If you are experiencing low back pain, you’re not alone. About 85% of working adults have experienced some sort of lower back pain.
In this article, we explain the relationship between your lower back pain and hip pain, identify possible causes of your back pain, and show you stretches for lower back and hip pain.
Relationship between hip and lower back pain
Your lower back and hips are interdependent structures that share many groups of muscles. A problem in one can cause dysfunction and pain in the other.
The psoas major (one of the hip flexors) is a large muscle whose function is to connect the upper body to the lower body, the outside to the inside, the appendicular to the axial skeleton, and the front to the back. It originates from the lower back (lumbar spine) through the groin and joins with another muscle (illsoas) that attaches to the femur (hip bone).
The Quadriceps (thigh muscle) is often hypertonic (increased muscle tone with lack of flexibility), due to running, excessive sitting, and leg length discrepancies. This hypertonicity pulls the low back vertebrae forward, creating an increased curvature. As a result, the thoracic spine (upper back) and hips can’t move the way they should, and the low back compensates by doing the work for them, which causes lower back pain.
The above hip flexor muscles (iliopsoas & quadriceps) are located in the front and to the sides of the lower back, and connect the lower back to the hip and the hip to the knee. Tight hip flexors compress the lower back and can weaken the gluteal muscles (which stabilize the knee, hips, low back and pelvis), resulting in overworked hamstrings and lower back muscles, which ultimately causes low back pain with or without accompanied knee pain.
Common Causes of Lower Back and Hip Pain
If you’re experiencing back and hip pain, it is recommended that you seek physiotherapy services for a proper diagnosis of your pain.
Sprains: Ligament in your back is overstretched, inflamed or torn
Strains: Tendon or muscle in your back is overstretched, inflamed or torn
Pinched Nerve: Pressure applied to a nerve by surrounding bones, muscles, or tissues and interrupts proper nerve function
Fibromyalgia: Chronic condition causing pain and tenderness throughout the body
Spinal stenosis: Spinal canal narrows over time, putting pressure on nerves of the spine
Spondylolisthesis: Caused by a stress fracture in one of the bones of the spine and causes part of the spine to move out of position
Nerve Damage: Conditions or injuries that damage the nerves in the back or the nerves that carry signals to the back
Stress and Anxiety: Unconscious tensing of muscles
Tight Hip Flexors: Increased tension in this muscle complex is often due to remaining in a seated position for too long
A Herniated Disc: The inner part of the disc (cushion like structure) migrates outwards due to weakness in its surrounding structure, putting pressure on the joint space or nearby nerve
Sacroiliac (SI) Joint Dysfunction: Joints connecting the lower portion of the spine to the pelvis move too much or too little
Arthritis: Breakdown of the protective cartilage of the spine causing the spinal bones to rub together and place greater pressure on the nerves in the lower back and hip
Ankylosing spondylitis: Form of arthritis causing chronic inflammation in the spinal joints
Type of Back Pain: Extension vs. Flexion
There are many different forms of back pain. For simplicity, we have divided back pain into two categories based on preferred and natural movements. Which of the following describes you?
Extension Responders
Surgery may not be needed if physiotherapy helps you eliminate pain or heal from an injury. Even if surgery is required, you may benefit from pre-surgery physiotherapy. You’ll have a faster post-surgery recovery by going into a surgery stronger and in better shape.
Symptoms
Increase pain with sitting and bending
Reduced pain with standing, walking, bending backward or increasing the arch in your back
Worst pain first thing in the morning
Extension responders who experience low back pain, are likely accompanied by sciatica (pain that starts in the low back and travels down the leg, or pain present in the leg) that worsens with sitting and bending. Sudden and abrupt movements, like coughing and sneezing, can increase the pain.
Exercises for Extension Responders
Sloppy Push-Up
Lie down on your stomach in push up position (toes untucked)
Inhale
Exhale while pressing upper body off the floor while driving hips towards the floor
Standing Lumbar Extensions
Stand with feet just greater than shoulder width apart
Place hands in the small of the back
Bend backwards as far as possible
Return to a neutral position
Hip Flexor stretch
Step forward with right leg into a staggered stance
Tilt pelvis posteriorly and brace abdominals
Lower into a lunge (untuck toes)
Flexion Responders
Surgery may not be needed if physiotherapy helps you eliminate pain or heal from an injury. Even if surgery is required, you may benefit from pre-surgery physiotherapy. You’ll have a faster post-surgery recovery by going into a surgery stronger and in better shape.
Symptoms
Increased pain with standing and walking
Improved pain with sitting, rounding back and bending forward
Radiating pain in one leg or both legs (tingling, numbness, weakness)
There are many reasons why you may be feeling pain when standing or walking. The explanation may be as simple as a strained muscle in the low back but may be as complex as degeneration in the spine, causing a narrowing of the spinal canal (a condition known as spinal stenosis).
3 Exercises for Flexion Responders
Double Knee-to-Chest Stretch
Lie down on your back
Hug both knees in towards the chest
Seated Forward Bend
Sit on the floor with straight legs in front
Bend forward, reaching your hands behind your legs
If you’re experiencing back and hip pain, the following are excellent movements that you might benefit from! The important thing to consider is that while these stretches are very effective for some people, these very same stretches might do the opposite. Therefore, it is recommended that you seek professional advice from a physiotherapist to determine the most effective treatment for your pain.
The number of suggested sets, repetitions, and hold times for each movement depends on your needs assessment. Your registered physiotherapist should give you specific parameters based on your individual needs. However, if increased joint mobility is the goal and the movement is targeting a stiff joint, then repetitions can be performed for longer durations.
1. Seated Spinal Twist
Stretches hips, glutes, lower back, and piriformis
Sit on the floor with legs straight in front and arms behind your back
Cross right foot over left leg and place it outside your left knee
Bring your left foot to your right side
Place left elbow on the outside of your right knee, creating resistance
Turn chest, head and eyes to the right
2. Happy Baby
Stretches hip adductors and opens the lower back
Lie face up and relax your head
Splay legs open
Lift feet off the floor
Use hands to grab the outside edges of feet
Pull feet toward chest
Allow knees to lower toward the respective side of the body
Keep back flat against the floor
3. Child’s Pose
Stretches hips, low back, back, and ankles. Should be avoided by extension responders
Kneel on hands and knees hip-width apart (tabletop position) with your feet together behind
Take a deep breath in
Exhale while moving hips backward and lowering buttocks towards heals
Lengthen neck and spine by drawing the crown of head away from shoulders and ribs away from the tailbone
Rest forehead on the ground, with arms, extended out in front
4. Knee-to-chest
Stretches lower back, hips, and hamstrings
Lie on your back, extending both legs flat along the floor.
Keeping the left leg straight, hug your right knee into your chest
Keep head and back flat against the floor
5. Wide-Legged Standing Forward Fold
Stretches lower back, upper back, glutes, and hamstrings. Should be avoided by extension responders
Move legs into a wide stance with toes pointing forward
Bend towards knees and bring hands to the ground
Keep a slight bend in your knees
Let your head hang heavy and the weight shift slightly towards your toes
Focus on feeling the release in your glutes, lower back, and hamstrings
Hold for 8 deep breaths
Slowly lift your torso by rolling up one vertebra at a time
6. Kneeling Hip Flexor Stretch
Stretches hips, quads, and glutes. May aggravate flexion responders if not performed carefully
Step forward with right leg and kneel down onto your left knee
Adjust by moving your right foot slightly forward and engaging the core
Slowly shift your hips forward, tilt the pelvis posteriorly, and squeeze your butt to stretch your left hip
7. Cat cow Stretch
Stretches back, hips, abdominals, chest, and spine
Kneel on hands and knees hip-width apart (tabletop position) with your feet together behind
Take a deep breath in while slowly arching back up towards the ceiling
Focus on expanding the back
Exhale by dipping your belly button towards the floor
Lift head and tailbone towards the ceiling
Inhale while moving slowly into the cat position
8. Three-Legged Dog
Stretches hips, shoulders, hamstrings, and back. Advanced movement
Bend over into a downward facing dog (feet hip-width apart, hips pushed up into the air, hands shoulder-width apart, fingers facing forward, neck aligned with your back, and head facing your knees)
Straighten right leg and lift it off the floor
Extend leg as high as possible while keeping it straight
Keep hips aligned with shoulders, parallel to the floor
9. Glute Bridge
Strengthens glutes
Lie faceup, knees hip-width apart, and feet flat on the floor
Drive heels into the floor and lift hips up
Engage core and glutes
Walk feet inwards to be directly underneath knees
Focus on using glutes keep lift hips up and parallel
10. Kneeling Side Bend Stretch
Stretches groin, hips, inner thigh, intercostal muscles, and abdominal muscles (especially obliques). Advanced movement
Kneel on the floor with back straight and core tight
Extend your right leg out to the side, in line with your body
Lift your left arm overhead and rest your right arm on your right leg
Gently bend torso and left arm to the right side (avoid bending forward)
Keep hips facing forward
11. Cobra
Stretches hip flexor, chest, and spinal muscles. Should be avoided by flexion responders
Lie on your stomach with big toes touching together
Place hands underneath shoulders, palms against the ground, and elbows against body
Lightly press feet into the floor
Inhale, then exhale while engaging the core
Inhale, and press palms into the floor to lift your chest up
Extend arms but keep a slight bend
Pull shoulders down away from the ears
Keep head slightly up
12. Standing Quad Stretch
Stretches quads
Stand up straight with an engaged core. Hold on to a chair, table, or wall for support
Lift left foot toward left hamstring
With your left hand, grab your left ankle and pull it towards the butt
Gently tilt the pelvis posteriorly
Raise right hand toward the ceiling
13. Lumbar Trunk Twist rotation
Stretches back, spine, hip, obliques, and glutes
Lie down on your back with your arms flat out
Bend hips and knees at 90 degrees with feet flat
Engage abdominal muscles
Slowly rotate knees to the right side keeping hips in contact with the floor (do not engage arms)
Rotate slowly to the left side
14. Pigeon pose
Stretches hip flexors, outer hips, glutes, and lower back (psoas). Advanced movement
Bend over into a downward-facing dog with hands shoulder-width apart
Step left leg forward between hands
Drop right knee down and untuck the toes
Slide left foot over toward the right pelvic bone, placing the outside edge of the left leg on the floor
Align hips parallel to each other, and press the left hip toward the floor
Bend over onto elbows or stay on hands depending on desired intensity
Treatment
If you are experiencing back pain or hip pain make sure to consult a registered physiotherapist for a proper diagnosis and personalized treatment plan to address your needs. If you’re in Mississauga or Etobicoke, Ontario, consider LIFT Physiotherapy, who specializes in pain management and exercise therapy.
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