Today’s guest post comes from Dr. Sarah Duvall, a physical therapist who specializes in women’s health and pelvic function, and who also loves to lift stuff off the floor while helping others do the same. She also has an awesome new course on Postpartum Corrective Exercise for fitness professionals which closes on January 22nd, so definitely check it out.

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.


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People understandably assume that the worst back pain is the scariest. In fact, pain intensity is a poor indicator of back pain ominousness,10 and some of the worst causes are actually the least painful (especially in the early stages). For instance, someone could experience the symptoms of cauda equinae syndrome, and be in real danger of a serious and permanent injury to their spine, but have surprisingly little pain — even none at all in some cases!
Sciatica refers to back pain caused by a problem with the sciatic nerve. This is a large nerve that runs from the lower back down the back of each leg. When something injures or puts pressure on the sciatic nerve, it can cause pain in the lower back that spreads to the hip, buttocks, and leg. Up to 90% of people recover from sciatica without surgery.
Piriformis syndrome is a type of neurological injury that is caused by compression of the sciatic nerve. The piriformis muscle sits deep within the buttock, behind the gluteus maximus. It starts at the lower spine and connects to the femur muscle. This nerve can become compressed from swelling of the piriformis muscle due to injury or muscle spasms or inflammation. Piriformis syndrome causes symptoms including pain in the back of the thigh, pain in the back of knee, buttock pain, pain in the calf, pain in sciatic nerve branches (pain in the nerves of leg and the buttocks, then), shooting pain in the legs, and hip pain after sitting.
The problem is that these muscles aren't designed to be prime movers—they're designed to support the action of the glutes. Inability of activating the glutes can result in low back pain (low back muscles compensating), hamstring strains (overacting hamstrings), hip pain (resulting from hamstring-dominant hip extension) and knee pain (poor glute medius strength).
I’m just going to briefly touch on this because this will look different for each person. But know that if your hip flexors are or always feel tight, there is a reason. Muscles don’t get tight with no cause, and it’s usually because they are compensating for a weakness elsewhere or are constantly in a shortened position (as is the case with sitting).
• Osteoporosis. Osteoporosis is a condition in which the bones loose so much mass that they become brittle and prone to break with slight trauma. The condition, which can occur with aging, inactivity, a low-calcium diet or use of corticosteroid medications, commonly affects the spine. When this occurs in the spine, the inner spongy bone and more solid outer portion of the vertebrae become porous. The weakened vertebrae can break – an injury called a compression fracture – and lose about one-half of their height. In most cases, compression fractures, are painful. In some cases, the resulting back pain is severe. Usually, the pain resolves within a few weeks, but for some people, it is long-lasting.
How to: Start feet hip-width apart, with your arms straight out in front of you. Step one foot back on a diagonal, feet flat. Once your foot reaches the floor, lower into a shallow lunge. Keep your knee bent and butt back, twist your pelvis, and rotate your arms back behind your body until they frame the knee. Return to starting position. That's one rep. Do eight reps on each side. Do three to four sets before moving on to the next move, resting for 30 seconds in between each set.

Of course, you know what it feels like to have a tight muscle. But tight hips aren't just uncomfortable—they can lead to all sorts of other aches and pains, especially in the lower back. "People focus on the hips and say their hips are tight, but we don't always think about the fact that the lower back connects to our legs at the hip," Charlee Atkins, C.S.C.S., instructor at Soul Annex in New York City and creator of Le Stretch class, tells SELF. Tight hip flexors make it harder for your pelvis to rotate properly, which can cause your lower back to overcompensate, "and this can be a setup for lower-back injury," Teo Mendez, M.D., an orthopedic surgeon at NY Orthopedics who focuses on operative and non-operative management of sports-related injuries, musculoskeletal injuries, and arthritis, tells SELF.
To do this stretch, sit on the floor with your legs about three or four feet apart, depending on how tall you are. Make sure your toes and knees are pointed straight up. Next, take a deep breath, and on the exhale, slowly fold your upper body forward. Rest your hands on your feet, legs, or the floor in front of you and hold this stretch for five deep breaths.
In cases of strains, tears, and other injuries, strapping or taping your lower back will provide the extra support it needs. Alternatively, for extra support, try the Elastoplast back brace. This will not only promote the natural shape of your lower back during exercise or daily life, but also limit any extra strain placed on your back. For tips on how to apply strapping and tape effectively, see our section on tape and strapping preparation.
Acute back pain is often the result of muscle sprains or strains. Sprains occur when your ligaments are overstretched and sometimes torn. Strains, on the other hand, are caused by stretching — and possible tearing — of your tendons or muscles. Though the immediate reaction is pain in your back, you may also experience dull aches or discomfort in your hip.

Start kneeling on your mat with knees hip-width apart and hips directly over knees. Press your shins and the tops of your feet into the mat. Bring your hands to your low back, fingers pointing down, and rest palms above glutes. Inhale and lift your chest, and then slowly start to lean your torso back. From here, bring your right hand to rest on your right heel and then your left hand to your left heel. (If you can't reach your heels, turn your toes under; it will be easier to reach your heels in this modification.) Press your thighs forward so they are perpendicular to the floor. Keep your head in a relatively neutral position or, if it doesn't strain your neck, drop it back. Hold for 30 seconds. To come out of the pose, bring your hands to your hips and slowly, leading with your chest, lift your torso as you press the thighs down toward the floor.

I’ve got zero flex in the hips and the tightest groin muscles anyone could ever have. In saying that I’m one of the most physically active person you’ll ever meet. Because of my tightness I’ve suffered a double hernia, severe sciatic nerve pain that stretches from my lower lumber through my glues down to my ankles. Thanks to your efforts in all of the above videos and through much of the “no pain no gain” stretches, I’m on the mend by Gods grace. We can all make excuses for the physical break down in our bodies but truly doing something about it without relying on medicating pain killers is the go. I believe IMO it all starts with stretching. All you guys in the above videos are legends.
Both types of problems are frequently helped by anti-inflammatory medications particularly in mild to moderate situations. Some types of analgesics can be used intermittently as well. It's important to realize that both problems can be helped significantly by weight loss, proper forms of exercise and conditioning. In fact, back pain can become chronic without a commitment to the appropriate exercises necessary to stabilize and strengthen the spine. Epidural blocks (corticosteroids are injected into the canal of the low back to reduce inflammation and pain) can help several types of back disorders. Using a cane when walking can help both hip and back pain.
To start, get into a lunge position with your right knee up and your left knee on the floor. Rest your hands on the ground, directly underneath your shoulders. Next, flex your raised right knee outward, so that you’re resting on the outside of your right foot. Press your chest forward to increase the stretch. Hold this pose for 10 seconds, then repeat on the other side of your body.
The same lack of correct breathing also perpetuates a diastasis. Without proper deep breathing, you can compensate a couple ways. The first is to draw in your belly button and go into a shallow breathing pattern and the second is to have belly only expansion. Both of these can hinder diastasis healing. The cool thing is that I’ve actually had women experience spontaneous firming of their diastasis when we get down a correct breathing pattern. It’s a phenomena that always amazes me. The same thing can happen with decreasing prolapse symptoms.
The condition is cauda equina syndrome. It involves “acute loss of function of the neurologic elements (nerve roots) of the spinal canal below the termination (conus) of the spinal cord,” where the nerves spread out like a horse (equina) tail. Again, this condition causes symptoms in the “saddle” of the body: butt, groin, inner thighs. BACK TO TEXT
Why so different? If you pay in United States dollars (USD), your credit card will convert the USD price to your card’s native currency, but the card companies often charge too much for conversion, well above the going exchange rate — it’s a way for them to make a little extra money. So I just offer my customers prices converted at slightly better than the current rate.

The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt.  However, this seems to be one of those stretches that I see a lot of people either performing incorrectly or too aggressively.  I talked about this in a recent Inner Circle webinar on 5 common stretches we probably shouldn’t be using, but I wanted to expand on the hip flexor stretch as I feel this is pretty important.
For example, one workout you may want to do lateral lunges with mini-band ankle walks. Another workout you may choose rotational step-ups with the 4-way cable hip exercise. The activation, mobility, and flexibility exercises can be done more frequently and not necessarily as part of a stand-alone workout. There's no one-right way to incorporate these exercises, so don't be afraid to experiment.
Hip flexor strains and injuries are often caused by “over doing it” (such as exercising) or periods of prolonged sitting combined with weak hip muscles. While hip flexor strains are typically not serious, they can be quite painful and severely limit your activity and mobility. Airrosti rapidly resolves most hip flexor injuries in as few as 3 visits — without the need for injections, medications, or long periods of rest.
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