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Are Your Tight Hips The Cause Of Your Back Pain & Knee Pain?

Written by: Nick Jack
Category: 2014
on 07 April 2015
Hits: 15573

Anybody who has had back pain, hip or groin pain before will know how frustrating this type of injury can be to shift. Apart from the frustration of re-occurrence if the underlying cause is not found and resolved, there is a stack of other injuries that are likely to follow if intelligent changes are not made. This article is intended to show you our most effective rehabilitation and injury prevention methods (injury tests, best stretches and exercises) that we have used successfully with many clients (see testimonials) for over 12 years working as Rehabilitation specialists in Melbourne. Our goal is to address the whole problem of your pain or injury, looking closely for the source of the problem so we can help you attain long term balance and optimal function. The hip joint, along with the ankles, is a joint we find where most of the troubles originate. It is also often missed in diagnosis of injury, as it may not present with pain, instead it will show stiffness and a lack of mobility. The hips are designed to be very mobile, having to withstand both direct loading stresses and large rotational forces with weight-bearing activities. It is especially vulnerable to injury in sports that involve pivoting or twisting movements, such as soccer, football, tennis and golf. Because the muscles around the hip joint attach directly on to the joint capsule, they have a large influence on the range of movement. And why we need explosive rotation in sports and even in some daily activities, these forces place tremendous strain on your ligaments, tendons and muscular structures designed to protect the joint. The failure to adequately control these forces can lead to chronic pain and a lifetime of restricted movement!

How The Hip Dysfunction Sets Off A Chain Reaction Of Problems

If you have read our other articles before then you will be very aware of what I am about to show you. As mentioned in the introduction hip dysfunction that shows itself either with stiffness or instability will create enormous problems at other joints, usually the ones directly above being the lumbar spine and below being the knee. But why? If you read Gray Cook's book titled Movement he discusses what he refers to as the joint by joint approach where each of the main joints in the body share different roles and affect the following or preceding joint. What you will see is that every second joint needs flexibility and mobility, and the other joints need the exact opposite being stability and strength.

Here is how it works.

  1. Feet - The feet have a tendency to being lazy, and easily losing strength and motor control. The feet need exercises to make them stronger and more stable.
  2. Ankle - The ankle tends to develop stiffness very easily and needs more focus on mobility in order to provide all the multi directional movements of the lower limb.
  3. Knee - The knee is basically a hinge joint and incapable of multi directional movement like the ankle. It needs Stability and strength work to ensure it does not get injured as in ACL tears.
  4. Hip - This joint is often the cause of many problems. Like the ankle it provides multi directional movements but for reasons we will look at shortly they have a tendency towards stiffness and as a result benefit from flexibility and mobility work.
  5. Lumbar Spine - The lumbar spine needs stability to prevent unwanted flexion or extension. A bit like the knee joint this is just a hinge and incapable of rotation.
  6. Thoracic Spine - Requires mobility and like the hips is pivotal in providing the athletic rotational movements in tennis, golf etc.
  7. Glenohumeral Joint - Requires a mixture of stability and mobility. This along with the scapula are a unique joint in that they require both. Another reason why they are often injured and difficult to treat.

Take a look at the pictures below. Either the ankle or the hip can play a big role in starting the chain reaction. In the first picture I have used the ankle as the culprit, but it easily could be the other way around and started at the hips. Regardless of who started it all, you now will have to design a program to correct all these joints. And you will have to do this both separately, and also in one integrated movement for that is how they function. Just working on them individually will change very little as we will discuss shortly.

There Are 2 Common Types Of Hip Problems

Problem #1 –Restricted Hip Motion

This type of problem can produce local hip pain or cause dysfunction in the lower back, SIJ or the knee, as a result of these structures attempting to compensate for the lack of movement at the hip joint. This is more common in non sporting people who sit too often behind computers and generally do not move around enough. We also see this with someone who has not spent enough time working on mobility or stretching drills in their training and allowed the ligaments, tendons and muscle fibers to become too short and stiff. But we do also see this in people with a lack of stability that has been left for too long, typical of chronic knee pain or hip conditions like piriformis syndrome. Often these injuries started out with good mobility, but a lack of strength and stability created too much mobility! This lack of stability forces the body to create a new plan for keeping the joint safe from dislocation, and this new plan is called STIFFNESS! Stretching as you will soon see may not be the best solution either.

Problem #2 -  Increased Amount of Hip Movement

This happens from a lack of control of the femoral head (top of the thigh bone) in the hip socket; you will often feel or hear clicking or clunking, or a feeling of weakness in the region. A failure to correct this lack of control can lead to joint damage and subsequent long-term restriction of movement. I myself had this for quite a few years, before I was a trainer, and as a result of not doing something about it, I developed Osteitis Pubis and all sorts of groin and hamstring problems. This lack of stability in the hip socket is caused by a lack of core strength and overall muscle mass. Which is why it is more common in elderly people and females who have lost too much strength. But we also see quite a lot of this in distance runners who do no form of strength training and people with poor movement skills. Hypermobile people will also most likely suffer from this problem. And as you will see this is important to know when deciding what course of action to take to correct it, for 90% of the time the treatments used for this person makes things worse!

Both of these problems if left unattended will end up causing dysfunctional movements that create other problems and ultimately end up with osteoarthritis in the joint.

What Can You Do If You Have Either Of These Problems?

Well the good news is there is something that can be done that does not involve surgery or medication. It really annoys me to see people think that this is only a genetic defect and that surgery is the only choice. In some cases by all means surgery is necessary and cannot be avoided, but it should be a last resort, not the first choice. A one size fits all approach to exercise will also not help either and many of the today's rehabilitation programs are very poor at working with lower limb injuries due to the over reliance of machines and sitting or lying down exercises. To help you out I have put together 5 Simple Steps to Loosening Tight Hips with some exercise descriptions and video examples, but in all honesty this is merely scratching the surface of what can be a complex problem.  To truly do the job right you will need to apply many more exercises to fully correct your problem.

I would strongly encourage you before reading further, if you are someone with a chronic hip problem causing pain to get one of the 3 great programs below that will go into great detail about how to assess your body to find the cause of your problems. This will explain exactly where to start, what exercises to do and avoid, and be guided on how to safely and effectively progress your program to get rid of your injury for good. Each program comes with a 60-90 minute video and PDF report on how to implement the program. Click the image of the program relevant to you to download or click here to go straight to our online shop.

Step 1: Address The Cause

If you have read any of our other articles before or seen our You Tube videos you will be sick of me saying this, but it is so important and is really a big problem in today's practice of treating injuries. Health practitioners are so caught up in getting rid of pain and treating symptoms that they fail to look at the big picture and find out what started the ball rolling the first place. Read our article on Chronic Pain What Is It Really & Why It Changes Everything to see more about this.

In most cases you will find stiffness all started the day you began sitting too much. Now it is not always sitting that can be the major cause, but it will play a big role in keeping your hips stiff and rigid. Sitting WILL create Tight hip flexors, hamstrings, calf muscles, tightness through the external hip rotator muscles. Not only will your hip become tight but also cause stiffness in the mid (thoracic) spine tight and hunched shoulders with weak lower shoulder muscles and tight neck muscles! The better the posture one can maintain during the day, the less likely it is that the above areas will become problematic. Make sure you read our article on The Dangers Of Sitting and how to set up our your workstation correctly if you know this is a problem. Many of the lower back rehabilitation clients we see are related to them sitting too often. And before the back pain became a problem they developed very tight hip flexor muscles that limited their range of movement and exposed their back to dangerous movements. If your job involves a lot of computer work then it is essential you have great ergonomic set up and some strategies for preventing hip tightness.

Below is a picture that sums up today's world.

Other things to consider are things that have happened in the past or things you do repetitively such as:

  • Previous injuries not rehabilitated correctly
  • Poor footwear
  • Poor running technique
  • Poor gym exercise technique
  • Sleeping position
  • Repetitive tasks at work
  • Sports
  • Yoga

You must find what repetitive tasks you are doing that may be leading to your problem. Just be very clear on this, if you don't address the cause you will not resolve your problem.

Step 2: Stretch or Strengthen?

This is a difficult one to explain for it could be both, but in most cases it ends up being more about stability than a lack of mobility or flexibility. This is such an important step to work out, because if you spend too much time on the wrong correction you potentially could make your problem worse! I see this all the time with people suffering with piriformis syndrome who have been stretching, and foam rolling all the time only to see their injury progressively get worse and to a point where they can barely stand up! Most people believe they need to stretch and loosen the hip for it to become free. But this is where the paradox lies and also why many of the traditional treatments fail the person who needs stability over stretching. This person needs to "tighten up to loosen up"! We see this very often with people who do too much Yoga or dancing. Their muscles have become so long and weak they now no longer have adequate stability and these weak muscles are unable to support the joints as they are supposed to, leaving the hard work to the ligaments and tendons. This is where the body adapts and creates new stability methods called stiffness to correct the problem.

To know if you need to stretch complete the 2 stretches below and if you are unable to achieve the optimal result you will need to do a stretching program outlined in Step 3. If however you can complete these stretches comfortably then your issue is not stiffness but lack of stability and you can go straight to step 4 and begin stabilizing and strengthening, avoiding stretching all together!

 

Stretch number one you should be able to get your front leg at 90 degrees while keeping an arch in your lower back. You can see from this picture I am slightly less than 90 degrees meaning I need to do this stretch. It is important to keep the arch in your lower back to ensure you stretch the correct muscles. This stretch we often see difficult for a person with back pain, piriformis syndrome or hip pain itself.

Stretch number two is more of a quadricep stretch than a hip stretch. I often look at this if someone presents to me with knee pain. This stretch is a real beauty for anyone who has tight muscles in the front of the hip. And often one we need to give you to loosen up. You should be able to achieve a tall upright posture with your hands touching the ball behind you like me in the picture. In this case I do not need to do this stretch. If I did do this stretch there is a good chance I will create tighter muscles elsewhere to balance out the joint, such as hamstrings.

It is all about balance, not too much and not too little. Just to the point of balance.

Step 3: What Stretches Do I Need To Do If I Established I Am Too Tight?

Firstly before getting straight into stretching I would recommend using the foam roller to help break up some of the tight fascia muscles like the ITB. You can watch a quick video on that below where I show you how to use it correctly. A regular massage from a skilled remedial massage therapist is also beneficial.  The stretches you can use are obviously the 2 tests I just showed you. But you will want to explore a much more comprehensive assessment to rule out stiffness at other joints contributing to your problem.  Below is a video giving you some good ideas.

What about Mobility? Mobility is not quite the same as flexibility. Stretching is usually a static stretch of one muscle crossing one joint, whereas mobility is a moving dynamic stretch of multiple muscles crossing multiple joints. Read this article Mobility & Flexibility Which Comes First & Why

I find with many people that they will benefit more so from mobility drills than just static stretching mainly due to the fact that it mimics a daily movement closely giving the brain the ability to change anything this drill shares in timing and positioning. Stretches are still needed for the person who lacks significant range of motion but they may not address the stiffness in the position you need when you stand up. This is where mobility drills will work much better and allow you to progress to the next stage quickly where all the long term correction really takes place.

Below is 2 videos of mobility drills for the hips, and you will notice these include the other 2 known tight areas with most people, the ankles and the thoracic spine.

Step 4: Stabilize The Hip Joint

Now this is where it gets really interesting and also confusing! I cannot tell you how many times I have assessed a person with all our flexibility tests and find them to pass them all yet when they stand up and show me how they squat or lunge it is so stiff and awkward presenting as if they have no flexibility. Yet only 10 seconds earlier they were incredibly mobile. In the book Vital Glutes by John Gibbons he makes a great quote

"Tight muscles show themselves lying down, whereas weak muscles show themselves standing up"

For many years I tried to correct the person's squat, lunge or movement with stretches in between with some success but not a huge result. It was not until I wised up and discovered I had been working on all the wrong things. They never had a lack of mobility it was the lack of stability forcing the body to apply stiffness when they stood up. The body senses it cannot stabilize itself so it had to stiffen the person up and create limited range of motion with exercises to prevent serious injury. The only way to correct this was to teach the person how to stabilize better. Does this mean do heaps of planks and crunches and you are right? No. I made that mistake too. The only way you can change this is by using drills that mimic the movement they are struggling with. Use of tools to "cheat" is also necessary so the brain can learn that there is a better way. You will also still need some isolated exercises to strengthen weak areas but you MUST put them back together in a standing position to have any chance of changing anything.

Told you it is confusing!

Below is 2 videos or a client who came to see me with this exact problem. He was a track and field sprinter, and had been dealing with hip problems for over 10 years that now were giving him back pain and preventing him from running. On stretch assessments he was really good, in fact too good. He had spent considerable time doing stretches and it showed. Yet when he stood up his body position was terrible. The interesting thing was he could actually change his movements when coached, the problem was he did not know that he was moving like this in the first place to need to change it. Within 3 months he was pain free and back running again. He had to continually work on several exercises and develop strength in areas that were weak, and he had to back off on his stretching.

If you determined that you needed to stabilize and strengthen more, then you will need to start with these exercises. There is 2 key parts here you will need to focus on. Abdominal stabilizers and your posterior chain muscles of the glutes and hamstrings.

Part 1: Inner Unit Function

Weak abdominal muscles that attach to the pelvis are a common source of weakness associated with hip pain. Your abdominal muscles play a pivotal role in stabilizing the pelvis and lumbar spine prior to movement. When the hips become more tight and restricted they also learn to become your stabilizers as well. This is a big problem for your hips are now trying to move you and also stabilize you at the same time. One of those things will be compromised, guess which one? Stability. When faced with this choice it will prefer to stay tight, and find the extra mobility at the next joints above and below being the lumbar spine and the knee! Now just doing heaps of ab exercises won't change much but it is a starting point to learn the fundamentals of how to recruit stabilizers so you can merge this into the more complex movements later on.

Watch the videos below to see how to do this correctly and also 2 other abdominal exercises that will teach your body to use your abs and not your hips!

Part 2: Isolated Strength Posterior Chain

The posterior chain muscles which are made up with the glutes, hamstrings and back extensors provide the major torque-producing capacity of the body during the activity of walking and running. From hip extension in walking, to powerful hip extension in sprinting, these are the key muscles in use. They work very closely with the abdominal muscless, to provide core stability for the low back and importantly the hip.  A strong focus on posterior chain exercises will help to address some of the typical muscle imbalances that people tend to have and one of the contributing factors to developing tight hips.

If you have not read our article on posterior chain exercises read this How To Strengthen Your Glutes 

Here would be 3 of our better exercises to get you started. The Bridge, The Clam and The Single Leg Hip Extension. Again there is so many more I might use depending on the circumstances and the injury but this gives you an idea.


How To Do Bridges

  1. Lie on your back with knees bent, feet and knees hip-width apart
  2. Squeeze the gluteal muscles and lift hips until you have a straight line running through knees and hips to the mid-back. Leave the shoulder blades on the floor
  3. Hold the position, focusing on using the gluteal muscles, for 10 seconds
  4. Place the hips back down, maintaining neutral spine build up the length of hold gradually to 30 secs, and three repeats (sets)

Now we are not quite ready yet to stand up and strengthen. We still have not really tackled stability on a reflex level yet. The abdominal exercises we showed earlier are great inner unit activation drills but they do not change how we work on a reflex level which is what happens as soon as we stand up. Lying down is much different to standing, which is also why so many Pilates type training is so ineffective, for nearly all the exercises are performed lying, kneeling and seated. Even the reformer has a limited capacity for multi-directional movement that the hip can provide. To grasp the concept of Stability read our article Stability Training What Is It Really & How To Do It Correctly.

This area can really branch out into so many possibilities but here is 2 very simple exercises you can use to help you. The first one is called the inline lunge drill. Amazingly difficult for the person with hips working as stabilizers but so effective at teaching them how to switch off and use your abdominal muscles for a change. The second one is the forward ball ball roll. This is an excellent exercise before moving straight into the more difficult exercises standing up. It teaches your body how to co-ordinate movement by using the abdominal muscles for stabilization and the hips to become free and mobile to produce movement of the trunk. Lastly great thoracic extension is required which pulls it all together. Again there is a video here where I show a real life example of a client with tight hips. I explain in detail how to do this correctly and teach your body how to use abs and not hips as stabilizers.

Step 5: Integrate Into Standing Movement

This last step is the hardest but arguably the most important. I like to use 3 exercises to teach the body how to do this. I repeat myself regularly in articles on this website and I will say it again because it is so true. The brain controls the muscles and organizes this process, so it makes sense to go to the brain to create good movement. Using isolated exercises from body building, pilates or from a therapist, although great in the early stages when you were in too much pain will now maintain at best and at worst create more dysfunction. This is also why most Rehab programs fail because people do not understand movement. Read our article on Why Movement Skills succeed and  Muscle Training fails to get a good understanding of this. Let's take a look at our 3 integrated exercises.

Top 3 Exercises For Optimal Hip Function

1. Deadlift

The deadlift is known as the king of strength training exercises in the gym and for good reason it really does provide some amazing strength to the entire body. In terms of hip development is awesome if done correctly. Many back pain sufferers will find it is in this movement that their back injury occurred. In particular with a disc bulge or herniated disc injury it is the FAULTY BENDING ACTION that created the pain. This exercise requires massive mobility of the hips, known as the hip hinge to protect the lumbar spine from flexing and squashing the discs and facet joints of the spine. Learning the skill of how to do this comes first but then applying loads and developing strength is what makes this movement so strong. The glutes become more powerful and no longer do you need your hips and lower back to produce the necessary power for lifting objects that we do in daily life every day. Below is 2 videos of how to do this.

2. Single Leg Squat

Now this exercise gives us the most information about what your entire body is doing in terms of stabilization and movement skills. I actually would rate this more important than the deadlift. You cannot underestimate the importance of being able to perfectly execute a single leg squat. This movement is how you walk and run, meaning if you have a problem with this exercise you now have a problem with walking and running. I have a golden rule with all runners or sporting athletes who come to see me for a strength program. You MUST be able to do 20 single leg squats perfectly before I will give you any type of performance plan. The chance of injury is extremely high for anyone who cannot do this exercise correctly.

The same is true for older adults and this particular exercise makes up a big part of our older adults strength programs. Try to do this in front of a mirror or with a partner so you can evaluate where you are breaking down. Use the previous exercises and stretches between sets to try and improve your form. Your goal is to make it perfectly aligned from ankle, through the knee up to the hip.

You can read more about the specifics of this exercise in our article Why The Single Leg Squat Is The Best Exercise For Lower Limb Injury Prevention

Below is 2 videos you can watch to see how to do this.

Technique:

  1. Begin the movement by flexing at the hip and continue bending the knee and ankle until your thigh is parallel to the ground.
  2. Make sure you can draw a straight line from the ankle through the knee right up to the hip.
  3. Keep hands in front of the body.
  4. Keep trunk as upright as possible, preferably neck above toes, avoiding excessive lumbar and thoracic curvature.
  5. Heel must stay in contact with the ground at all times.

More recently I have been doing this exercise standing on a sensa mat to encourage better foot stability and ultimately stability through the entire kinectic chain. Read our article about the Sensa Mat to see more on this as it really is an awesome tool to assist hip dysfunction.

3. Multi-Direction Lunge

One of my favorite exercises and one I use with sports players of all ages due to the fact it mimics many movements required in sport. This is a highly coordinated movement that requires balance, agility, strength and importantly flexibility. The hips are meant to be able to move in all directions to create athletic fluent movement, yet at the same time maintain your balance and stability from activation of your core. I cannot think of a better exercise than this to tie everything together. So while we use this for sports to improve performance, we also use this for rehabilitation to improve flexibility of the hip musculature and stability and strength of the core. Watch the video below of how to do this correctly and try it yourself and see how hard this really is!

Below is videos of this in action.

Conclusion

We have covered a lot of stuff in this article for as you can see there is just so many factors you must address. Skip steps and you can go backwards really fast and create bigger problems. This really is quite a tricky topic to try and explain in a short article like this but I hope I have opened your mind up to the areas you may need to explore to find an answer to your problem. Whether it is back pain, knee pain or hip pain, you will find a common theme. Your hips are becoming stronger and tighter and your posterior chain and abdominal muscles are becoming weaker and dysfunctional. The longer this stays in place the more injuries you will develop and problems you will have. There is some free reports at the bottom of the page you can get instantly that give you a ton of information and examples, but I do suggest getting the more specific programs I provided earlier in the article.

Alternatively if you live in Melbourne you can schedule a FREE Postural and Movement assessment at our studio. I can then identify your problem straight away and work out a plan to help you. If fill in the form below I will get back to you within the next 24 hours to schedule an appointment.