As I mentioned in the into, there are numerous reasons people experience pain in their low backs. I just want to discuss one possible scenario and remind folks that sometimes all you need to do is address the hip flexors.
First, a little anatomy lesson.
This LINK will take you to a Google search of the hip flexor muscles. I was going to add a picture to the post, but due to risk of copyright issues, I'm just linking the Google search.
The three hip flexor muscles that get the most attention are:
- Iliopsoas (which is a combination of the iliac and the psoas muscles)
- Sartorius
- Rectus Femoris
These muscles work together to help bring your thigh upward toward your chest (or flex). All of these muscles begin at either the lumbar spine (low back) or the iliac crest/pelvis and attach to a bone in your leg, either the femur (iliopsoas), the patella via the quad tendon (rectus femoris), or the tibia (sartorius).
Next, let's discuss what the orientation of your pelvis might look like if you have "tight" hip flexors.
This LINK will take you to a Google search of an anterior pelvic tilt. There's one thing I want you to focus on when looking at these images. Notice the curvature at the low back on these people/skeletons in the pictures. This is what we call and excessive lumbar lordosis.
Everyone should have some lordosis of their low back or lumbar spine. However, an anterior pelvic tilt creates and excessive curvature which, typically, leads to low back pain. The increased strain that this places on your low back, while also "lengthening" your anterior core/lower abdominals, makes it even more difficult for you to stabilize your spine.
Too much of anything can be considered a bad thing; and too much mobility in your spine creates instability that can lead to pain.
Alright, so what do we do about this???
Make sure you are working with an educated and, hopefully, licensed medical professional to determine if this is what your true problem is causing your low back pain.
If so, there are a few steps we can take to reduce your low back pain/symptoms. Just remember, we don't want to make the pain worse while performing any of these exercises. I typically tell my patients/clients that some discomfort is OK, but I don't want to push you into pain. This will only increase your soreness, possibly cause some inflammation, and reduce the likelihood that you'll want to continue working with me to help solve your low back dilemma.
I like to work on mobility before transitioning to strengthening. I don't want to place strength on top of a joint that can't move throughout it's full range, or at least very close to it.
Let's take a look at your hip flexor mobility. Can you lay flat on your back, legs out straight, without your low back curving upward (into excessive lordosis)? You may think you can, but you'd be surprised at the number of people who cannot.
One of our biggest enemies is or jobs and/or sedentary lifestyles. So many people, kids and adults alike, sit the majority of their day. Whether it's driving to and from school/work, then sitting through 7-8 hours of class, or a full work day, then going home and sitting to eat supper/watch the news/etc. We spend so much time with our hips flexed. Over the course of time, this can push us toward an anterior pelvic tilt and decrease our ability to get back to a neutral position effectively (as our muscles weaken).
A prone quad stretch/prone hip flexor stretch ...
can help to improve the mobility at the hip. I will often times have patient/clients attempt this stretch first before trying it in a kneeling position. There are other variations, obviously, but this is just one example.
If we can start to make progress with your mobility at the hip, then we can start moving toward strengthening the muscles around our hips/low back to provide support and decrease your back pain.
My preferred method is almost always by attacking the glutes (butt muscles) and the lower abdominals, but the core in general.
The glute bridge is a great way to start:
This exercise hits both the gluteals and the abdominals, while also getting your hips into extension.
Another exercise I like to try with clients is an abdominal bracing technique to recruit the lower abs:
This gentleman is pressing down into the exercise ball with his arms to engage his core muscles. This one can be challenge if you haven't improved your hip extension yet, as some people struggle to not engage their hip flexors during the exercise.
There are hundreds of variations and different exercises that can be used, and these are by no means the only ones I teach, but I just wanted to give you a couple of examples.
Again, I want to reiterate that low back pain can come from numerous different avenues. And just as easily as I can argue that tight hip flexors are a "bad" thing, I can also give examples in which this is a "good" thing (maybe an idea for a future post!).
Please make sure you are working with a qualified medical professional when discussing your low back pain. Not every route you take will lead you to your destination, and some take longer than others, but being on the right path sure does help!
(Photo cred goes to HEP2GO; so if you're reading this in the future and there are no pictures, that's why)
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