It has long been common place in the treatment of lower back problems to incorporate core stability (or whatever you like to call it) exercises into one’s management. Numerous studies over the years have investigated this and come to the conclusion that yes, it will help reduce your disability, improve your function and decrease your pain.
As Physiotherapists, anecdotally we’ve always known that in addition to the core stability work we employ in a rehab program if we can also improve an individual’s hip control, strength and mobility has a positive effect on their lower back pain. The research to support the thinking that hip focussed strength work plays a vital part in the management of lower back symptoms has always been limited however…until now.
A recent, high quality research paper published just last year in 2017 involved splitting two groups of patients with mechanical (not inflammatory) low back pain into two intervention groups. One group undertook management strategies targeted to the lumbar spine only, including manual therapy, neural mobilisation procedures and trunk coordination, strengthening, and endurance exercises. The other group undertook the aforementioned program as well as a program targeting the hip including hip mobilisation as well as 3 exercises specifically targeting the hip abductors and extensors to be completed each session as well as at home twice per day.
The group that undertook the lumbar spine management program AND the hip management program rather than the lumbar program alone demonstrated:
Significant changes in self reported disability, pain levels and patient satisfaction.
But why does treating the hips help your back?
Hip joint stiffness or poor hip control can alter movement patterns which can place increased stress on the lumbar spine. For example, if our gluteus medius (a hip abductor) is weak it can cause our pelvis to drop in the opposite side during walking or running, which increases the stress placed on our lower back.
Another example is that of a tight hip flexor. Due to our increasingly sedentary lifestyle, our hip flexors are in a shortened position for much of the day which can cause them, over time, to maintain more of a shortened position. Because our hip flexors attach into our lumbar spine and pelvis it can cause an anterior (or forward) pelvic tilt which can increase the strain on our lower back. Hip flexor stretching (not covered in the study or in the post) as well as some targeted strength work for this area can help to manage this.
So we can see that the hip can have a substantial effect on what happens higher up in our chain in our pelvis as well as our lower back. If you’re struggling with low back pain, it is very helpful to engage in strength/control work for your trunk but your improvements can be amplified by adding in hip strength work as well.
Try the following exercises for 2 sets of 12-15 reps, 2 times per day.
Hip external rotation clamshell with theraband
Quadruped hip extension
Single leg bridge
If you or someone you know could use some guidance with their lower back problems, call the clinic on 8490 0777 to discuss or book an appointment online today 🙂
Bade M, Cobo‐Estevez M, Neeley D, Pandya J, Gunderson T, Cook C. Effects of manual therapy and exercise targeting the hips in patients with low‐back pain—A randomized controlled trial. J Eval Clin Pract. 2017;23: 734–740. https://doi.org/10.1111/jep.12705
Delitto A, et al. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012;42(4):A1-A57. https://www.jospt.org/doi/pdf/10.2519/jospt.2012.42.4.A1