1 Limitation all of our low back pain patients have and how to fix it.
What if I told you there is one common similarity between all the patients we see with low back pain?
What if I also told you most people can improve this by changing the way they stretch and adding in a few strengthening exercises?
What’s the one thing most patients with low back pain have in common? Stiff hips that are limited in their ability to extend.
When you’re trying to picture what hip extension, picture your leg behind you when you’re walking, or standing up from sitting, or coming back up from picking something up off the floor.
You may even think to yourself “my back hurts sometimes while doing those things”. That’s a sign of a limitation in hip extension.
When we lose this range of motion our body will compensate by dumping our pelvis forward resulting in more pressure being placed on the low back and a smaller space where the sciatic nerve travels down the leg.
Most of our patients with limited hip extension will have one if not both of these symptoms - achyness right around their belt line and tension or even numbness in their butt where the sciatic nerve sits.
Now let’s talk about the 3 main ways, plus one bonus tip, so we can improve your symptoms by improving what caused the pain in the first place - limited hip extension.
Addressing the tightness in the back of the hip
When the back of your hip is tight there isn’t enough space for your hip to move into while your leg swings behind your when walking resulting in the pelvis being pushed forward and the low back arching
A simple fix for this is by gently stretching this area.
The problem is most people stretch this area in a way that isn’t very helpful and that can actually make the problem worse.
Figure 4 stretches and pigeon pose may feel like you're getting to the root of the issue but you’re actually putting the hip in more of the same position its already in: External rotation
In order to improve hip extension we need to improve internal rotation while feeling a stretch in the back of our hip.
We love these versions of the hip capsule stretch:
Kneeling HC Stretch
Wall walk down stretch
Quadruped hip capsule stretch
Try doing these stretches 1-3 times per day for 5 - 10 breaths per side and see if you notice a difference in how you feel and move.
Most patients will report that while they're walking they “feel lighter”. This is because of the decreased tension in the back of their hip making things like walking, standing up from sitting, and coming back up from picking something up off the floor way less compressive on the low back.
Train / Strengthen Hip Extension
Now when I say strengthen I don’t mean lifting super heavy weights. I’m referring to a few exercises that will help teach your foot and hip to do what they are supposed to do during hip extension without extending your back.
These exercises are very “neurological in nature”, think “mind-muscle connection.”
Exercise 1. Foam roll hip extension
Exercise 2. Hook Lying hip extension
Exercise 3. Bodyweight step up
By practicing these exercises once or twice a day it will start to change and improve the way you move, without having to think about it!
Treatment to improve hip extension
In some cases your hip could be limited enough to need specific hands on treatment in order to see sustainable improvements. This is where our hands-on treatment expertise comes in.
The primary areas we treat to improve hip extension are:
The sacral ligaments
The posterior hip capsule
Sciatic Nerve at External Rotators
And the psoas muscle and femoral nerve.
With the use of our hands, instrument adhesion release tool, or radial shockwave we can break down adhesion, free up nerve entrapments, and stimulate tissue healing specifically with radial shockwave.
Depending on the severity of the issue we will do some combination of these treatments a handful of times until we improve your hip extension to full range.
Bonus Tip: Footwear
This one might be my favorite for my patients because it’s so easy and yet so effective. Just by wearing the correct footwear you can improve your gait and decrease the tension in your lower back.
The key to the right footwear is a shoe that supports your heel, not allowing it to cave in. A shoe that supports your unique arch shape whether you have high, medium, or low arches. And finally, a shoe that supports big toe extension.
We have had a ton of success with specific models of New Balance and Hoka.
It’s important that your range of motion improves after wearing the shoe for a few minutes. That way we know the shoe is right for you.
To sum it up, hip extension is a big deal.
If we don’t have enough of it, our body finds ways to fake it by dumping our pelvis forward which can lead to an increase in pressure on our low backs and sciatic nerves.
Wearing the right footwear, performing the correct exercises and stretches, and getting treatment if needed are crucial for improving your body’s ability to move and more importantly fixing long lasting back and sciatic nerve issues.
If you or someone you know is struggling with back pain that isn’t getting better try these exercises and get fitted for a good pair of shoes.
Or
If you’re ready to go all in on fixing your symptoms and improving how you feel and move, shoot us a message and we can meet online or in-person.
