Benefits of the Williams protocol in the treatment of lower back pain in older adults
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Abstract
Introduction. Low back pain is one of the leading causes of disability and a frequent reason for seeking physical therapy. Among active treatment options, William’s flexion exercises have been proposed as a simple and accessible strategy for reducing pain and improving functionality in adults and older adults, although evidence on their use is scattered. Objective. To analyze the scientific evidence on the effectiveness of the Williams flexion method in reducing pain and improving functionality in people with low back pain. Methodology. A literature review was conducted in open-access databases and academic repositories, including articles published between 2015 and 2025 in Spanish and English. Studies in adults with low back pain were selected where Williams exercises would be used as the main or combined intervention. Clinical trials, quasi-experimental studies, and reviews were included, of which 11 met the inclusion criteria. Results. Most studies report a significant reduction in pain, measured using scales such as VAS or NRS, along with improvements in functionality and activities of daily living. In older adults, a decrease in pain and greater autonomy are described, and in work contexts, less interference of pain in occupational performance is observed. Williams exercises are effective, although not always superior to other active programs, and show better impact when combined with other physiotherapy modalities. Conclusion. Williams' flexion exercises are an effective, low-cost, and easy-to-apply therapeutic alternative for the management of low back pain. However, randomized clinical trials with standardized protocols and prolonged follow-ups are required to define the optimal dose and the profiles of patients who benefit most. General study area: Health Sciences. Specific area of study: Physiotherapy / Musculoskeletal Rehabilitation. Type of study: Literature review.
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2. International Association for the Study of Pain (IASP) [Internet]. The global burden of low back pain. 2021 [cited 2026 Jan.08]. Available from: https://www.iasp-pain.org/resources/fact-sheets/the-global-burden-of-low-back-pain/
3. Syroyid IS, Cavero-Redondo I, Syroyid BS. Effects of resistance training on pain control and physical function in older adults with low back pain: a systematic review with meta-analysis. Journal of Geriatric Physical Therapy [Internet]. 2023 [cited 2026 Jan.08];46(3):E113–E126. Available from: https://doi.org/10.1519/JPT.0000000000000374
4. George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, et al. Interventions for the management of acute and chronic low back pain: revision 2021. Journal of Orthopaedic & Sports Physical Therapy [Internet]. 2021 [cited 2026 Jan 08] ;51(11):CPG1–CPG60. Available from: https://www.jospt.org/doi/10.2519/jospt.2021.0304
5. World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. [Internet]. 2023 [cited 2026 Jan 08]. Available from: https://www.who.int/publications/i/item/9789240081789
6. Sukmajaya W, Alkaff FF, Oen A, Sukmajaya AC. Williams flexion exercise for low back pain: a possible implementation in rural areas. Open Access Macedonian Journal of Medical Sciences [Internet]. 2020 [cited 2026 Jan.08];8(B):1–5. Available from: https://oamjms.eu/index.php/mjms/article/view/3988
7. Amila A, Syapitri H, Sembiring E. The effect of William flexion exercise on reducing pain intensity for elderly with low back pain. International Journal of Nursing and Health Services (IJNHS) [Internet]. 2021 [cited 2026 Jan 08];4(1):28-36. Available from: https://ijnhs.net/index.php/ijnhs/article/view/374
8. Piele D, Rusu L, Calina ML, Marin M. Efficiency of William’s versus McKenzie’s therapy for patients diagnosed with low back pain. Discobolul – Physical Education, Sport and Kinetotherapy Journal [Internet]. 2024 [cited 2026 Jan.08];63(1):15–26. Available from: https://doi.org/10.35189/dpeskj.2024.63.1.2
9. Viderman D, Kalikanov S, Myrkhiyeva Z, Alisherov S, Dossov M, Seitenov S, et al. Impact of exercise therapy on outcomes in patients with low back pain: a narrative review. Journal of Clinical Medicine [Internet]. 2025 [cited 2026 Jan 08]; 14(17):5942. Available from: https://doi.org/10.3390/jcm14175942
10. Ube Coronel DE, Villamar Vizueta AD. Ejercicios de Williams y su influencia en adultos mayores con lumbalgia que acuden al área de rehabilitación Hospital General Martín Icaza en el periodo junio–septiembre 2024 [Tesis de pregrado, Universidad Técnica de Babahoyo, Babahoyo, Ecuador]; 2024 [citado 2026 enero 8]. Disponible en: https://scholar.google.com/scholar?hl=es&as_sd
11. Solórzano Pérez CA, De León Hernández EA, Saravia Aguirre VM de los Á. Efectos terapéuticos del método Williams vs los efectos de los ejercicios hipopresivos en pacientes femeninos de 30 a 45 años de edad para disminuir dolor lumbar a causa de sobrecarga mecánica [Tesis de pregrado, Universidad Galileo, Guatemala]; 2023 [citado 2026 Ene 8]. Disponible en: http://biblioteca.galileo.edu/tesario/handle/123456789/1457
12. Halimah N, Pradita A. Effectiveness of infrared and William flexion exercise on reducing pain and increasing flexibility in patients with low back pain. Babali Nursing Research [Internet]. 2023 [cited 2026 Jan 08] ;4(3):401–411. Available from: https://doi.org/10.37363/bnr.2023.43260
13. Anung ZL, Kusumaningtyas M, Windiastoni YH. Effect of additional William flexion exercise on functional ability in myogenic low back pain patients. Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal Public Health) [Internet]. 2023 [cited 2026 Jan.08] ;7(2):82–88. Available from: https://doi.org/10.35910/jbkm.v7i2.609
14. Rahmawati I, Nurmalia D, Ulliya S, Warsito BE. Metode William fleksi pada low back pain: studi literatur. Jurnal Keperawatan Klinis dan Komunitas [Internet]. 2022 [cited 2026 Jan.08] ;5(2). Available from: https://jurnal.ugm.ac.id/jkkk/article/view/63222
15. Taufandas M, Aupia A, Sapwal MJ, Ikhwani DA, Khairari NDD. The effect of William flexion exercise on low back pain in pottery artisans. Prisma Sains [Internet]. 2025 [cited 2026 Jan.08] ;13(3):886–894. Available from: https://doi.org/10.33394/j-ps.v13i3.15797
16. Kaple N, Phansopkar P. Effect of William flexion exercise and movement control exercise on pain, range of motion, muscle strength and functionality in non-specific low back pain: randomized controlled trial. F1000 Research [Internet]. 2023 [cited 2026 Jan.08];12:770. Available from: https://doi.org/10.12688/f1000research.137087.1
17. Mohite PP, Pathan UI. Comparative study of core stability exercises and Williams back exercises on non specific low back pain among ward nurses. Chinese Journal of Evidence-Based Medicine [Internet]. 2025 [cited 2026 Jan.08] ;21(1):157–161. Available from: https://doie.org/10.10399/CJEBM.2025789607
18. Coca OR, Flores MC, Gómez Nicolalde RV, Zamora Parra XA. Estudio comparativo sobre las capacidades físicas del adulto mayor. Alfa Publicaciones [Internet]. 2020 [citado 2026 enero 08];2(4):38-50. Disponible en: https://alfapublicaciones.com/index.php/alfapublicaciones/article/view/13
19. Cabezas Flores MC, Ochoa Sangurima VL, Carrasco Coca OR, Jara Martínez RM. Como influyen los ejercicios de flexibilidad y elasticidad para aliviar el estrés en el adulto mayor. Alfa Publicaciones [Internet]. 2020 [citado 2026 enero 08];2(3):6-12. Disponible en: https://alfapublicaciones.com/index.php/alfapublicaciones/article/view/31