Why Hip Degeneration With Lower Back Pain Is Common

In those with chronic and long standing lower back pain, it is common that the factors that have led to the injury of the lower back have also taken their toll on the lower body joints as well. This is why it is common that we find that those with lower back pain will have hip issues too. In today’s article we’ll be covering the association with hip degeneration and why it really makes a lot of sense that your hip could be degenerated if your lower back is. 

Firstly we have to recognise the inextricable link between your lower back and hips. With the exception of the Sacroiliac “joint” the lower back is the next step in force transference through the body. The way in which we use our body on a daily basis will affect the health of our lower back as well as our hips. The opposite works too, and if we do not support our back and hip health with good practices then they will suffer too.

Quite often we will hear comments like, 

“I know I’m doing the program for my lower back, and it’s helping and all, but I’ve just found out I’ve got a hip problem too, what can I do?”

This is a reasonable question and the short answer is, you’re already doing it. Whether it is hip osteoarthritis (degeneration), a labral tear, glute tendinitis or greater trochanteric bursitis, these diagnoses are all going to fundamentally benefit from a healthier, stronger body. Of course there might be some short term tricks or band-aids that can be used, specific treatments that could help with short term relief, but this doesn’t work on the problem.

It should come as a surprise to suggest that if you lack the strength, control, function and flexibility to keep your back healthy, your hip might also be compromised too. After all, practically all the exercises that you might be doing to stabilize the lower back would be working muscles which have an influence or act across the hip joint too.

We should always remember that modern medicine separates out these regions of the body and even has specific specialities in almost granular detail, but the body acts as a unit. For example, a recurrent stomach problem could have a significant impact on the lower back as you frequently adopt a rounded posture because of the pain, and regularly strain going to the bathroom. Yet you would perhaps see two separate specialists for this related issue, that infrequently communicate with one another as well as we would like. 

I recall very vividly a case of a patient with severely degenerative neck and shoulder pain having a real challenge to get the shoulder surgeon to talk to the neck surgeon even though they were in the same building! A combined approach proved to be the most sensible and fruitful way forward as the two were so closely related!

As with the hip and the lower back. Disuse with one, will often lead to problems having a knock on effect.

The health of your hip to prevent degeneration 

Understanding the basics of your hip health is important and will lead nicely into the lower back. The hip is a synovial joint that requires full movement to keep it healthy, this allows for fluid inside the joint to provide nutrients to the whole joint surfaces. The hip has a huge available range of motion however, as you would expect, certain positions are more efficient than others, requiring less muscular effort to maintain. A deep squat for example, requires significantly more in the way of power from the musculature than standing erect. 

It is no surprise that this region sees many of the strongest muscles in the body controlling it. However, we spend so much of our time with the hip in a flexed position sitting all day, so much so that some of us barely ever return to a full erect position with the hip extended nicely, let alone fully extending the hip as you would do sprinting, or during a lunge or hip thrust. This means that certain ranges of motion hardly ever get used. You know the phrase, use it or lose it! 

Over time our body sees no need to maintain such muscle as it is never used and so wasting occurs – degenerative change of the soft tissues around the joint, with this it is only a matter of time before the degenerative change starts to affect the hard tissues too. 

Your hip health affects your lower back too!

Over time your hip becomes less and less healthy. The consequence of this is that we start “using our backs more” the clearest example of this is the loss of squatting motion when getting out of or into chairs. This means that we start to see a spread of the poor hip health into the lower back health. For many this process is happening slowly and under the radar. They never really notice the slow deterioration of their body. It is often only when we look back, or see a relative or friend who’s not seen us in many years that we realise how far we have fallen. 

You could “get away with this” and many do, never perhaps suffering with a severe back injury or pain. The process continues, we gradually do less and less until we can do so little that we start employing aids to do anything.

For some however, this peaceful process (not good) is interrupted with an episode of pain or injury. Reflecting on this now, you could perhaps view this in a good light, a blessing. For it perhaps is the prod you needed to turn things around and start working to arrest this process of degenerative change and degradation that is allowed to progress so insidiously, before it has gone too far. 

If you are someone who is struggling with damage to the hip, acute or degenerative, the important thing to recognise is that your hip and back health are closely related. And the exercises and strategies that work on building the back, will also go a very long way to rebuilding your hip safely too. If you’ve had more invasive procedures such as hip replacements, then there will be periods where a little adjustment is required. However for the long term, working with larger compound movements to generate strength, as well as asymmetrical movements to stimulate power and control, will be a recipe for success. Throwing in additional work at times on areas specifically like glute control of the knee and ankle will also serve to further enhance your overall health and wellbeing, whatever your status or diagnosis, weakness is never a strength, and strength never a weakness. 

We can all be better than we currently are.

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3 Steps for improving your hip health

• Prioritise strengthening

You must be strong in order to handle movement successfully. Nowadays, with very few exceptions we have a pandemic of weakness and vulnerability. Exercises to improve the strength of your hips are vital as they enhance much more than just the muscles.

• Know what a strengthening exercise is

Too many people do not understand what a strengthening exercise is, some even being given such false information that they believe their stretching routine is improving strength. This is not your fault! 4 exercises that you should be doing for your hip strength would be: the Squat, Split Squat, Hip Hinge & Hip Thrust. These exercises are best used to objectively evaluate your hip strength.

• Stretching improves mobility & joint health too

You cannot be strong and stiff, yes this is better than weak and wobbly, but stiffness needs to be worked on! You should be working regularly to improve your flexibility in the main muscle groups. This doesn’t take hours but it does need to be done regularly. Our Lower body stretching routine is a great way to hit the main muscles and with the addition of a modification to a hip flexor stretch you’ve got everything covered