If your hips are killing you, you probably spend a lot of time sitting – in the car, at work, on that spinning seat – which puts your hips in near-constant “flexion”, says Cori Lefkowith, NASM-certified personal trainer and owner of Redefining Strength in Orange County, California. Even running involves a repetitive flexion movement that can cause pain.
The bones of the hip are supported by specific muscles. The strongest muscle in the body is actually one of the main flexors of the hip, it is called the iliopsoas muscle. It has two attachments to the inner part of the hip as well as the lower part of the back. This muscle is involved in iliopsoas tendinitis, iliopsoas bursitis, and is one of the most common causes of muscle pain that causes hip pain. The tendons attach the muscles to the bones and the ligaments attach bone to bone. Areas that are often susceptible to increased pressure are the tendons or the muscles attached to the bone, so that is another source of pain in iliopsoas tendinitis. The bursa are pockets of fluid that also protect the top part of the bone to prevent pressure on the bone. There are about 160 bursa in the body, and when they get irritated, it can develop into bursitis.
Deanna is an ACE® certified personal trainer, Balanced Body® Pilates instructor, and NASM® Fitness Nutrition Specialist. She is passionate about inspiring others to lead a healthier lifestyle through fun workouts and healthy food. When she’s not creating new workouts and recipes for her blog The Live Fit Girls she enjoys running with her two dogs and traveling.
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Low back pain that lasts at least one day and limits activity is a common complaint.[7] Globally, about 40% of people have LBP at some point in their lives,[7] with estimates as high as 80% of people in the developed world.[22] Approximately 9 to 12% of people (632 million) have LBP at any given point in time, and nearly one quarter (23.2%) report having it at some point over any one-month period.[7][8] Difficulty most often begins between 20 and 40 years of age.[1] Low back pain is more common among people aged 40–80 years, with the overall number of individuals affected expected to increase as the population ages.[7]
Low back pain can be caused by tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.
Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. During prolonged periods of sitting, elevate feet on a low stool or a stack of books.
In this study, one patient with sciatica was sent for ten MRIs, which produced 49 distinct “findings,” 16 of them unique, none of which occurred in all ten reports. On average, each radiologist made about a dozen errors, seeing one or two things that weren’t there and missing about ten things that were. Yikes. Read a more detailed and informal description of this study.
You may hear a clicking noise when you move your hip, but that sound is not necessarily a hip flexor issue. Siegrist says the clicking isn't generally the hip flexor alone and often comes from a moving part, like the joint. "Maybe there is a loose body in the joint or loose cartilage at the edge of the hip joint that is mechanically getting irritated,” she says.
Imagine not being able to climb stairs, bend over, or even walk Changes in hip joint muscle-tendon lengths with mode of locomotion. Riley, P.O., Franz, J., Dicharry, J., et al. Center for Applied Biomechanics, University of Virginia, Charlottesville, VA. Gait & Posture, 2010 Feb; 31 (2): 279-83.. All pretty essential if you ask us! But that’s what our bodies would be like without our hip flexor muscles. Never heard of ‘em? It’s about time we share why they’re so important, how your desk job might be making them weaker (ah!), and the best ways to stretch them out.
Epidural steroid injections are a commonly used short-term option for treating low back pain and sciatica associated with inflammation. Pain relief associated with the injections, however, tends to be temporary and the injections are not advised for long-term use. An NIH-funded randomized controlled trial assessing the benefit of epidural steroid injections for the treatment of chronic low back pain associated with spinal stenosis showed that long-term outcomes were worse among those people who received the injections compared with those who did not.
Behavioral therapy may be useful for chronic pain.[16] There are several types available, including operant conditioning, which uses reinforcement to reduce undesirable behaviors and increase desirable behaviors; cognitive behavioral therapy, which helps people identify and correct negative thinking and behavior; and respondent conditioning, which can modify an individual's physiological response to pain.[17] The benefit however is small.[91] Medical providers may develop an integrated program of behavioral therapies.[17] The evidence is inconclusive as to whether mindfulness-based stress reduction reduces chronic back pain intensity or associated disability, although it suggests that it may be useful in improving the acceptance of existing pain.[92][93]
Back pain can be confusing enough as it is. Sometimes it may be difficult deciphering if the pain is even coming from your back, and trying to figure out what causes it can be mind-boggling. And many experts recommend focusing on mechanical sources of your back pain rather than anatomical sources of your pain. Is it a herniated disc, bulging disc, or facet joint arthritis causing your problem? It can be hard to decide, so focusing on what you are doing and the positions you put your back in may be the best way to determine the cause of your back pain.
Low back pain is not a specific disease but rather a complaint that may be caused by a large number of underlying problems of varying levels of seriousness.[25] The majority of LBP does not have a clear cause[1] but is believed to be the result of non-serious muscle or skeletal issues such as sprains or strains.[26] Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture and poor sleeping position may also contribute to low back pain.[26] A full list of possible causes includes many less common conditions.[5] Physical causes may include osteoarthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, broken vertebra(e) (such as from osteoporosis) or, rarely, an infection or tumor of the spine.[27]
To understand various causes of low back pain, it is important to appreciate the normal design (anatomy) of the tissues of this area of the body. Important structures of the low back that can be related to symptoms in this region include the bony lumbar spine (vertebrae, singular = vertebra), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Pain on the outside of the hip is most commonly due to greater trochanteric bursitis. The greater trochanter is the protrusion where the thigh bone juts outward at the base of the neck (which connects the ball to the femur and is the site of hip stress fractures). A lubricating sac (or bursa) lies over the boney protrusion so that the surrounding muscles do not rub directly on the bone. The top region of the iliotibial (IT) band, known as the tensor fascia lata, is commonly involved in greater trochanteric bursitis.
Low back pain that lasts at least one day and limits activity is a common complaint.[7] Globally, about 40% of people have LBP at some point in their lives,[7] with estimates as high as 80% of people in the developed world.[22] Approximately 9 to 12% of people (632 million) have LBP at any given point in time, and nearly one quarter (23.2%) report having it at some point over any one-month period.[7][8] Difficulty most often begins between 20 and 40 years of age.[1] Low back pain is more common among people aged 40–80 years, with the overall number of individuals affected expected to increase as the population ages.[7]
2016 — More editing, more! Added some better information about pain being a poor indicator, and the role of myofascial trigger points. This article has become extremely busy in the last couple months — about 4,000 readers per day, as described here — so I am really polishing it and making sure that it’s the best possible answer to people’s fears about back pain.
How to: Position yourself on your hands and knees, in tabletop position. Engage your abs engaged by pulling your belly button in towards your spine (a). Keeping your hips pointed towards the ground and leg bent to a 90-degree angle, raise your left knee out to the side as high as you can (b). Pause at the top, then return to starting position (c). Repeat, then switch legs.
Stop focusing on a specific diagnosis. Up to 85% of low back pain can be classified as "non-specific." This means that the origin of your pain cannot be localized to one specific structure or problem. While common diagnostic tests for low back pain can show the bones, discs, and joints with great detail, no test can tell the exact cause of your pain with 100% accuracy.
There are a number of ways to classify low back pain with no consensus that any one method is best.[5] There are three general types of low back pain by cause: mechanical back pain (including nonspecific musculoskeletal strains, herniated discs, compressed nerve roots, degenerative discs or joint disease, and broken vertebra), non-mechanical back pain (tumors, inflammatory conditions such as spondyloarthritis, and infections), and referred pain from internal organs (gallbladder disease, kidney stones, kidney infections, and aortic aneurysm, among others).[5] Mechanical or musculoskeletal problems underlie most cases (around 90% or more),[5][34] and of those, most (around 75%) do not have a specific cause identified, but are thought to be due to muscle strain or injury to ligaments.[5][34] Rarely, complaints of low back pain result from systemic or psychological problems, such as fibromyalgia and somatoform disorders.[34]
Doing the bridge exercise in the morning gets your muscles working, activated, and engaged and will help support you the rest of the day, says Humphrey. Lie on your back with your legs bent and your feet flat on the floor, hip-width apart. Press down through your ankles and raise your buttocks off the floor while you tighten your abdominal muscles. Keep your knees aligned with your ankles and aim for a straight line from knees to shoulders, being sure not to arch your back; hold this position for three to five seconds and then slowly lower your buttocks back to the floor. Start with one set of 10 and build up to two or three sets.
Antidepressants may be effective for treating chronic pain associated with symptoms of depression, but they have a risk of side effects.[13] Although the antiseizure drugs gabapentin, pregabalin, and topiramate are sometimes used for chronic low back pain evidence does not support a benefit.[79] Systemic oral steroids have not been shown to be useful in low back pain.[1][13] Facet joint injections and steroid injections into the discs have not been found to be effective in those with persistent, non-radiating pain; however, they may be considered for those with persistent sciatic pain.[80] Epidural corticosteroid injections provide a slight and questionable short-term improvement in those with sciatica but are of no long term benefit.[81] There are also concerns of potential side effects.[82]
You’d think so. But consider this story of a motorcycle accident: many years ago, a friend hit a car that had pulled out from a side street. He flew over the car & landed on his head. Bystanders showed their ignorance of spinal fracture by, yikes, carelessly moving him. In fact, his thoracic spine was significantly fractured … yet the hospital actually refused to do an X-ray because he had no obvious symptoms of a spinal fracture. Incredible! The next day, a horrified orthopedic surgeon ordered an X-ray immediately, confirming the fracture & quite possibly saved him from paralysis.
Spinal fusion eliminates motion between vertebral segments. It is an option when motion is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a curvature (scoliosis), or severe degeneration of one or more of your disks. The theory is that if the painful spine segments do not move, they should not hurt.
When was the last time you got on your gym's abductor or adductor machine and got in a good workout? It's probably been a while. Both are machines that don't get a lot of use, and they are often the target of coaches' ridicule on those "useless gym moves we should all skip" lists. Perhaps rightly so, especially if you're hopping on those machines hoping for a slimming effect.
Enthoven WT, Geuze J, Scheele J, et al. Prevalence and "Red Flags" Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice. Phys Ther. 2016 Mar;96(3):305–12. PubMed #26183589. How many cases of back pain in older adults have a serious underlying cause? Only about 6% … but 5% of those are fractures (which are serious, but they aren’t cancer either). The 1% is divided amongst all other serious causes. In this study of 669 patients, a vertebral fracture was found in 33 of them, and the chances of this diagnosis was higher in older patients with more intense pain in the upper back, and (duh) trauma. BACK TO TEXT
How to: Get on your hands and knees, in a tabletop position (a). Slowly widen your knees out as far as they can go and bring your feet in line with your knees. Your shins should be parallel with one another (b). Flex your feet and ease yourself forward onto your forearms. (If the stretch is too intense, try putting your arms on a block or firm pillow.) Hold for eight to 12 breaths (c). If holding the stretch for longer, try slowly moving your hips forward and backward to bring the stretch to different parts of your hips.
Stop focusing on a specific diagnosis. Up to 85% of low back pain can be classified as "non-specific." This means that the origin of your pain cannot be localized to one specific structure or problem. While common diagnostic tests for low back pain can show the bones, discs, and joints with great detail, no test can tell the exact cause of your pain with 100% accuracy.
Analgesic medications are those specifically designed to relieve pain. They include OTC acetaminophen and aspirin, as well as prescription opioids such as codeine, oxycodone, hydrocodone, and morphine. Opioids should be used only for a short period of time and under a physician’s supervision. People can develop a tolerance to opioids and require increasingly higher dosages to achieve the same effect. Opioids can also be addictive. Their side effects can include drowsiness, constipation, decreased reaction time, and impaired judgment. Some specialists are concerned that chronic use of opioids is detrimental to people with back pain because they can aggravate depression, leading to a worsening of the pain.
Coccydynia is an inflammation of the bony area (tailbone or coccyx) located between the buttocks. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Pain is often worsened by sitting. There are many causes of tailbone pain that can mimic coccydynia including: fracture, pilonidal cysts, infection, and sciatica. Treatment methods include medication and rest.
Here is how you do the hip rotation stretch: Sit on the floor with your knee out straight. Cross one leg over the other by placing your ankle on top of your knee (as if crossing your legs while sitting). Gently pull your knee across your body, and hold for five seconds. Then gently push the knee of the top leg away from you until a stretch is felt in your hip. Hold this position for five seconds, then slowly release. Repeat 10 times.
Those are some great stretches! I own a personal training studio in Severna Park, Maryland. Majority of my clients have physical limitations – so it’s important for them to stay flexible. I send these to my clients and even do these exercises for myself. I highly recommend these stretches to anyone, even people without physical limitations. I love the fact these are actually videos and not just stretches because it’s so much easier for people to figure out how to perform the stretches. You guys are the real MVP! 
Why is back pain still a huge problem? Maybe this: “It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.”
Tight hip flexors can also make it harder for your glutes to activate—since they're opposing muscle groups, when one is really tight the other becomes lengthened. When a muscle is more lengthened than it should be, it takes away some of its ability to contract. When your glutes are in this compromised position, it can cause other muscles to do more work than they should, making your workouts less efficient and sometimes, increasing your risk of injury.
Electrodiagnostics are procedures that, in the setting of low back pain, are primarily used to confirm whether a person has lumbar radiculopathy. The procedures include electromyography (EMG), nerve conduction studies (NCS), and evoked potential (EP) studies. EMG assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body. NCSs are often performed along with EMG to exclude conditions that can mimic radiculopathy. In NCSs, two sets of electrodes are placed on the skin over the muscles. The first set provides a mild shock to stimulate the nerve that runs to a particular muscle. The second set records the nerve’s electrical signals, and from this information nerve damage that slows conduction of the nerve signal can be detected. EP tests also involve two sets of electrodes—one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.
Deanna is an ACE® certified personal trainer, Balanced Body® Pilates instructor, and NASM® Fitness Nutrition Specialist. She is passionate about inspiring others to lead a healthier lifestyle through fun workouts and healthy food. When she’s not creating new workouts and recipes for her blog The Live Fit Girls she enjoys running with her two dogs and traveling.
