Why Your Hips Are Breaking Your Back?

Back Pain and sciatica are a major issue for so many of us. But for so many the hips are a major issue contributing to the back pain remaining, and the injury not recovering. However, the way in which different people choose to address this is widely varied across the internet. As a consequence noble objectives of “improving the hips” are pursued, however the way in which we work on these things, as well as the stage in the recovery process is also something that frequently could be done better. Hopefully over the next couple of releases, we’ll be able to help you understand a little more about how the hips can feed into the lower back, and how mobility in both spine and the hips can be worked on.

The hips as a weak link in spine injury

When we think about the hips we must think also about the legs as so many of the muscles span this hip region into the lower body, muscles like the hamstrings and glutes on the back, the adductor group on the inside of your thighs and muscles like sartorius and rectus femoris, run across the hip and well into the thigh musculature on the front. With some of these acting both over the knee and the hip joints. It is not so much that the joint is strong or mobile, but perhaps more that the muscles of the hip are strong and flexible. Unfortunately however the muscles of the hip are much less likely to be both strong AND flexible. 

More frequently, we see weakness and stiffness in these muscles and perhaps in a close second, flexibility but a complete absence of strength as in the many that suffer from back injury who have a degree of hypermobility.

Hips made worse with back pain & sciatica

If we superimpose a layer of back injury over our lackluster hip health, we see additional issues compounding the problem. Most injury to the low back occurs at the L4,L5 and L5,S1 segments of the lumbar spine, the last two mobile joints in our back. The nerves that come out of these segments of the spine go on to form the sciatic nerve. These nerves also control the muscles of the buttocks and the muscles of the back of the thigh. 

When injured we all know about sensory dysfunction; the pain, burning, tingling, numbness, pins and needles. We also frequently have motor dysfunction; this is the control of those muscles previously mentioned, this nebulous term of “dysfunction” is another way of saying “not working well”, and it will understandably make matters worse when we already have weakness and inflexibility at the level of the hips. 

We make things worse by accident

Most practitioners you see unfortunately make matters worse in cases of back injury by often chasing these muscle dysfunctions, sometimes for months before acknowledging the injury is actually in the lower back. While the weakness and inflexibility often preceded the injury, deploying stretches and strategies that ignore the lower back in the pursuit of “stretching the muscles of the legs and buttocks” makes the back injury worse. 

How many times have you been given piriformis figure 4 stretches, knee hugs, touch your toes and other movements to try and relieve the tension and aching in the buttocks or thigh, only to realise it’s going nowhere. We speak to people all the time when joining the program who’ve been told for months, sometimes longer, that the issue is in the legs, only to find out after pushing for imaging that actually there’s a disc bulge at L4,L5. No wonder it wasn’t working. 

The problem is that all those stretches previously mentioned frequently are not done properly, they’re done in ways which also bend the back. So frequently people are trying to combat tight hamstrings by turning their lower back into a fishing rod. Rather than stopping when the movement at the hip stopped. There is not the appreciation that when hip movement finishes, you’ve done the stretch, extra movement is not helping the stretch! 

Why hip mobility does not work for back pain

The problem is that in this scenario, the weakness and stiffness in the hip musculature did pre-date the back injury, as it does quite frankly for most. However, now the stiffness is maintained by the back injury. So all your stretching and mobility work irritates the back injury, which results in signals going straight back to those muscles to tighten up again. Cue the vicious cycle so many find themselves in. With no clear strategy or measure for progress. 

At this stage, with the back injury you will be punished for trying to “stretch the hips” if you do it badly. And even if you do it correctly, those with inadequate strength and stability in the hips AND midsection will find themselves constantly at risk of flare up and re-aggravation, restarting this perpetual tightness and tension that so many battle with. 

A quick word on spine stability

Ultimately you need to be doing spine stability, something we’ve discussed on over 100 other episodes of the podcast, so we won’t labour the point here. But you need to focus on building stability back into the midsection in order to recover from back pain and sciatica. Exercises like those we talk about in the Core 5 For Spine Health are perfect for this, you will note these exercises all leverage the hips, which is what we’ll get onto next!

Part of the problem but essential for the solution

The Back In Shape Program could well be considered the “hip in shape program” because we are leveraging the hips in such a huge way to rebuild health in our lower back. But it must be done in the right way. Real movements like the squat and hip hinge, as well as the step up, are ones we must use to rebuild hip strength first. 

Hips in a vacuum

The reality is that our hips do not work in a vacuum, they work with our spine or rather “midsection”. The midsection provides stability so the powerful hip muscles can move us out of a chair or up a flight of stairs. Without that ability to provide stability in the midsection, it’s like trying to push a cooked piece of spaghetti across the kitchen table, it just bends under the lightest of pressure, buckling and going nowhere fast.

Because our hips need to work in concert with midsection stability, building this ability is vital, and being absent of this ability is also why our stretching was so ineffective as discussed earlier. 

Building strength as a priority

Many of the habits that stop your back injury getting better are directly related to your weak hips, you bend and round your lower back because it’s too much effort to go down to the floor, unlike the toddler that’s up and down all day, you’re craning over and have been doing so for all your adult life. So of course those hips have become weak and stiff. And if you know the muscles are weak, subconsciously, you avoid those movements more so weakening and stiffening becomes a spiraling feedback loop.

But if we focus on rebuilding strength we can start to improve the functionality and health of these muscles and joints. Starting to leverage movements to restore strength in the hips in movements that are emblematic of everyday movements, such as getting out of chairs and going up stairs brings us immediate benefits. Not to mention the fact that we’re improving both our hip and back health simultaneously. 

Building in flexibility through strengthening

More and more there seems to be research coming out talking about the ability and perhaps superiority of building flexibility THROUGH strength training. For example, working hard through your hip hinges you will make improvements in hamstring strength but when done thoughtfully and tactically you’ll improve the flexibility too! Many will attest to the observation that after a couple of sets of hip hinges they find that with a neutral spine the hamstrings allow them to go a little lower than the opening sets.

Check out this interesting summary of a recent study looking at just this phenomenon.

Healthy hips for your best back

The thing is, if we rebuild both hip strength and flexibility, in conjunction with spine stability, we will find that we have the ability to move around the world with less lower back involvement. Too many are building spine hypermobility, particularly into forward bending instead of working on improving their hips, their back looking more and more like a cooked spaghetti. The spine is not equally strong in all ranges and the further from the neutral, the more load and strain focus on specific tissues. With strong and mobile hips, we can move into deep squats with minimal spinal bending, get dressed in the morning without folding ourselves in half, put our shoes on without turning our back into a fishing rod. 

The topic of spine flexibility is something for a future episode (probably next week) but for the time being know that your hips could be considered the safeguard of your back health, and to the degree we have more challenging spinal injuries, their STRENGTH first, and flexibility second, will do the world of good in the long term.