Managing Low Back & Hip Pain

Build A Solid Foundation Through Your Low Back & Hips

Low back pain affects many people worldwide. The causes of low back pain can be from many different factors, but the role of hip mobility and stability can often be overlooked.

The overall anatomy of the lumbo-pelvic-hip complex (LPHC) is quite intricate with a series of muscles, ligaments, joint capsules, fascia, and bony support all providing a stable structure that allows for mobility. For the sake of simplicity, let’s just talk about the general concept of mobility & stability between the hips and the spine. By understanding the relationship between the hips and the low back, we can create effective strategies to eliminate and prevent low back pain.

Let’s take a step back to take a look at the general structure of the spine. If we think of the spine as a stack of blocks, then each block is a separate unit (vertebrae) allowing the spine to move in all directions - forward, backward, to the side, and rotating. The spine is not only capable of moving in all directions, but it also serves a critical role as the body’s main support structure with all of the blocks (vertebrae) nicely stacked over each other. Our stack of blocks sits on top of a platform (the pelvis) which attaches to the hips and lower extremities. This is where the hips come into play as a crucial role in what happens to the body’s support structure (spine).

Mobility Deficits in the Hip
When the hips lack significant mobility in any given direction, the human body will find a way to compensate for this and make it up elsewhere in the body. This can present excess or hypermobility in segments of the spine, and while on its own is not necessarily a bad thing, too much uncontrolled mobility at a specific segment can lead to increased stress, irritation, or tissue degradation in that region. One example is when someone lacks hip extension. The compensation strategy is often seen as excessive extension or overarching of the low back. Over time, this can lead to joint pain in the spine.

Stability Deficits in the Hip/Pelvic Complex
Let’s go back to our analogy of the stack of blocks sitting on a stable platform. We want a stable platform with adequate strength and stability of the muscles in the hip and pelvic girdle. If there is an imbalance, where one side is significantly weaker than the other, our platform (the pelvis) may start to tilt or “collapse” under the forces placed from daily activities or functional activities in sports & exercise, putting abnormal pressure and forces on one side of a block (vertebrae) vs the other. If both sides are equally weak and unstable, the platform as a whole becomes more unstable and less resilient. The most common example of this is a lack of strength and stability in the gluteus medius muscle, which plays a very crucial role in keeping the platform (pelvis) level from side-to-side.. Weakness here can present as a pelvic drop or compensatory pelvis/hip hike, which now stresses other pieces of our support structure (spine).

Here’s What To Do
Address these hip & low back deficits with an integrated approach of mobility & stability exercises, as well as overall strength training.

Mobility: the hip is a true ball and socket joint that allows motion in all 3 planes of motion (frontal plane - cuts the body into front and back halves, think side to side movement, sagittal plane - cuts the body into left and right halves, thing front to back movement, and transverse plane - cuts the body into top and bottom halves, think rotational or twisting movement), therefore mobility should be incorporated in all three planes.

Stability: the hips should prioritize glute (gluteus medius, gluteus maximus) strength, but also needs to balance strength in the hip flexors, adductors, hamstrings, and abdominals.

Incorporating these key elements will optimize not just low back & hip joint health, but overall whole body health and create a focused and well rounded fitness program.