of postural muscles…”. Williams suggested that a posterior pelvic-tilt position was necessary to obtain the best results.

Both flexion and extension exercises have been shown to help reduce back pain and have been demonstrated to accomplish the following:

• significantly increase the canal area,
• increase the midsagittal diameter,
• increase the subarticular sagittal diameter
• increase all the foraminal dimensions significantly.

Procedure of WFE ( Williams flexion exercises)

These exercises were performed in the supine position on a floor or other flat surface. There were variations, but the primary maneuver is to grab the legs and pull the knees up to the chest and hold them there for several seconds. The patient then relaxes, drops the legs down, and repeats the exercise again. The primary benefit is supposed to be the opening of the intervertebral foramen, the stretching of ligamentous structures, and the distraction of the apophyseal joints.

Following of the variations of the WFEs are below:

Pelvic tilt:

Lie on your back with knees bent, and feet flat on the floor. Flatten the small of your back against the floor, without pushing down with the legs. Hold for 5 to 10 seconds. Pelvic tilt exercises strengthen muscles that support your low back.

Single Knee to chest:

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

Double knee to chest:

Begin as in the previous exercise. After pulling the right knee to the chest, pull the left knee to the chest and hold both knees for 5 to 10 seconds. Slowly lower one leg at a time. Knee-to-chest stretches to improve flexibility in your low back.

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. Partial sit-ups strengthen the upper and lower abdominal muscles at the same time.

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. The hamstring stretch improves the flexibility of the muscles along the back of your thighs.

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 (armpit region). Repeat with right leg forward and left leg back. The hip flexor muscles are located at the front of your hips. These muscles are often tight, particularly if you sit a lot during the day. It improves hip flexibility.

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. The squat exercise strengthens muscles in your hips. Perform this exercise near a sturdy surface if you have difficulty with your balance.

Lumbar flexion position with rotation

Take Supine Position with your knees bent and feet flat on the floor. Extend your arms out to the sides for stability. Keeping your shoulders slightly elevated, gently drop your knees to one side, aiming to touch the floor. Hold for a few seconds and then bring your knees back to the starting position. Repeat on the other side. This exercise helps to stretch and mobilize the muscles and joints in the lower back and hips.

Seated Forward Bend

Sit on the edge of a chair while keeping your feet flat on the floor. Slowly bend forward from your hips, reaching towards your feet or the floor with your hands. Keep your back straight and avoid rounding your shoulders. Feel the stretch in your lower back and hamstrings. Hold for about 20-30 seconds and then slowly return to an upright position.

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