by Dr. Matt Fontaine
“When it comes to running injuries, many think of foot, ankle or heel pain, shin splints, runner’s knee or ITB syndrome. But poor hip mobility and function can lead to LOW BACK PAIN in runners and also cause runners to lose power and efficiency in their runs.”
-Dr. Matt Fontaine
Defining the problem
TC was a long time avid runner. He had ten marathons under his belt but began to experience severe lower back, hip and ITB pain. He continued to run through the pain until he could no longer tolerate it. He saw his primary care doctor who ordered an X-Ray but that came back negative. He completed several courses of physical therapy and reported some relief from doing his exercises. He was told he needed to strengthen his hip and quads and that he had muscle imbalances from years of running. When he came to see me he had just completed Marine Corps Marathon and he was complaining of severe lower back pain, hip pain and knee pain.
His examination revealed decreased range of motion in his hips, compression and poor joint motion in his lumbar spine and a weak core. We performed a running analysis which revealed he was hyperextending his lower back and overusing his hamstrings and lower back muscles while running. The result was wear and tear in the joints of his hips and lumbar spine. Lumbar X-Rays revealed he had some arthritic change in his lower back, but nothing that should prevent him from running. He began an integrative active treatment regimen consisting of joint manipulation of the hips and lower back, soft tissue release work, and specifically prescribed exercises to address his weak core and muscle imbalances. Back on the mend, he is continuing to run and training for yet another marathon.
This is a common situation that we see time and time again in clinic. The big challenge is that most runners have failed to have the root cause of their pain diagnosed.
Diagnosing Lower Back and Hip Pain
The challenge is we sit way too much in today’s modern world, causing our hip flexors to get tight and increasing incidence of low back pain. The hip flexor muscles sit in front and to the sides of our lower back and connect the lower back to the hip.
The above picture is taken from the visible body
Tight hip flexors compress your lower back and can cause joint injury. The body’s gluteal muscles stabilize the knee, hip, low back and pelvis in weight bearing positions. These powerful muscles are also the engine driver that pushes us forward as we walk, jog or run. Tightness in the hip flexors can weaken your gluts, resulting in overworked hamstrings and lower back muscles and ultimately, LOW BACK PAIN. The driving forces behind repetitive motion injury besides the repetitive motion are muscle imbalance and poor joint mobility. These issues are widespread in most cases of chronic musculoskeletal pain and even play a critical causative role in acute setting sports injuries. With muscle imbalance, some muscles have become glued down and tight and need to be released, while some muscles have become weak and need to be activated in order to get them to work better. The key here is to train your muscles to develop better motor control in order to move better and to prevent re-injury.
Assessing Hip Movement
It is important to note that most athletes with pain lasting more than two weeks should see a healthcare professional for evaluation. Most salient is to determine how your body moves as a whole during functional movements such as bending, squatting, lunging, and running. Functional Movement Assessments are designed to assess seven prime movements of the body. Humans that move well have the right combination of both mobility and stability in specific areas of the body and they have great motor control over their movement. Our foot needs to be mobile, our knee needs to be stable. We need mobile hips, a stable lower back and core, and mobile upper back. In the shoulder girdle and neck it gets a bit more complicated. We need to have controlled movement of our shoulder girdle as we move our arms overhead. So we need both stability and mobility of the shoulder girdle, upper back and a stable neck.
As mentioned above, the driving force in chronic pain and acute setting sports injuries is repetitive motion in the face of muscle imbalance and poor joint motion.
“The latest evidence based research shows that the best outcomes come from integrating manipulation with soft tissue treatment and corrective exercises” says Dr. Fontaine.
It is always important to note that proper nutrition is essential to optimize your physiology, facilitate healing and fuel performance. It is important to note that proper management of these injuries requires an overall treatment plan that is an ‘all encompassing’ approach — not just an exercise video — not just therapy or exercises — it’s a multi-pronged approach. Best practices address restricted joint and soft tissue mobility with a combination of manipulation, soft tissue manual therapy such as Active Release Techniques® and Graston, exercises to help stabilize the changes made with manual treatment, and proper nutrition to optimize your physiology. The BIG KEY here is that the rehab exercises help to stabilize the changes made through the hands on treatment of manipulation and soft tissue therapy. These all complement each other, and if any are missing, treatment success will not be optimal. With that said, two exercises that can help are hip flexor stretches and bridging.
Exercise stands in as one integral part of a three pronged approach:
1. Joint manipulation
2. Soft Tissue Manual Release
3. Corrective Exercises
Two of our most prescribed exercises are: 1. The hip flexor Stretch: 2. Gluteal Bridge: Here are two videos of our most prescribed hip exercises: