National Spine Care | Dr. McMorland Patient Stretch

Two simple tests to determine if your hips are contributing to your back pain

Back PainIs Your Back Pain the Victim or Culprit?

If you suffer from persistent or recurrent back pain, you may want to consider that your back isn’t the problem. Your back may be the victim rather than the culprit. During a recent Spine Boot Camp Class, one of our patients, Barb related she had a light bulb moment. She said it made all the difference for her between living in constant pain and finally getting some relief. Here is what Barb told us…

Barb’s Story (does this sound familiar?)

Barb had been suffering from back pain for years and was really frustrated with the laundry list of treatments she had tried with only limited success. Chiropractors adjusted (“cracked”) her back, physiotherapists needled her muscles and gave her core stability exercises and massage therapists worked out the tight/sore muscles. Her doctor gave her pain meds and sent her for injections. She had a MRI which showed some arthritis and degenerative disc disease but a surgeon told her surgery wasn’t the answer.

At best she would get temporary relief from a treatment but if she didn’t keep going for appointments her pain would gradually return. Then there were the complete back pain blow outs that would occur if she moved wrong or lifted. One of those episodes would take her out of the game for at least a week or two. She was at a point where she was scared to do any activities or exercises out of fear they would flare her up.

So what changed for Barb?

When she started coming to Spine Boot Camp Classes, she learned about the joint-by-joint model and how most back pain occurs due to repetitive strain injuries. More on those two things in a minute. For now Barb learned that her back was a victim of her hips not moving properly. To compensate for poor hip mobility, her body had to gain mobility in her low back. This caused repetitive strain on the joints and soft tissues which build over time to create a back injury. The treatments she tried focused on the pain and injury in her low back but forgot to look around at the other areas (Whoops)…

How to tell if your hips don’t move properly

Here are two tests you can do to see how well your hips move. Both of these require you to get into child’s pose. This position locks your low back down so your body can’t use it for movement. If you are quite stiff, be careful getting into this position. Your knees may not bend well enough to get your butt right down on your heels. If that is the case you should put something like a rolled up towel, pillow or yoga block on your heels that your butt can rest on.

  1. Hip extension: While in child’s pose, extend one leg straight out behind you. Without letting your butt come off your heels, try and lift your leg in the air
  2. Hip abduction: While in child’s pose, stick a leg out straight out to the side so that your hip and knee are bent to 90 degrees. Without letting your butt come off your heel or twisting in your low back, try and lift your leg up off the ground.

I said they are simple tests but they are likely pretty tough. If you can’t move your leg very well in these positions it means that your hips are too stiff and are likely contributing to your back pain. Your back is a victim of poor hip movement. You can’t move very well in your hips so your body has to ask your back to move more which sets the stage for a RSI. This means you can be straining your back doing simple, every day things like walking, sitting or chores around the house. That was the aha moment for Barb when she was at Spine Boot Camp. Guess what? She started focusing on the hip mobility routine and she finally feels that she is regaining control over her back pain!

I promised more information on the Joint-by-joint model and Repetitive strain injuries so read on (if you aren’t stuck on the floor in child’s pose!)…

Joint-by-joint model

This is a system credited to Mike Boyle and Gray Cook where areas of the body are either stable or mobile. You see the body is built as a series of linkages that alternate between areas that are supposed to be stable and areas that are supposed to be mobile. If we build you from the ground up, it goes like this:

Image result for joint by joint approach
  • Feet: Stable
  • Ankles: Mobile
  • Knees Stable
  • Hips Mobile
  • Back (Core): Stable
  • Thoracic region (Rib cage): Mobile
  • Shoulder blades:Stable
  • Shoulder: Mobile
  • Neck Stable

If you mess with that formula, you run into trouble. Usually the problem happens when an area that is supposed to be mobile becomes too stable (Stiff). You can imagine if one body part isn’t moving properly then the body has to gain mobility somewhere else in order to keep you moving. Now you have a situation where you are asking a body part to become mobile when it is designed to be stable. That sets up a scenario for repetitive strain which if left unchecked builds over time to become pain and injury.

Repetitive Strain Injury (RSI)

These are injuries that are caused by prolonged use over long periods of time. If you imagine two things combining to create an injury

  1. The amount of force (load)
  2. The number of times that force (load) occurs

The cumulative effects of these two things determine whether your body is capable of tolerating things. So if the load is high then it takes a lower number of times you experience it before an injury occurs. Examples of this are slips, falls, accidents and heavy lifts. If the forces are low then it takes a much higher number of repetitions for things to build up before the tissue or tissues in your body say “We’ve had enough”. Make sense?

Remember we told you that most back pain occurs because of RSI? Now you understand the joint-by-joint model, you can imagine a scenario where the hips and thoracic areas are too stiff (stable). If you can’t move in those areas then the body will compensate by gaining mobility the low back. The low back is supposed to be stable but now you are asking it to be mobile. This creates the perfect storm for a RSI and the joints, discs and soft tissues in your low back will not like this. They aren’t designed to handle those forces and will complain bitterly about this new job you have asked them to do.

National Spine Care | Patient Hip StrechIs Core Stability the answer?

Makes sense right? The back (core) is supposed to be stable so you better get planking to build that stability. I’m not against doing core stability exercises, however you have to make sure you’re not fighting against what your body is trying to do. If your body needs your core to be mobile to compensate for the hips or mid-back being too stiff then you will really have a hard time stabilizing your core.

Better idea: WD-40 and Duct Tape!

Step one: Loosen up the stiff areas.

Hip and thoracic mobility routines are like applying WD-40 to rusted bolts. They get those parts moving and doing their job properly. This will automatically unload your low back which will allow it to stabilize

Step two: Stabilize the loose areas

Now that your back is automatically starting to stabilize because it isn’t compensating for poor hip and thoracic mobility, you can enhance it through core stability exercises. This is like putting duct tape on something to hold it together (Stabilize).

  1. WD-40 (Loosen/mobilize)
  2. Duct Tape (Stabilize)

Summary

The joint-by-joint model is a beautiful way of figuring out if your back is under too much strain. These two tests are a quick way to determine if your hips move properly. If this sounds like you or someone you know who has been struggling with back pain for a long time, maybe you’ll be like Barb and this could be your light bulb moment! I love feedback on these ideas so feel free to comment or share this article.


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