Low back pain is, by far, the most common complaint reported today.
I rehab hundreds of cases each year, both acute & chronic, and they mostly have one thing in common…poor pelvic/hip mobility. Before we can discuss what therapies can help, we need to understand what causes our hip to become impaired in the first place and how that leads to low back pain. We know that mobility means “the ability to move or to be moved freely and easily.” So what is causing to opposite to happen?
The hip joint is the largest joint in the body and holds the majority of our weight when we are standing. People often think that the hip joint needs to have stability to function correctly but when look at our bodies joint by joint, we need mobility. We do need our joints to be stable enough to minimize many common injuries such as sprain/stains but understanding where we need mobility and where we need stability is important to decrease common aches and pains.
The hip is incredibly complicated and merits a great amount of attention with low back pain sufferers. Patients and doctors often only look at the pained area and believe that is the main cause. I have found over the years, we need to look at how all the body’s joints are functioning to determine the true cause of pain.
What we need to understand is, tight muscles around the hip can have a direct impact on the lumbar spine. Most of us have heard the term “hip flexors” but do you know what muscles they are talking about, its ok…they most likely don’t either. The main hip flexor is the Psoas muscle (pronounced SO-as). It attaches to the lower segments of our spine and inserts on the posterior aspect of our thigh and it is a major contributor when linking poor hip mobility with low back pain. Why? Sitting disease! I know, get the giggles out of your system. Sitting disease, as it’s known, might sound crazy, but it’s a real concern. Global studies show, on average, we sit 7.7 hours a day and some results estimate people sit up to 15 hours a day.
The Psoas muscles pull on the pelvis and lumbar spine to create an anterior pelvic tilt or medically called “Lower Cross Syndrome.” This condition alters posture and also inhibits, or turns off, the opposing muscle group, such as the gluteus maximus, abs and hamstrings, leading to muscle imbalances. When we sit, we place the Psoas muscle into the flexed or shortened position, when we continue to do this day after day, year after year, the muscle begins to adapt to it new “normal” position of flexion. Have you even noticed that when you sit for a while it is very difficult or painful to stand up straight?
So, what can we do the help release the tightness and get some relief? Before we discuss any exercise or stretching we need to change up some of the day to day repetitive stuff that started the issue in the first place, because let’s face it, if we don’t change that, this will be a revolving door. Let’s start with micro-breaks. Research studies on micro-breaks have not only shown to decrease low back pain in the work place but also help with increasing productivity. Another great way to combat sitting disease and many other health issues is the use of standing workstations or adjustable desks. Lastly, sitting with correct posture at your desk is crucial! Sitting hunched over at your desk may feel comfortable; just know that it comes with a cost.
Now for my specialty, exercises and stretching you can perform to help correct lower cross syndrome. When it comes to treating lower cross syndrome, my focus is to stretch the muscles that are tight and strengthen the ones that are weak, sounds simple, right? Well the problem with performing all this on your own is keeping everything balanced. Muscle imbalances lead to overcompensation patterns, overcompensation leads to injuries. Performing a complete personalized SFMA movement assessment will find your exact triggers and imbalances. But in the meantime these stretches and exercises can help get some relief.
- Psoas Stretch or Kneeling Fencer Stretch
- This is by far the most popular psoas stretch out there. The most important thing to remember is to move your body forward while keeping your spine straight up and down. You will feel a stretch in the front of the hip. To increase the stretch, move your forward foot ahead. This stretch can also be performed in a standing position if needed
- Cat/Camel Low Back Exercise
- This exercise should be performed at a slow & controlled pace. First arch your back up toward the ceiling, mimicking a scared cat. Increase the movement as you inhale deeply. Then exhale, tighten your abdominals, drop your chest toward the floor and lift your head slightly. Performing the cat-camel will teach you good coordination for movements of your spine.
- The Bird Dog exercise is a great core exercise that emphasizes lower back strength and help with balance. Begin on all fours (quadruped), make sure your hands a directly under your shoulder and you knees are under your hips. Tighten your abdominals and keep you back and pelvis in a tight and stable position (minimal movement). Reach out with one arm at the same time reach out with the opposite leg. It is very important that you engage your glutes (butt) muscle during this exercise. Return to the starting position and repeat with the opposite limbs.
- Supine Bridge
- The Supine Bridge is an exercise that is performed lying on your back; it is considered a glute activation exercise. Start off lying on your back (supine) with your knees bent and your arms to your side. Next, elevate your hip off the ground, pressing with your heels and “squeezing” your glutes. Lastly, lower yourself slowly back to the starting position.
As with all exercises please start off slowly and progress gradually. All of the exercises can be performed on a daily basis and the amount of repetitions depends on your physical level. A good starting point is 6-8 reps for each exercise 2-3 times per session.
Proper mobility and strengthening is something I recommend to all my patients. It is very important to be properly diagnosed by a medical professional when dealing with low back pain to insure proper condition specific treatment is being administered. If you have any questions, you can contact the office at 561-708-5700 or check out our website www.chiropalmbeach.com for more information.