Low back pain is something that strikes about 80% of us "older" (>35) adults. It's the number one cause of activity limitation, and it's an overall huge burden financially, psychologically, and physically.
But despite the mass prevalence, finding meaningful low back pain relief can be puzzling to figure out.
What I learned theoretically in Physical Therapy school was difficult to apply in real life, because people are people and they are more than a black and white case of mechanical low back pain.
What I have learned since my early days is that while there are a multitude of pain generators in and around spine (joints, ligaments, muscles, discs, etc), I don't really need to know what's going on structurally to design an effective treatment plan.
In fact, unless you're going to have surgery (which, by the way, is not shown to be any more effective than conservative treatments, so I suggest you don't!), your doctors don't really need to know either.
We've learned from countless research that a picture on a scan does not necessarily equate to the cause of symptoms. There have been studies done where they scan a cross section of the population and find perfectly happy, pain-free people living with bulging discs and degenerative joints.
And then people with pain may not show a thing on their MRIs.
A good clinical exam can provide a lot more data than a scan of your still spine while you're lying down at one moment in time.
One of the benefits of my concierge practice is that I get a lot of time with my clients. I have time to listen and really hear them.
My emperical evidence suggests that factors like stress play a HUGE role in back pain.
Like 99.9% of my clients who come in with a back pain flare up report something going on in their personal lives.
I've experienced this myself, and magically all my pain disappeared the moment I went on vacation..and when I removed that stressor from my life the pain never came back. Amazing. You just can't ignore the nervous system component of back pain.
I'm pretty sure this is why we've found that yoga works just as well, if not better, than other conservative treatments.
Now I'm a scientist by nature, so I do also appreciate some concrete evidence and a structured plan.
Several studies point to a correlation of lost hip mobility and low back pain.
It makes sense, the femurs and the spine all connect into the pelvis, what one does or does not do intimately effects the other.
I'll save you from reading several research papers - hip rotation imbalances are present in a statistically significant number of cases of low back pain.
Therefore we conclude restoring hip mobility is a good idea in terms of treatment.
This makes sense when you step back and observe function, which is where a solid clinical exam comes into play. If someone lacks hip mobility they'll have to make up for it somewhere else, and often times that is through the spine.
By watching someone squat, walk, weight shift, side bend, and rotate I can get a clear picture of what structures are restricted, weak, or just not working. Watching someone move will give me far more information than an MRI scan.
Statistically we know that the imbalance looks like this: external rotation is typically greater than internal rotation, and extension is limited by about 10 degrees.
Check out my instagram video to see what this looks like:
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The correlation between lack of hip internal rotation and extension range of motion with incidence of low back pain is well documented. 🤔👩🏻🏫 Here’s one quick and easy screening tool to check your range of motion. 🧐 Standing in neutral spine flex the hip and rotate the lower leg inward and outward, slowly so that nothing else moves. This is isolating of your hip internal vs external range of motion. The two should be equal, internal = external and R= L. ⚖️ You can see I’m not perfectly symmetrical! 🤷🏻♀️🤫 Now let’s check hip extension. Again stand tall in neutral spine and let’s see 👀 how far the leg can extend behind the body arching the low back. 🚫 Ideally you’d be able to demo 10-20 degrees of motion here. 💯 Studies tell us that a lot of people have difficulty reaching neutral hip extension, let alone 10-degrees past neutral! 😟🙈 So let’s find neutral in our kneeling hip flexor stretch. 👍 🔑keys: ✔️Stack the hip over the knee ✔️Rock the pelvis into a slight posterior tilt. ✔️Don’t worry about lunging forward, we are just trying to get neutral extension here without jamming the hip. 💡 ✔️raise the same side arm and side bend in the opposite direction to From here you can release into a longer line runner’s lunge. Try rocking forward and back, up and down until you find the sweet spot 👌 Hang for a handful of deep breaths in each position, then follow up with some simple strength support on all 4’s. 🧘🏻♀️💪 Now re-check your motion and see if you made some gains! 🤞 enjoy your new mobility! 🧘🏻♀️👏🙏 #yogaforlowbackpain #hipstretches #stretchesforlowerbackpain #hipopener #hipflexorstretch #alignment #posture #mobility #hipmobility #physicaltherapist #physicaltherapy #yogaismytherapy #yogateacher #balancedbodyyoga #theyogasuites #spinecare #spinehealth #mobilehipshappyspine
Bilateral deficits correlate with low back pain whereas unilateral deficits tie in more with sacroiliac joint dysfunction.
Again if you take a step back this shouldn't be a surprise.
As a society we sit for the majority of the day, which results in tight hip flexors.
Tight hip flexors means loss of hip extension mobility, and because the body is brilliant it knows to just move up the chain and take the mobility from somewhere else.
Your lumbar spine.
Results of these studies show average hip extension in people with low back pain in the negatives, meaning meaning they can’t even extend to neutral!
So what happens when they simply try to stand up, let alone walk?
The lumbar spine compensates.
This pattern can only go on for so long before the body says enough, I can't do it anymore, this is not what my spine is meant to do, break down!
So should we just stretch our hip flexors?
It's a good place to start, but but may not be the complete solution in and of itself. The hip muscles overlap with the diaphragm, back, pelvic floor, and leg muscles.
The best stretch for you is the one that addresses your unique deficits. It should also be one you can do without pain, with full breath, and with no compensation strategies. This might take some 1:1 work with a physical therapist (ahem) to figure out.
Also remember the flip side of stretching is strength. A system is not balanced without.
So if you haven't addressed your hips and you are struggling with back pain issues, I suggest you go there next. I have a free training series that addresses everything in this complicated lumbo-pelvic-hip junction. If you're ready for more, sign up for that series below!