Low Back Pain is the most common condition I treat as a Physical Therapist. At least two or three patients with low back pain every single day in the clinic. Chances are, you have suffered from it before. My job is not only to help relieve the ongoing pain but also ensure they know how to self treat if the pain returns. Teaching prevention technique is a huge part of management of low back pain.
Excessive lumbar flexion is a widely recognized cause of low back pain. What is lumbar flexion? It means rounding your lower back. Let’s try a simple activity. Drop a piece of paper on the floor and pick it up from a standing position. What did you do? Did you bend down from your back, with knees straight? All you did is lumbar flexion. This lumbar flexion all day and everyday is the villain. We are in a flexed posture throughout the day- sitting at your desk, doing dishes, vacuuming. Most activities will make you flex your spine. This repetitive micro trauma is the culprit. You do not have to be lifting heavy objects to suffer from back pain. A simple movement of picking up a piece of paper from the floor can set off low back pain, unless you know the right technique to avoid lumbar flexion. So how do you avoid flexion and still pick up things and bend at the sink and do all your chores? By learning to maintain a neutral spine and hinging your hips. We are going to learn the ever so popular hip hinging techniques.
Simply instructing to keep your back straight and fold at your hips doesn’t work very well. Most people have developed poor movement patterns that need more than verbal instructions to fix. These improper movement patterns can be related to physical impairments like tightness in hamstring muscles, weakness in back extensor muscles. But strength and flexibility patterns are not the only factors. These movement patterns are also a result of habits that are learnt overtime. Strength and flexibility is definitely addressed when we treat low back pain. But addressing the offending movement is the key to success. And needs to be done as soon as one can tolerate it early in the rehab phase.
So what is Hip Hinging exactly? It is bending forwards from your hip with a slight bend in knees, while keeping your spine straight. Here’s how you do it.
If you are not used to this movement, it needs some practice. I will break it down in few different steps. This has helped a lot of my patients to understand the concept of Hip Hinging. I like to remind my patients that the goal is to make this pattern automatic. We want our bodies to default to this movement when needed. And that needs practice, lots and lots of repetitions. So, let’s break it down in few progressions.
- Hero Squats: This is a good starting point. It takes the knees out of the picture, forcing you to hinge at the hips.
- Butt Taps: Next, progress to a standing position. Butt taps are good to train you to unlock your hips. Have the wall as the target and reach back with your hips with a slight bend in your knees.
- Chair Folds: Once you get the concept of unlocking your hips, progress to chair folds. Use a Chair/bench in front of your knees to limit the forward shit of the knees. With a slight bend in the knees, think of folding the top half at the hips.
- 3 Point contact: Now that you have mastered unlocking your hips, work on keeping neutral spine. The best way to introduce this is 3 point contact hinge. Keeping the cane over back of your head, Midback and pelvis while going through the movement will ensure you have a neutral spine. Watch out for excessive arch in low back or rounding of your back low back.
These are some exercises that can help with good hip hinging mechanics. Good flexibility in hamstring muscle is another important factor here. Tight Hamstring muscles will force your lumbar spine in flexion. Going back to my Motto, “Stretch your muscles regularly”. You can find all you need about stretching in the post here.
Some other techniques to avoid lumbar flexion:
- Golfer’s lift: For this technique, one leg is allowed to lift off behind you that acts as a counterbalance that keeps the spine straight. The other hip flexes to fold your body down. One hand reaches down to lift the object while other hand is holding onto a stationary object like a countertop/chair
- Half kneeling:
Another good option is half knealing. Half knealing is great for reaching the front load washer, dryer, reaching under the sink cabinets. It fits the criteria of spine straight and flex at hips.
If you are suffering from low back pain, control and avoid lumbar flexion especially first couple hours after waking up in the morning. There is increased fluid content in the intervertebral discs after long duration of inactivity (overnight) which makes the spine vulnerable to flexion injuries. In simpler words, your spine is stiff in the morning and bending forwards can aggravate your back pain. Knowing how to maintain neutral spine and the correct hip hinging techniques can get you through your morning activities like bending to wash your face, brush your teeth or pulling your pants up pain free.
Not every situation will allow you to use proper body mechanics. But most of our everyday activities can be done safely using proper mechanics to avoid back injury. Practicing hip hinging does wonders. It’s all about making this a habit.
- Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann KB. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. A randomized controlled trial. Spine (Phila Pa 1976). 1998;23(23):2601-2607. doi:10.1097/00007632-199812010-00015