Is your low back pain debilitating your life? Chronic back pain leaving you with a feeling of helplessness? Want to start a new endeavor like running, triathlons, Spartan racing, etc., but can’t seem to muster up the desire to do it because your back is limiting you? The key to unlocking your body’s ability to get rid of that chronic back pain may not be that far from your grasp.
At Complete Athlete, our fundamental approach to our body’s performance is found within our own control. Using the “joint-by-joint approach” founded by elite Performance Coach Mike Boyle and renowned therapist Gray Cook, we can look at the body in a way that allows us to not only decipher what parts of our bodies are causing the problem, but also how we can go about fixing the problem. In this continuum that we follow, pain associated in one area of the body is usually caused by a joint above or below the site of pain. In regards to low back pain, it is usually common to find that low back pain can be a result of some dysfunction in the hips.
In a study (1) done by therapists JB Ellison, SJ Rose, and SA Sahrmann; “Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain”, they sought to determine the prevalence of passive hip rotation deficits in healthy subjects and those with low back pain. Their research suggested that there was an association between those with hip rotation range of motion (ROM) imbalance and the presence of low back pain. In accordance with this direction, we can surmise that if we increase range of motion in our hips, then we can start to alleviate some of the symptoms of chronic low back pain.
Another perspective we can approach our low back pain with is this; Is our low back (lumbar spine) performing compensatory movements that are dysfunctional elsewhere in our back? Is our low back doing the twisting, rotating, flexing, and bending that our upper back or “thoracic spine” should be doing? As stated, our thoracic spine is what is responsible for the multiple levels of movement necessary for healthy movement and not our lumbar spine.
Our lumbar, however, is built for stability. It is meant to support the weight of the body and any excessive weight added to our body. It is also meant to resist excessive rotation and twisting. Its stability characteristics are meant to act as a transfer point of power generated through the hips and then transferred to our mobile thoracic spine. Let me be clear here, I am not saying that the lower back shouldn’t move, I’m just stating that it is not meant to move greatly and instead meant to be solid and reliable.
At the hips, we want to make sure we can flex and extend, internally and externally rotate, and can abduct our hips to decrease strain on other structures like our knees and low back.
To mobilize the hips, intentional strategies must be implemented daily to try to regain the mobility that the hips need to allow for basic functional movement. Below are some mobility drills that you can start to implement right now to help facilitate more hip mobilization.
#1.) Seated hip external and internal rotation.
This exercise is an amazing two for one, bang for your buck movement that will address multiple facets of hip mobility. Leaning towards the front leg will address hip external rotation limitations. Leaning backwards, it will address external rotation issues as well as addressing hip internal limitations.
#2.) Rear foot elevated ½ kneeling hip extension.
To begin with, you will want to start off with a “neutral spine” position. This position is best described as “ribs down/towards your belt and tailbone or butt tucked under”.
Next, we activate/squeeze the butt cheek on the same side that the knee is down (or the hip that is being mobilized). This action makes sure that the pelvis is in a neutral position and can allow for a better stretch of the muscles of the hip and thigh.
Lastly push your hip forward and feel the rectus femoris, TFL, and hip flexor (PSOAS) being stretched.
#3.) Quadruped Hip Rock.
Now to address the adductors. The adductors can be either hip flexors or hip extensors. It all depends on what position our lower body is in. When we perform this exercise, make sure that you are maintaining a good neutral spine. Rocking back will target the end range of that squat or deadlift pattern. Rocking forward, it will target the adductors responsible for the end range of our hip extension.
Next, to alleviate compensatory movement of our lumbar (or low back), we must facilitate better movement of our t-spine (or upper back). This is generally where most of our extension and rotation of the back should occur.
#4.) Quadruped thoracic rotations.
In a quadruped, or all four position, place one hand on the back of your head. This will force a bit of thoracic extension. Then, rotate as far as possible towards the elevated arm. Focus on locking the hips and concentrate on just the upper back doing most of the rotation.
#5.) Seated thoracic rotations.
In a criss/cross applesauce seated position, place both arms behind your head as you would in a sit-up movement. Do your best to maintain a neutral spine. Next, rotate to your body to the right as far as you can and then to the left as far as you can. Again, make sure that it is the upper back that is doing the bulk of the moving.
By adding in these subtle movements into your daily exercise routine, you should start to feel that unwanted back pain minimizing and eventually gone. Remember, mobile hips, stable lumbar, and mobile upper back is the recipe we want to have for a pain free back.