Lower-back pain is not fun. Unfortunately, based on the current evidence we have available, about 80% of the population will suffer from an episode of lower-back pain during their lifetime. The problem with this is, we don’t know how long that episode will last for, nor do we know if it will be a one-time thing or if it becomes more of a persistent problem. The traditional approach of rest, medications if applicable, and use of ice or heat is a very short-sighted approach to managing lower-back pain, as it doesn’t truly address the reason of why it’s there in the first place.
While there are so many factors that can potentially be a contributor to why people suffer from lower-back pain or episodes of lower-back issues, there are a few things we try to look at from a physical standpoint to determine if we can reduce the likelihood of lower-back pain occurring often. Let’s talk about why assessing and addressing the hips is a good place to start when people are dealing with lower-back pain.
It’s All In The Hips
The hips are a potential source of why people can have lower-back pain. Again I’ll emphasize this may not be the only reason, but it can be a contributor to it. When looking at the joint by joint approach to the body, the hips should be a mobile area, whereas the lower back should be more of a stable area. While you need some range of motion in your lower back, you don’t need as much as you think you do.
If the hip is unable to move throughout its full range of motion due to lack of mobility, then the motion has to come from somewhere. The body is going to do everything it can to create motion when needed so if the hip is not moving as well as it should, the body will compensate by getting that motion from the lower back or somewhere else. Think of a golfer or a rotational sport athlete. If the hips don’t move well into rotation, then the likelihood of it putting more stress on the low back is pretty high. Another example is thinking of someone who sits at a desk all day and then immediately goes to the gym to train or play racquetball without getting the body prepared for that activity. Going from one extreme (sitting all day) to another (training or playing a sport) can create undue stresses on the back if the hips aren’t adequate enough from a movement standpoint. Assessing the hip and how it moves can potentially explain why the lower back is a source of issues for a lot of people that we train.
Hip Mobility Assessment
Here are some quick and easy ways to assess the hip joint to determine if the hip could be a contributing factor to lower-back issues. The key areas we look at are hip outer (external) and inward (internal) rotation, as well as the ability to bring the knee to chest and extend it back behind them. When assessing the hip, it is imperative to know where the motion is coming from! Many times when assessing both hip flexion (bringing knee to chest) and hip extension (bringing leg behind them), I’ll put my hand in the small of their lower back to see if the lower back is doing the work in addition to the hip, or if it’s just the hip itself.
If the lower back is too involved, then maybe you need to address not only a potential mobility/range of motion issue in the hip, but also a stability/control issue in the lower back. Understand that these tests are just pieces of the puzzle to get a better idea of what is going on at the hip and if the hip could be contributing to low back discomfort. They are not the end all be all of tests; they are just assessments to get a better overview of what the next steps should be for a client.
Standing Hip Flexion Test: This test is done where you attempt to bring the knee to your chest as far as you can without letting the back round or move. If someone struggles or flexes their spine to get their knee to the chest (2nd demonstration in video) then the hip might not have adequate mobility to do that motion by itself as to why the low back has to make up the slack.
Prone Hip Extension Test: This test attempts to take the lower back out of the equation, but if someone struggles to extend the hip behind them (think running or lunging) without their back arching or the client feeling all the stress in the lower back, then that could tell you a little more about what is going on.
FABER Test: This test combines a number of hip motions, but mainly focuses on outward rotation of the hip. Attempt to cross your leg over and then bring your knee down as close to the table as possible without your back arching off the table. We normally measure the distance the knee is from the table to get an idea if there is a big discrepancy from side to side.
90/90 Hip Internal Rotation Test: This test looks at the inward motion of the hip (don’t be fooled as to where the feet are going) to get a better understanding of its potential role in contributing to lower-back issues. A lack of inward rotation, especially in the rotational sports realms, can cause the lower back to either have to over-rotate in certain instances to get the body to where you want it to be. Being able to turn and have the motion come mainly from a joint that’s supposed to be mobile like the hip is ideal instead of asking an area that is supposed to be stable like the low back to do the heavy lifting.
Remember that in order to truly help your clients, you need to understand what could potentially be contributing to their discomfort. Assessment of the hip, in addition to other areas like the upper back, knee, and ankle are also valid areas to look at depending on what the client is having issues with. Lower-back pain can be tricky and really challenging to get under control. There is no one-size-fits-all treatment or management when it comes to lower-back pain or any discomfort that people deal with. You need to truly assess and ask the right questions to come to be a better conclusion as to what might be contributing to their discomfort so you can build out the right plan for them.