Now that summer has well and truly arrived (hurrah!), we are noticing a seasonal trend in clinic - more people are attending for advice and treatment of lower back pain relating to recent increase in exercise. On physical examination we are finding that, very often, this lower back pain is closely related to tight hips that have been caused by a long winter of reduced activity. This blog post is to discuss the role that the hips play in the normal functioning of the lower back and explore some simple remedies for this common problem.
Over the past 20 years, the number of people with lower back and neck pain increased by nearly 21% in the UK, overtaking ischaemic heart disease as the number one cause of disability, a 2017 Arthritis and Musculoskeletal Alliance study revealed.
The hips are complex, but usually stable, joints that are responsible for supporting much of the body's weight and allowing for movement. As we stride forward our hips go through a sequence of movements – flexion with a little external rotation to heal strike followed by transition to internal rotation and extension as we toe off. When we sit our hips are flexed to 90 degrees or more and for comfort they normally externally rotate and abduct a little unless we sit cross legged in which case one hip will be more flexed and adducted that the other. When the hips are tight, they can restrict movement and cause compensatory movements in other areas of the body, including the lower back.
Tight hips can lead to an anterior pelvic tilt, which is when the pelvis rotates forward, causing the lower back to arch excessively. Conversely tight hips can also cause a posterior pelvic tilt resulting in a loss of the curve in the lower back. This can put added stress on the lower back muscles and ligaments, leading to pain and discomfort.
In addition, tight hip muscles can irritate the sciatic nerve, which runs from the lower back down through the pelvis and legs. Irritation to this nerve can cause pain, numbness, and tingling sensations in the lower back and legs, a condition commonly known as sciatica.
Hip muscles and joint capsules can become tight for a few different reasons including injury, lack of physical activity, poor or prolonged posture and age related wear and tear. Some medications such as statins can also contribute to muscle soreness and tightness.
When you lie down on your back do your feet relax and turn outwards to about 45 degrees or more bilaterally?
Are you able to sit cross legged on the floor comfortably without support?
Can you squat comfortably?
Can you lower yourself to sit on the floor without using your hands to hold onto something? Can you rise to standing from sitting on the floor without holding onto something to help yourself up? This is called the sit- and -rise test. In a 2014 study The European Journal of Preventive Cardiology proposed that this test could be used as a predictor of longevity. It is also an excellent way to test your hip mobility.
If the answer is no to most of these questions then you likely have tight and restricted hip mobility.
Caution – please don’t attempt this if you are at risk of injury. Ensure that you can grab something to assist you if you need to, or that you have someone to help you.
If you have concerns about your hips and lower back, I recommend that you chat with a health care provider such as a chiropractor about it before launching into a difficult exercise regime. Lower back pain caused by tight hips can be frustrating and debilitating problem. Fortunately, there are many treatment options available to help alleviate pain and improve mobility. It's important to work with a qualified healthcare provider to develop a comprehensive treatment plan that addresses the underlying cause of the pain and meets the individual's specific needs.
