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.”
It’s well established that about eight in 10 people in the U.S. will experience back pain at some point in their lives. And while the causes of such pain often vary, say physical therapists and other medical professionals say that increasingly, in a world that accommodates a more sedentary lifestyle, the blame for low-back pain can often be traced to an area a little lower in the kinetic chain: the hips.
“As a result, they’re at greater risk of injury,” says physical therapist Ioonna Félix, clinical supervisor at the Hospital for Special Surgery’s Sports Rehabilitation and Performance Center in New York City. Many times, those injuries manifest themselves in ways that seem entirely separate from your hips, like IT band issues, low-back pain, or plantar fasciitis.
Although cauda equine syndrome is a rare condition—it is one that can cause permanent loss of movement in the lower body (paralysis) and permanent incontinence if not caught quickly. Cauda equine affects the leg nerves in such as way as to cause feeling of loss of control of the muscles in the leg. Cauda equina syndrome (Latin for Horses' Tail syndrome) is a condition caused by compression of the nerves at the base of the spine in the lumbosacral region of the spinal cord.
The sacroiliac joint connects the lower spine to the pelvis and any injury or strain to this area can cause a lot of back, hip, groin, and sciatic pain. Sacroiliac joint dysfunction (SJD) can cause not only radiating lower back pain but can also severe pain in the hip area including hip pain at night when sleeping and hip pain when sitting. Often the pain resembles that of a hip injury it is so severe. SJD can also cause severe pain in the groin area. Women may also notice pain running along the distribution of the sciatic nerve. Treatment for sacroiliac joint dysfunction includes rest, anti-inflammatory drugs, and sciatic nerve massage.
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.
Before discussing different strength and mobility exercises, we should first look at activation exercises for your Gluteus Maximus (referred to as the glutes) muscles. The reason for needing to activate your glutes is simple—as a population, we spend way too much time sitting, and as a result, what happens is what noted spinal researcher Stuart McGill terms gluteal amnesia—your glute muscles can "go to sleep" and not function properly.
Apply the above concept to your hips. When you sit, your hips are in a "flexed" position. Therefore, the muscles that flex your hips are in a shortened state. You probably spend at least a third of your day sitting down. Think about how much time those hip flexor muscles stay shortened. A lot. Over time, they become tighter and tighter until you look like the old man in the picture. So unless you want to look like that, perform the stretches shown below.
Mobility and exercise (e.g., walking, running, stretching, etc.) help to more evenly distribute the forces of impact and weight through this ball-and-socket joint. As people age or find themselves living a more sedentary lifestyle from (e.g., sitting a lot at work), the wear and tear of the hip joint is less distributed, taking place in a smaller area within the socket.
The good news: You’re not powerless against hip problems. The right exercise routine can go a long way in helping you prevent falls, maintain mobility, and manage pain. Here are the best exercises for bad hips and the exercises you should limit or avoid. Of course, if you’re being treated for a serious injury, ask your doctor when you can resume exercise and which exercises are safest for you.

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.
Hi John, Thank you for the video and instructions. My question to you is that I’m schedule to have a reconstructive hip repair (Laberal tear) in July for my right hip and (second) and told that I have a tear in the right as well. I’ve been suffering from back pain too and know its because of the hips and my sitting because of work. If I can tolerate the exercise, would your recommend to do them? And if so, should I take it down from your suggested reps? I’ve been doing DDP Yoga for the last week and besides general soreness and some discomfort in my right hip, i’ve been able to make it through a full workout as well as do the core exercises. Your response would be greatly appreciated.
Approximately 15 degrees of hip extension is required to walk normally. If hip flexors are tight then in order to walk, compensatory movement needs to take place through the lower back causing back pain and premature disc degeneration. Like other joints, if we fail to take them through their full range on a regular basis we eventually lose mobility.
Strong ligaments and muscles support the SI joints. There is a very small amount of motion in the joint for normal body flexibility. As we age our bones become arthritic and ligaments stiffen. When the cartilage wears down, the bones may rub together causing pain (Fig. 1). The SI joint is a synovial joint filled with fluid. This type of joint has free nerve endings that can cause chronic pain if the joint degenerates or does not move properly.
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.
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.
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