Low back pain
Low back pain continues to be the most common complaint in the health industry that limits individuals. Rehabilitation of the low back is transitioning from focusing on reducing localised pain and therefore symptoms to a biomechanical approach looking at how other areas of the body such as the hip impact low back pain. This biomechanical approach is effective in finding the movement dysfunction to prevent further aggravation of the injury rather than simply relieving symptoms.
Hip mobility and low back pain
A recent study highlights the influence of hip mobility on low back pain. Hip extension mobility was evaluated in two groups, those with and without low back pain and found:
- Hip extension in those with low back pain = -4.16 degrees
- Hip extension in those without low back pain = 6.78 degrees
A total loss of 10 degrees of hip extension in those with low back pain.
Loss of hip extension relates to low back pain
There is a strong correlation between loss of hip extension and low back pain with as little as 10 degrees being significant.
large majority of the population sit for some time each day, increasing
as we age. Among many things, this results in tight hip flexors and
With recreational activities aside like sports and running this anterior tilt posture with tight hip flexors causes a loss of hip extension mobility resulting in the low back taking the load through hyperextending. This occurs whilst simply walking and in a standing posture.
The results above highlight those with low back pain have negative hip extension meaning they can’t extend to neutral. As we know the body will compensate, hips don’t extend? No problem we will extend our spine more.
This compensatory pattern could potentially lead to overuse, fatigue and altered motor activation patterns in the hip and lumbar spine leading to low back pain and injury. Thus, highlighting the importance of hip joint range of motion.
There are many techniques to improve hip flexor length. One effective method is the true hip flexor stretch in a ½ kneeling or side-lying position. Important things to note whilst performing this stretch is that there should be no compensatory low back extension and those in an anterior pelvic tilt posture should focus on posterior pelvic tilt.
You can now see how mobility in hip in extension can improve your outcomes. Once you have started to gain some hip mobility there is much more work to be done on gluteal and core control. Focusing on hip extension mobility and strength should be one of the key components in low back pain recovery and prevention.
In the moment: Sports medicine Jordana Bieze Foster: Athletes with hip flexor tightness have reduced gluteus maximus activation. Lower Extremity review Vol 6, Number 7 2014
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