Official Website of Sarah E. Rippel, BS, CPT, FMS

-Tight Hips and Low Back Pain-


I have always believed that Fitness Professionals must EDUCATE their clients.  I’m not talking about “wowing” people with scientific terminology.  I’m not talking about throwing out the big words so that one appears knowledgeable.  I’m talking about conveying pertinent, helpful information to the people we train.  After all, what good is a trainer who just has their clients perform exercises?  Typically this type is more interested in everyone else in the gym BUT their client.  Scary, huh?!  I obviously don’t train my clients in a gym.  I don’t particularly care for them.  I have found that it’s so much easier for my clients to stick to their workouts, focus, and get things done because the “gym hassle” is out of the picture.  That’s a whole other post in itself.  My point is that when you train with me, you’re going to get educated, whether you like it or not! 🙂  I don’t “force” info on my clients, BUT I do explain the “how’s and why’s” behind their exercises.  I help them understand the things that I feel will greatly benefit them in their fitness journey.  I DON’T spit out muscle terminology for the sake of sounding smart.  My clients KNOW I know what i’m talking about.  I don’t have to try and prove it!

With this being said, the topic at hand is HIP MOBILITY.  What is it and what does it mean to most of us?

Mobility simply means “the quality or state of being mobile.”  THE ABILITY TO MOVE.  Why does this matter?  Well, when you look at the human body, it’s basically a stack of joints.  In his article, “A Joint By Joint Approach to Training,” Mike Boyle states:

“Each joint or series of joints has a specific function and is prone to specific, predictable levels of dysfunction.  As a result, each joint has specific training needs.”

Joint Primary Training Needs
Ankle mobility (particularly sagittal) 
Knee stability
Hip mobility (multi-planar)
Lumbar Spine stability
T-Spine mobility
Gleno-humeral stability

Looking at this table, the joints simply alternate mobility and stability.  What’s completely obvious to most Fitness Professionals in the know, is that this table represents the “average” client.  Most people lack the mobility where it’s important and also cannot stabilize where it’s important.  This most often leads to a cascade of dysfunction.

Boyle also states:

“Over the past 20 years, we have progressed from the moronic approach of training by body part (sorry, bodybuilders) to a more intelligent approach of training by movement pattern. In fact, the phrase “movements, not muscles” has almost become an overused one, and frankly, that is progress. I think most good coaches and trainers have given up on the old chest-shoulder-triceps thought process and moved forward to a push-pull-hip extend-knee extend thought process.”

I couldn’t have said it better.

Dysfunction at one joint typically shows up as pain in the joint above or below.  Boyle uses the low back as a perfect example of this.  He says:

“It seems obvious based on the advances of the past decade that we need core stability. It’s also obvious that lots of people suffer from back pain. The interesting part lies in the theory behind low back pain. My theory of the cause? Loss of hip mobility. Loss of function in the joint below (in the case of the lumbar spine, the hip) seems to affect the joint or joints above (lumbar spine). In other words, if the hip can’t move, the lumbar spine will. The problem is that the hip is built for mobility and the lumbar spine for stability. When the supposedly mobile joint becomes immobile, the stable joint is forced to move as compensation, becoming less stable and subsequently painful.”

So, in a nutshell, if your ankles can’t move properly, your knees will hurt.  If your hips can’t move, your low back will compensate, and you’ll have low back pain.  If you don’t have thoracic mobility, you’ll get neck and shoulder pain (or low back pain).  Pretty simple, huh?

What’s interesting is that, as Boyle states:

“The hip can be both immobile and unstable, resulting in knee pain from the instability (a weak hip will allow internal rotation and adduction of the femur) or back pain from the immobility. How a joint can be both immobile and unstable is the interesting question.”  

So, if the hip flexors lack strength and/or aren’t firing properly, lumbar flexion will result as a substitute for hip flexion.  I am always saying that most people’s butts simply do not work!  I blame this on the fact that most people sit at a desk for eight hours a day, placing the glutes in a lengthened state, which essentially “turns them off.”  Oftentimes, it can be extremely challenging to get a client back in touch with their butt!  I’m serious!  The main function of the glutes is to extend the hip.  What happens is that glute weakness and/or lack of activation will results in an extension pattern of the lumbar spine that attempts to replace the motion of hip extension.

This creates a cycle of dysfunction.  The hip loses mobility as the spine moves to compensate for the it’s lack thereof!  It appears that lack of strength at the hip leads to immobility, and immobility in turn leads to compensatory motion at the spine.  

“The end result is a kind of conundrum,” states Boyle, “a joint that needs both strength and mobility in multiple planes.”

So, what is my protocol for improving hip mobility and lumbar stability?  I’m throwing in work that addresses other areas as well, as the body must be seen as a “unit,” and it would be erroneous to think that by focusing on just the hips and low back, one’s issues would be sufficiently addressed.  Here’s what I do, an “activate/isolate/integrate” approach:

  1. SMR (self-myofascial release)via a foam roller and/or a device called the Tiger Tail or “The Stick” of the calves/peroneals, quads, IT band, TFL, piriformis, and lats to “de-activate” these typically tight areas.
  2. Active Isolated stretching of hips and legs.
  3. Static stretching of SCM, upper traps, etc (neck muscles) to de-activate these areas as well, which makes the corrective exercises to follow a lot more productive.
  4. Corrective exercises to address glute activation and hip mobility, lumbar stability, thoracic mobility, and scapular control.  As with every exercise, these require the client to stabilize the low back through proper bracing, so there is a lot more going on than just “working on the weak spots.”
  5. Dynamic, total-body movements that require body awareness and control, specific to client’s level.
  6. More specific movement pattern training (pushing, pulling, rotation/anti-rotation, level changes, and locomotion)

Wow…this post sure took on a mind of it’s own! 🙂  My apologies for being excessively long-winded, but I hope you have gained some insight and learned a few things!  Feel free to contact me and/or leave a comment below!

Sources:

“A Joint by Joint Approach to Training” by Mike Boylewww.PTonthenet.com

Also check out Boyle’s to-the-point article, “Desk Jobs are Bad for You”

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8 responses

  1. I need to get my hips more in shape! 🙂

    November 13, 2008 at 11:32 am

  2. Pingback: -Excessive Lumbar Rotation- « “Outside the Box” Training

  3. Awesome posts!

    I cite your blog here: http://tinyurl.com/rkc-hips

    🙂

    March 12, 2009 at 11:31 am

    • Thanks, Leslie!

      March 12, 2009 at 12:22 pm

  4. Jason

    Sarah – do you have a hip mobility workout that you could put on your site? I have trouble with hip internal rotation and would be very interested in your thoughts. I’ve tried a few PTs in the area with no success. I like your total body approach to a joint issue. I do have a PT report I could send along to help you plan a workout. Thanks.

    Jason

    April 6, 2009 at 11:36 pm

    • Hi Jason!!!

      I think I could manage that! Other readers would benefit as well, so it’s a win-win! Most clients I work with initially have a lack of hip internal rotation. There are ways of “sneaking in” this important movement of the hip so it becomes more natural! I will shoot a vid soon and get it up here! Thanks for asking! 🙂

      Yours in Health,
      Sarah

      April 7, 2009 at 4:12 pm

      • Jason

        Fantastic! I’m excited to see what you cook up. Let me know an email address I can send the PT workup sheet to.

        Jason

        April 8, 2009 at 9:56 pm

        • Sweet! I love projects! 😀
          I really do like problem-solving, and hopefully I have some things up my sleeve that differ (in a good way) from what the PT’s typically do. At one point, I was thinking about PT school…what’s cool is that now i’m able to utilize some corrective strategies along with exercise know-how, so it’s like the best of both worlds! Also, like I was telling a client the other day…i’m not too keen on wound treatment…and PT’s have to deal with wounds…ewwww…and to think at one point I was trying to get into med school as well? Craziness! lol
          I’ll shoot you an email right now, and then i’m hittin’ the hay!
          S

          April 8, 2009 at 9:59 pm

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