Back Pain? It's All in The Hips

If you’ve visited a physical therapist with a nagging niggle, odds are the PT said the problem originated from your hips.

With muscles ranging from the powerful glutes to the small and little abductors, the hips control practically all of our movements. It’s easy to overwork some hip muscles while underworking others, causing severe imbalances that other injuries can stem from.

A recent study shows how imbalances create injuries. Orthopedic surgeon Paul Niemuth conducted a study with 30 of his clients struggling with various injuries and tested hip mobility and strength. Compared to a control group of healthy recreational runners, the injured runners had weaker hip flexors and hip abductors on the injured side regardless of their injury complaint. However, all 30 clients had overdeveloped adductor muscles creating extreme imbalances in their stride, resulting in lower leg and back pains. On the other hand, the healthy runners displayed no side-to-side differences in muscular strength.

Niemuth showed that weak, imbalanced or inactive hip muscles can manifest itself in seemingly unrelated ways. Lower-back pain, knee issues and, in my case, Plantar Fasciitis are all common symptoms of neglected hips. Fortunately, it’s pretty easy to strengthen and activate your hip abductors, external rotators glutes and all the little muscles in between. Here are a few hip mobility and strengthening exercises to do pre workout to help you stay healthy.

1. Hip Flexor Stretch

What is it: Lunge forward with your right knee on the ground and the left knee bent forward in an extension, foot flat on the ground. You should feel the stretch deep within your hip flexors. Hold for up to 30 seconds, then extend the front leg left, slightly shifting the right leg to the left and opening the hips. Hold this position for up to 30 seconds. On the final position, turn out the left leg completely left, leaning deep into the stretch. Repeat this set in reverse with the right leg extended, with two sets of 10 in each direction.

Why it works: When sitting at a desk or on the couch, stationary hip muscles shorten and tighten. The kneeling three-way hip flexor stretch provides relief and opens tight hip flexors to improve alignment, release the hip flexors and give your body access to your glutes. Boulder-based PT Jim Heafner describes tight hip flexors (and hips in general) as a hose folded in half. If a hose is folded in half, you won’t have access to the water. Similarly, limited mobility in the hip flexors stunts access to other muscles such as your glutes. If your hip flexors are tight and immobile, you won’t have access to your glutes no matter how rock solid. In my case, inaccessibility to my glutes led to overactive calves and foot pain.

2. Donkey Kicks

What is it: Start on your hands and knees in a tabletop position. Hold a resistance band directly beneath your shoulders. Loop one foot through the band, so it sits halfway down the foot. When ready, move only the banded leg backward, keeping the knee at a 90-degree angle.

Your foot should be facing the ceiling, and your hip, thigh, and knee should all be in alignment and parallel to the floor.

As you move your leg backward, focus on contracting the glute and not moving the knee joint. When you can’t extend back farther without changing your leg position, stop and hold. Make sure your glutes are flexed while everything around your glute muscles stays as relaxed as possible. Slowly lower back down to your hands and knees.

That’s one rep. Repeat this movement, alternating sides each time.

Why it works: Also known as “hip extensions,” this exercise isolate the gluteus maximus, which is commonly anyone whose sport makes them quad dominant such as cyclists. Even if your glutes are already strong, this is an important exercise to activate the glute max before exercise to help ensure you’re using the right muscles during activity. These are to be done after your hip flexor stretch to allow for increased hip extension and therefore, better glute activation.

3. Monster Walk With a Band

What is it: Loop a resistance band just above your knees, and stand with your knees slightly bent and feet hip-width apart. Take a giant diagonal step forward with your right foot, then follow it to your left. Alternate your lead foot with each step. Repeat, stepping diagonally backward. If you look like an awkward monster, you’re doing it right.

Why it works: Monster walks are great for the hip adductors in the outer thigh and the lateral glute. They also fire up the hip flexors and extensors. By targeting all of these little muscles needed for stabilization, you ensure a balanced stride while using all of the right muscles.

4. Bridge With a Squeeze

What is it: Hip bridges with ball squeeze are an easy and effective way to strengthen the hips, as well as engage the core and gluteus maximus. Core muscles are critical to a healthy back, as they offer the foundational support for the spine and the entire upper body. A healthy back is the start to a healthy body.

Why it works: Lie on your back with knees bent and your feet shoulder-width apart. Place a small exercise ball between the thighs and squeeze. Pushing with the heels, lift the hips towards the ceiling, squeezing the ball with the thighs. Hold for 30 seconds, then gently steer hips to the floor. Do between two and three sets of 15 reps. Again, you’ll be able to do these more effectively after a hip flexor stretch.