Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Too much sitting is the enemy of stiff or achy hips, says Lisa Woods, a personal trainer and yoga teacher in Eagle, Colorado. The big problem, though, isn’t just the discomfort in the sides of your thighs. It’s the chain of pain that dysfunctional hips can create, including sciatic nerve pain that can start in your lower back and go down the backs of your legs. 
From a physical therapist’s perspective, these are excellent exercises for lower back pain (LBP) resulting from muscular tightness or stiff joints. However, LBP can also be caused by bulging (or “herniated”) discs, pinched nerves, and the like. If your LBP worsens (or radiates into your leg) upon attempting these or any other low back exercises, you should seek medical attention. Physical therapists are musculoskeletal experts that are able to properly evaluate and treat your back pain symptoms. And, according to a recently passed law in the state of Michigan, a physician referral is no longer necessary to seek treatment from a physical therapist. So, if you are experiencing LBP that is not improving…#getPT!
Discectomy (the partial removal of a disc that is causing leg pain) can provide pain relief sooner than nonsurgical treatments.[14] Discectomy has better outcomes at one year but not at four to ten years.[14] The less invasive microdiscectomy has not been shown to result in a different outcome than regular discectomy.[14] For most other conditions, there is not enough evidence to provide recommendations for surgical options.[14] The long-term effect surgery has on degenerative disc disease is not clear.[14] Less invasive surgical options have improved recovery times, but evidence regarding effectiveness is insufficient.[14]
As the structure of the back is complex and the reporting of pain is subjective and affected by social factors, the diagnosis of low back pain is not straightforward.[5] While most low back pain is caused by muscle and joint problems, this cause must be separated from neurological problems, spinal tumors, fracture of the spine, and infections, among others.[3][1]
The hip rotators not only rotate the thigh on the pelvis but more functionally rotate the pelvis on the weight bearing fixed thigh. Activities such as swing a golf club, and even just walking require some rotation of the pelvis on the weight bearing leg. While we don't need that much range of motion to walk, activities such as running, dancing, tennis, and many other sports can require more hip rotation.
In addition to strengthening the core muscles, it's also important to address any mobility problems, says Jacque Crockford, M.S., C.S.C.S., exercise physiology content manager at American Council on Exercise, which can sometimes be what's causing pain. If specific movements like twisting or bending or extending your spine feel uncomfortable, there may be mobility (flexibility) issues at play. Doing some gentle stretching (like these yoga poses) might help. (If it gets worse with those stretches, stop and see a doctor.)
Simply stand up straight with your feet about shoulder-width apart. Slowly bend your knees and hips, lowering yourself until your knees obscure your toes or you achieve a 90 degree angle. Hold for a count of 5 and then gently resume your original position. This can be a tough one so again, don’t overdo it and hold on to a table if you need a little extra support! Try to repeat between 5-10 times.
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]
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.
Meanwhile, many non-dangerous problems can cause amazingly severe back pain. A muscle cramp is a good analogy — just think about how painful a Charley horse is! Regardless of what’s actually going on in there, muscle pain is probably the main thing that back pain patients are feeling. The phenomenon of trigger points — tiny muscle cramps, basically11 — could be the entire problem, or a complication that’s more painful and persistent than the original problem. It’s hard to overstate how painful trigger points can be, but they are not dangerous to anything but your comfort.
Neglect your lower body too often and you risk losing mobility — that thing that allows you to plop down on the floor to play with your kids, or get up and out of even the cushiest chair with ease. “A lot of people sit all day, so they’re not necessarily using their glute muscles,” says Daily Burn Fitness/Nutrition Coach Allie Whitesides. “And a lot of people are in the car all the time, so we’re not using our leg muscles much, either.”
If you have hip pain, you may benefit from the skilled services of a physical therapist to help determine the cause of your pain. Your PT can work with you to develop a treatment strategy to treat your hip pain or hip discomfort. Understanding why your hip is hurting can help your physical therapist and doctor prescribe the right treatment regimen for your specific condition.
Discectomy (the partial removal of a disc that is causing leg pain) can provide pain relief sooner than nonsurgical treatments.[14] Discectomy has better outcomes at one year but not at four to ten years.[14] The less invasive microdiscectomy has not been shown to result in a different outcome than regular discectomy.[14] For most other conditions, there is not enough evidence to provide recommendations for surgical options.[14] The long-term effect surgery has on degenerative disc disease is not clear.[14] Less invasive surgical options have improved recovery times, but evidence regarding effectiveness is insufficient.[14]
Muscle Imbalances – The front of your hips, your hip flexors, are the muscles that will tighten and shorten while you are sitting for hours each day. While you are sitting, the back of your hips, your glutes and your hip extensors, are being overstretched. But just because they are being tightened and stretched respectively, doesn’t benefit either of them. They are also being weakened because of the lack of use of each muscle group.
Initial management with non–medication based treatments is recommended.[6] NSAIDs are recommended if these are not sufficiently effective.[6] Normal activity should be continued as much as the pain allows.[2] Medications are recommended for the duration that they are helpful.[13] A number of other options are available for those who do not improve with usual treatment. Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects.[4][13] Surgery may be beneficial for those with disc-related chronic pain and disability or spinal stenosis.[14][15] No clear benefit has been found for other cases of non-specific low back pain.[14] Low back pain often affects mood, which may be improved by counseling or antidepressants.[13][16] Additionally, there are many alternative medicine therapies, including the Alexander technique and herbal remedies, but there is not enough evidence to recommend them confidently.[17] The evidence for chiropractic care[18] and spinal manipulation is mixed.[17][19][20][21]
Hip bursitis — an inflammation between your thighbone and nearby tendons — is commonly diagnosed when patients have pain on the outer side of the hip. However, several other conditions can cause similar pain, and require different treatments. "Doctors often assume that pain on the outer side of the hip is due to bursitis. But 90% of the time, it's not bursitis," says Dr. Lauren Elson, a physiatrist with Harvard-affiliated Massachusetts General Hospital.
Increasing general physical activity has been recommended, but no clear relationship to pain or disability has been found when used for the treatment of an acute episode of pain.[48][54] For acute pain, low- to moderate-quality evidence supports walking.[55] Treatment according to McKenzie method is somewhat effective for recurrent acute low back pain, but its benefit in the short term does not appear significant.[1] There is tentative evidence to support the use of heat therapy for acute and sub-chronic low back pain[56] but little evidence for the use of either heat or cold therapy in chronic pain.[57] Weak evidence suggests that back belts might decrease the number of missed workdays, but there is nothing to suggest that they will help with the pain.[50] Ultrasound and shock wave therapies do not appear effective and therefore are not recommended.[58][59] Lumbar traction lacks effectiveness as an intervention for radicular low back pain.[60]
However, even the things you do every day — like sitting in front of a computer or at a desk for hours — can both weaken and shorten (tighten) your hip flexors, making them more prone to injury. Because of this, exercises (such as squats) and targeted stretches which focus on strengthening the hip muscles and improving hip mobility are key to preventing injuries.
A healthy diet is important for a number of reasons when you have lower back pain. First, eating well can help you maintain a healthy weight. Excess weight puts extra strain on your lower back, adding to your pain. Second, a diet that’s high in key nutrients can help promote bone growth and keep your bones strong. These must-have nutrients include:
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
Or anything else. Pain is a poor indicator, period! The human nervous system is really terrible about this: it routinely produces false alarms, and alarms that are much too loud. See Pain is Weird: Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it. BACK TO TEXT
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Really great content. I also had some lower back problem but now that I know the source, I will work on it. My counsins also talked to me about this product called Panifix, or "Unlock your hip flexor" which Gives You A Practical, Easy-to-follow Program You Can Use To Instantly Release Your Hip Flexors For More Strength, Better Health And All Day Energy. Proven Swipes And Creatives Here:https://tinyurl.com/yd6nbzfh
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!
The multifidus muscles run up and down along the back of the spine, and are important for keeping the spine straight and stable during many common movements such as sitting, walking and lifting.[12] A problem with these muscles is often found in someone with chronic low back pain, because the back pain causes the person to use the back muscles improperly in trying to avoid the pain.[31] The problem with the multifidus muscles continues even after the pain goes away, and is probably an important reason why the pain comes back.[31] Teaching people with chronic low back pain how to use these muscles is recommended as part of a recovery program.[31]
Approximately 9–12% of people (632 million) have LBP at any given point in time, and nearly 25% report having it at some point over any one-month period.[7][8] About 40% of people have LBP at some point in their lives,[7] with estimates as high as 80% among people in the developed world.[22] Difficulty most often begins between 20 and 40 years of age.[1] Men and women are equally affected.[4] Low back pain is more common among people aged between 40 and 80 years, with the overall number of individuals affected expected to increase as the population ages.[7]
Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]
There are many causes of hip joint pain. Some hip pain is temporary, while other hip pain can be long-standing or chronic. Causes of hip pain include arthritis, inflammatory and noninflammatory arthritis, fracture, sprain, infectious arthritis (septic arthritis), avascular necrosis, Gaucher's disease, sciatica, muscle strain, iliotibial band syndrome (IT band syndrome), and hematoma.
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.
Lay on your back on your mat and pull your knees to your chest. Place your hands on the inside arches of your feet and open your knees wider than shoulder-width apart. Keeping your back pressed into the mat as much as possible, press your feet into hands while pulling down on feet, creating resistance. Breathe deeply and hold for at least 30 seconds.
Moist heat may help relax your muscles. Put moist heat on the sore area for 10 to 15 minutes at a time before you do warm-up and stretching exercises. Moist heat includes heat patches or moist heating pads that you can buy at most drugstores, a wet washcloth or towel that has been heated in a microwave or the dryer, or a hot shower. Don’t use heat if you have swelling.
“Red flags” are signs or symptoms that something medically ominous may be going on. Red flags are not reliable, and their presence is not a diagnosis. When you have some red flags, it only indicates a need to look more closely. Sometimes red flags are missing there really is something serious going on … and sometimes they are a false alarm.18 Check off all that apply … hopefully none or few or only the least alarming of them!
Nucleoplasty, also called plasma disc decompression (PDD), is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves. Several channels may be made depending on how tissue needs to be removed to decompress the disc and nerve root.
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.
Emerging technologies such as X-rays gave physicians new diagnostic tools, revealing the intervertebral disc as a source for back pain in some cases. In 1938, orthopedic surgeon Joseph S. Barr reported on cases of disc-related sciatica improved or cured with back surgery.[100] As a result of this work, in the 1940s, the vertebral disc model of low back pain took over,[99] dominating the literature through the 1980s, aiding further by the rise of new imaging technologies such as CT and MRI.[100] The discussion subsided as research showed disc problems to be a relatively uncommon cause of the pain. Since then, physicians have come to realize that it is unlikely that a specific cause for low back pain can be identified in many cases and question the need to find one at all as most of the time symptoms resolve within 6 to 12 weeks regardless of treatment.[99]
The hip rotators not only rotate the thigh on the pelvis but more functionally rotate the pelvis on the weight bearing fixed thigh. Activities such as swing a golf club, and even just walking require some rotation of the pelvis on the weight bearing leg. While we don't need that much range of motion to walk, activities such as running, dancing, tennis, and many other sports can require more hip rotation.
Hip labral tear. This is a rip in the ring of cartilage (called the labrum) that follows the outside rim of the socket of your hip joint. Along with cushioning your hip joint, your labrum acts like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket. Athletes and people who perform repetitive twisting movements are at higher risk of developing this problem.
How to: Lie on your back with your right knee bent and foot flat on the floor (a). Extend your left leg up to the ceiling and wrap a strap around the sole of your left foot (b). While holding both ends with your left hand, extend your right arm directly out to the side in order to anchor yourself (c). Slowly let the left leg fall toward the left while keeping your right side grounded. Hold for six to eight breaths, then repeat on the opposite side.
If surgery is recommended, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If there are several nerve roots and discs causing the pain or if there is degeneration and instability in the spinal column, the neurosurgeon may opt to fuse the vertebrae together with bone grafts and stabilize the vertebrae with instrumentation, including metal plates, screws, rods and cages. A successful fusion will prevent the disc from bulging or herniating again. Following a fusion procedure, a patient may gain restored mobility in the back, including the ability to bend over. He or she will most likely experience more mobility after surgery than before. In addition, the patient may require postoperative physical therapy.
In terms of diagnosing hip pain, typically a patient will expect when they come in to be asked about their symptoms, and it’s very important to find out when did these symptoms start, how long they have been going on, how frequent they are, if they come on in the morning or the evening, do they come on with any certain activity, and if there is something that makes it better or worse. The intensity of the pain is also important. Does it have any associated radiating symptoms? Is it localized in one spot or does it move? After getting a history and finding out what type of pain the patient is having, which also includes whether the pain is dull, aching, sharp, or intense, then it’s important to do a good physical exam. The physical examination involves testing the muscle strength, testing for sensation, doing provocative maneuvers which might help us rule out one type of injury from another.
A pinched nerve causes pain, numbness, or tingling in the affected area due to pressure on a nerve. Caral tunnel and sciatica are two examples of conditions caused by a pinched nerve. A pinched nerve is diagnosed by taking a patient history and performing a physical examination. Electromyography may be performed. Treatment for a pinched nerve depends on the underlying cause.
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.
Congenital bone conditions: Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.
