The lower back and hips have an intricate connection, and wellbeing in one has a huge positive impact on the other. However, when the hips deteriorate, even in the absence of degenerative change, it can spell real trouble for your lower back health. Weakness, injury and disability in one area will almost always occur with inefficiencies in the other. Failure to address these issues is one of the root causes for why some find it tremendously difficult recovering from lower back pain. Knowing that the hips are important is one thing but how do we go about improving the status quo? In today’s article we’ll cover the relationship between the lower back and hips, how substandard health in one affects the other, we’ll also cover common errors that people make when trying to address these issues and give you our best recommendations for what you should be doing to help both your hip and low back health at the same time!
Your hips are weak and it’s making your low back worse
Modern life is demanding less and less of us, with sedentary behaviour taking up a disproportionate amount of our day. It is no wonder that we are weaker and less healthy than we should be. The hips specifically are one area which is poorly used. When it comes to the joints of our body, the synovial joints, of which the hip is one example of many, movement matters. Although we think of wear and tear as the degenerative process, disuse is often not considered to be a factor in the degradation of health in such joints.
Your hips need movement and stimulation for good health
All synovial joints require good movement, full movement in order to maintain health, not just in the bones and cartilage but the soft tissues do too. This is full movement, balanced movement, with load, because life has load. This ensures that your hips are strong in all ranges and the muscles that control and support these joints, are strong and competent too. This is how you keep your hips healthy.
Degenerative arthritis in your hips
Your hips will be degenerative long before you have visible changes on an X-ray or MRI image. People spend too much time focussing on the degenerative bony spurs that can occur, and not enough time on the reality that the ligaments and muscles around that hip joint are going to be of equally abysmal health. It is the poor health in these soft tissues that is the root cause of any pain you’re getting in the hips, in the vast majority of cases. Although the thought of bony spurs sounds dangerous or scary, they’re not the cause of pain in most cases.
When it comes to the progression of hip degeneration, one of the important considerations for your lower back is how arthritis affects movement. When your hip is in a flexed position like sitting in a chair, it is relatively decompressed, i.e. the ball and socket move away from one another slightly. When your hip joint is in an extended position, like when standing upright with good posture, the joint surfaces are connected more to one another, compressed together.
This makes sense on many levels as the relative decompression of flexion gives rise to a little more freedom of movement, flexibility, which is likely to be desirable, if for example, you were sat cross legged on the floor. When standing, the “screwing in” of the hip socket helps provide a more sturdy transfer of force. Thinking about it, this makes sense as more load is likely to require more stability and in circumstances where we require more flexibility, it is probable that forces on the body will be lesser.
When the hip becomes degenerative, it is common for the extension movement to be lost, the desire of the person to even move the hip close to a position that is akin to being stood upright reduces significantly. In the extreme the person is standing leaning forwards to avoid “screwing the hip in” tightly. This eases discomfort in the hip in most cases.
We can all visualise an older family member with “bad hips” leaning forwards slightly when standing “upright” and it’s a posture that tends to only go in one direction… Further forwards.
The simple truth is that this kind of postural change starts years or decades before it is a known problem. Too many people do not use their hips properly, they spend too much time sitting, the muscles weaken, habits develop and often the realization of just how long ago this problem started is ignored.
The effect of poor hip health on your lower back
Even a healthy lower back, without disc injuries or degenerative change will be challenged by the same factors that lead to degenerative change in the hip. Thinking through the patients and members over the years, it is very very rare for someone with a long standing back issue to have adequate hip health. When we say adequate hip health, we’re talking about appropriate strength and conditioning in the hips. The reason being, in most cases, those who have healthy hips, will often recover rather swiftly from a low back injury, so we never see them!
Why the hips are so important to your lower back pain recovery
The lower back is a stack of blocks held in place by ligaments and supported by muscles. When injured, the ligaments no longer hold a specific segment in place properly and the muscles therefore struggle too! The one thing we must work on at this point is to stabilise the lower back and eliminate excess and unnecessary movement. But if we do this, how do we move?
The hips do!
Healthy and strong hips are a powerhouse. The muscles that move the body through the world are focused around the hips, they can propel us to slam dunk in basketball, run 100 miles, lift 1000 lbs when worked properly. Even if you have a fraction of this, your hips will be an asset to your lower back recovery. They’re stable in more or less all ranges of motion, and when powerful and flexible the muscles around the hips can act as a great compensator for your lower back.
The key way they do this is by participating in more movement so your lower back doesn’t have to, for example, squatting down to the floor instead of craning over with your lower back.
Unfortunately, so many neglect our hips, particularly in western cultures. The use of chairs from a young age and the absence of a daily requirement to get onto the floor leads so many to lose strength and flexibility in the hips. Coupled with the absence of resistance training to strengthen these hips, we’ve got a real issue when injury occurs leading to back pain.
It’s not just injuries to the low back where recovery is made more challenging if our hips are not healthy though. If you’re not taking care of your hips, keeping them in good condition, using them properly, then the very way in which you move is likely contributing to the elevated risk of a lower back injury. Like anything, when neglected, issues more easily arise.
Recovering from back pain and the role of your hips
As you’ve probably gathered by now, your hips are important. Their health, strength and mobility, is vital, this extends to not only the hip socket, but the tendons and muscles around the hips too. Issues like hamstring and glute tendonitis, or greater trochanteric bursitis, all too frequently occur in those with back pain. In nearly all cases, the individuals again have woefully inadequate competence in the hip region, soft and hard tissues alike. If there is one thing that is imperative for you to understand as we move forwards into the “what you should do” section of this article, it is to think of your hips properly. Your hips are the combination of hard bone and cartilage, and soft tissue ligaments, tendons and muscles. You can make improvements in the soft tissues regardless of the state of affairs in the hard tissues. Understand that it takes time, but if you do, you can avoid a helpless downward spiral that ensnares so many with back pain.
The objective: strengthening your hips
Our goal here is simple, to make significant increases in the control and strength of our hips in the safest possible way. Gradually adding in greater ranges of motion, more movement, and in doing so, stimulate and strengthen more of the hip musculature through this enhanced range of motion. This will create a competent joint that can support your lower back health and recovery. We won’t go into your core strength here but if you saw the episode of core training for your lower back pain, you’ll notice some striking similarities.
The back friendly movements to strengthen your hips
Good form here is imperative, these simple movements work. You must appropriately gauge your competence, as too often people spend too long on inferior movements. For example, a bridge on the floor is a common “hip strengthening exercise” but 10 reps of this is not going to do anything for your glute strengthening if you can get out of a chair 10 times (squat). People fail to understand how strengthening works, and exercises that are comfortably within your competence and ability will not trigger change within your body. So if you’ve just started or come out of surgery, the bridge might be worth working on first, but you’ll find very quickly, you should move onto the upright movements.
Our favorite movements are the squat, hip hinge and split squat. A more advanced option for the future could also be the “cable pull through”. The reason these are great movements is that they are essential to life. You can begin with the smallest amount of movement, a slight bend at the hips and knees in the case of the squat and split-squat, or a slight pivot at the hips for the hip hinge. You can progress, over time to more full ranges of motion as your competence and strength improves. Finally you can add weight to make these really challenge your body effectively.
Tips on starting to strengthen your hips with these exercises
- Always begin with good core and postural engagement: this ensures that your spine is strong and supported and you do not cause trouble for your lower back. After all, that’s the whole reason we’re strengthening the hips!
- Keep an eye on your knees: The most common sign of weakness in the hips is that the knees will fall towards the middle as you do your squat and split-squat. This is primarily a balance and hip weakness issue and should be avoided. It is common that this occurs in those with weak hips, which is why issues with the knees are an additional factor that needs consideration. The good news is by correcting your technique here, you’re going to help your knees too!
- Focus on your best pain free, well choreographed range: Don’t be reckless, use a mirror or a recording to make sure your form is perfect to begin with, it’s no good going all the way down if your knees are wobbling all over the place and your back is completely rounding. Instead, make sure you have a safe starting point, no matter how rudimentary it may seem at first.
- After technique is mastered, work hard! Understanding how to do these safely using the first 3 tips is important and it is likely that these exercises will not be all that exhausting for you. Once technique is acceptable you have to actually work hard to get change, so now you should be focusing on sets of 10 reps. Figure out how many you can do, 3, 4, 5 sets of 10 before you struggle to do the full 10 reps with good form.
- Introduce weights or resistance bands to challenge yourself: These will help you continue on with the previous point. For some of you, even 10 reps will be a challenge which is fine, but sooner or later, you’re going to need to add resistance in the way of a weight or resistance band, this will help you continue to challenge yourself.
- Work both weights and range of motion going forwards: Now comes the long term plan. Steadily work both increasing the weights you’re using, and the depth of your movements over the months and years ahead. Commit to steady improvements and you will find the results speak for themselves.
Remember that your hips did not become weak, degenerate or just generally of poor health overnight. It took a lifetime of neglect to get to this point. However, your body will be forgiving, regardless of your age, you can be better in 6 months than you are today. Granted, it is much easier to do this when you do not have back pain, the presence of which adds additional challenges. Having said that, had you not experienced the back pain that led you to this article, you probably would have carried on, not working on this area and allowing things to further degrade over time, under the radar.
If you are one of those who thought you were doing enough to keep your hips and body strong through “staying active”, walking, running or swimming, don’t beat yourself up, it certainly will have been better than doing nothing. At the same time, acknowledge that those activities miss out on significant areas that promote hip health and robustness. Use some of your previous work as a springboard to help propel your hips into a greater condition for the long term, you’ll thank yourself for it.
If you’re one of our members of the Back In Shape Program, know that you’re already doing all the right things, as you move through the program, you’ll be working on your hips through the many exercises. As you reach and move through Phase 4 this process of strengthening your hips will accelerate. Keep consistent and remember we’re there to help you along the way!
If you’re struggling yourself with low back pain, and you’ve been told your hips are weak, or if you have issues with your hips themselves, check out membership to the Back In Shape Program. We’d love you to join our growing community of people all over the UK and around the world who are getting their bodies and their backs “Back In Shape” and learning the skills and strategies to keep it that way for the long term too!