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Low back pain due to stiff hips and thoracic spine

The low back (lumbar spine) is located in between the mid back (thoracic spine) and hips.  When the thoracic spine and hips are stiff, the lumbar spine compensates by moving TOO much.  This is the reason so much is made of core stability.  Many physical therapists, chiropractors, physicians and trainers harp on core stability and lumbar stabilization (just google core stabilization and you have your pick of what book to buy) which is important, but if the hips and thoracic spine are more stable or stiff compared to the lumbar spine, excessive movement will still occur at the low back no matter how much “core stabilization” work you do.  The areas of the body where people often feel pain are usually hypermobile, meaning they move too much.  Too much movement eventually results in irritation and inflammation which leads to pain.  The body recognizes this and acts to remedy the problem, so the muscles around the painful area tighten up and clamp down.  That’s why people often have muscle spasms and tightness in their low back when it’s painful.  The picture below shows how the low back bends forward excessively due to the hips being more stiff compared to the low back.

How is this treated?  Stretching the muscles of the low back and trying to make the low back more mobile because it’s stiff!  While this may give temporary relief because stretching tight muscles feels good, it does not “fix” the problem.  It treats the symptoms of muscle spasm and tightening that are the result of a low back that moves TOO much.  So all you’re doing is actually making your back move more when this is the problem to begin with.  The long-term solution is to improve hip and thoracic spine mobility while increasing low back stiffness.  With adequate hip and thoracic mobility, the lumbar spine will not be required to move excessively.  When not required to move excessively, inflammation and irritation of lumbar structures such as joints, discs, and nerves goes away.  No inflammation of these structures means NO pain.

The best athletes and strongest individuals are able to maintain lumbar stiffness during high level, dynamic activities while moving through the hips and mid back.  This is how someone hits a home run, plows over a linebacker while running the football, dunks a basketball, or squats 600 pounds.  Without significant lumbar stiffness or “stability” as it’s called, none of these exertions is even possible.  This is also the reason that surgical treatment for chronic low back pain is often a fusion.  A fusion is simply screwing vertical rods into the vertebrae of the low back so there is no movement.

People without back pain are able to maintain sufficient lumbar stiffness during everyday activities so there is no excessive motion along the lumbar spine.  People with back pain are unable to maintain sufficient lumbar stiffness during simple activities like walking, standing from sitting, or exercising.  This is usually due to weak trunk muscles (think core stabilization) AND a stiff thoracic spine and stiff hips.

Often times reducing low back pain is simple but not easy.  Simple because what’s required is nothing earth-shattering.  Not easy because a commitment is required – you must be consistent with mobility work and corrective exercises or movements.

It’s rare that I don’t see a patient with low back pain who will not benefit from improved hip and thoracic spine mobility.  Below, I have listed several simple movements (along with demonstration videos) to improve mobility in these areas.  Consistently complete these mobility drills daily for one month and watch your back pain decrease significantly or disappear completely.

Thoracic spine mobility:

1. Thoracic extension over towel roll or chair: 20 reps

This video shows the technique using a foam roll.  http://www.youtube.com/watch?v=lTP2TDdMHoY 

If you don’t want to purchase a foam roll, you can roll up a towel or use a chair as seen in this video. http://www.youtube.com/watch?v=JoW4Q76AhSg

2. Thoracic rotation mobilization: 10 times in each direction

http://www.youtube.com/watch?v=K_gipH-bJ3o

Hip mobility:

1. Hip flexor mobilization: 10 times each side

In this video, only do first technique explained.  They walk through a progression and as your back pain decreases you can progress through the stretches.  Start with the first one for two weeks.

http://www.youtube.com/watch?v=l0o5LDr-INs 

2. Fire hydrant: 10 times each side

http://www.youtube.com/watch?v=f-GRxDrMC4Y

This will take you literally five minutes.  Don’t do it once and say it didn’t work.  Continually complete these simple drills daily for one month.  Commit to it;  your back will thank you.  Simple but not easy.