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Lower Back Pain - It’s All In The Hips

By Simon Caddy

Lower back pain. We’ve all had it, or know someone who has. More importantly, we all hate it. It can be debilitating, stopping us from moving let alone working, even causing pain on breathing in severe cases. But where does it come from?

Is it because we are always moving forwards? Is it because that pen we leaned over to pick up was abnormally heavy? Maybe we didn’t warm up properly before we leaned over the sink as we brushed our teeth. Whatever we think the cause may be, there is an increasing trend in the appearance of a cause. There is now a common “bully in the body” that can profoundly limit our movement and cause immense lower back pain.

“Great! Where is it?” I hear you cry. The answer is…the hips. More importantly it’s the front of the hip in the hip flexors.

These muscles, which are called the psoas major, psoas minor, iliacus, rectus femoris, sartorius, tensor fasciae latae, pectineus, adductor longus, adductor brevis and gracilis.

Now, this is not to say that it is all of these muscles that cause low back pain. No way. I’m not going to be that vague.

The most important of these muscles are the iliacus and psoas (both major and minor). Collectively they are called the iliopsoas, and as you can see from the diagram they run from their origins in the lumbar spine (lumbar vertebrae 1-5 for psoas major) & the hip (iliac fossa of os coax for iliacus) to the combined insertion on the lesser trochanter of the femur.

Now, here’s how this problem works.

As the rectus femoris tightens, the tendinous expansion from the hip to the muscle pulls the hip into an anterior rotation. As this anterior rotation occurs the anterior inferior iliac spine (AIIS) is brought nearer to the head of the femur. As this happens, the psoas major is put into more of a stretch. However, as the psoas does not like being stretched, it resists as much as it can and pulls the lumbar spine into extension. This creates a hyperextension of the lumbar spine (hyperlordotic curve). Once this has happened, if you try to move into extension you are actually hyperextending an already extended joint. Not good. This is what causes the lower back pain.

The answer very simply is to reverse this process.

To do this you need to stand with one-foot forwards, in a static lunge stance. Firstly you need to push the knee of the front foot slightly forwards and repeatedly do so. Now, keeping the back leg straight, push the hips forwards until you feel a light stretch in the front of the hip for the back leg. Perform 10 - 15 repetitions, and then repeat for the other leg.

There is a problem. This isn’t always the answer to lower back pain!

As I write this article I have just seen a client who presented with lower back pain. Perfect timing! After an assessment of hip movement and the location of the pain, the following was found:

Only a slight restriction in hip extension on both hips
Pain on hip flexion with each leg forwards
Pain on spinal flexion (bending over to stretch)
Pain on thoracic rotation to the right (pain in left lumbar spine)

The solution…place the left foot forwards, step slightly wider, and point the toes out (external rotation). From this position, my client pushed her hips directly to her left side and BANG, we’d found the tight muscle and made it start to utilise the stretch reflex. Within 12 repetitions the pain in my clients lower back had subsided, and I’ve just seen her complete a 15-minute run on a treadmill without pain.

However, this still comes down to the title of the article “Lower Back Pain: It’s All In The Hips”. Once again it was shown that a tightening of a muscle that is found around the hips could cause a deferred pain in the spine. In my clients’ case it was because the tight muscle (gluteus minimus) was causing the hip to move slightly from its normal position, it was causing an abnormal load further up the body that resulted in stress and ultimately, pain.

So remember, when you experience a case of lower back pain and you can’t seem to get the spine to move better and release and tension, it could be because the spine isn’t the problem but rather the symptom of a deeper (or lower) cause.

About the Author:

Simon Caddy has been a qualified Boxercise, Kick-Boxercise and Cardio-Kickbox instructor since 2005, and delivers several classes each week across a 20 mile radius from his home in Caerphilly, as well as using it in one-to-one sessions with his clients. For more information about these classes or one-to-one sessions, please visit SimonCaddy.com