There are cases of low back pain that have alarming causes, but it’s rare. Once in a while back pain is a warning sign of cancer, autoimmune disease, infection, or a handful of other scary culprits.7 Over the age of 55, about one in twenty cases turns out to be a fracture, and one in a hundred is more ominous.8 The further you are from 55, the better your odds.
Premkumar et al present evidence that the traditional “red flags” for ominous causes of back pain can be quite misleading. The correlation between red flags and ominous diagnoses is poor, and prone to producing false negatives: that is, no red flags even when there is something more serious than unexplained pain going on. In a survey of almost 10,000 patients “the absence of red flag responses did not meaningfully decrease the likelihood of a red flag diagnosis.“ This is not even remotely a surprise to anyone who paid attention in back pain school, but it’s good to have some harder data on it.

The hip joint is designed to withstand a fair amount of wear and tear, but it’s not indestructible. For example, when you walk, a cushion of cartilage helps prevent friction as the hip bone moves in its socket. With age and use, this cartilage can wear down or become damaged, or the hip bone itself can be fractured during a fall. In fact, more than 300,000 adults over 65 are hospitalized for hip fractures each year, according to the Agency for Healthcare Research and Quality.


That’s a problem. “Elongated periods of sitting sends messages to certain muscles to stay turned on, which keeps other muscles turned off,” says Beachbody fitness expert Cody Braun. “This creates an imbalance, which can immobilize your hips.” Your hips are built to move in almost any direction, explains Braun, and when they’re stiff, they don’t just make exercise more difficult; they also make you more prone to pain in surrounding joints — including the oft-troublesome lower back.

Located deep in the front of the hip and connecting the leg, pelvis, and abdomen, the hip flexors— surprise, surprise— flex the hip. But despite being some of the most powerful muscles in our bodies (with a clearly important role), it’s easy to neglect our poor hip flexors— often without even knowing it. It turns out just working at a desk all day (guilty!) can really weaken hip flexors since they tend to shorten up while in a seated position. This tightness disrupts good posture and is a common cause of lower back pain. Weakened hip flexors can also increase the risk of foot, ankle, and knee injuries (especially among runners) Hip muscle weakness and overuse injuries in recreational runners. Niemuth, P.E., Johnson, R.J., Myers, M.J., et al. Rocky Mountain University of Health Professions, Provo, VT. Clinical Journal of Sport Medicine, 2005 Jan; 15 (1): 14-21.. So be sure to get up, stand up every hour or so! And giving the hip flexors some extra attention is not just about injury prevention. Adding power to workouts, working toward greater flexibility, and getting speedier while running is also, as they say, all in the hips The effect of walking speed on muscle function and mechanical energetics. Neptune, R.R., Sasaki, K., and Kautz, S.A. Department of Mechanical Engineering, The University of Texas, Austin, TX. Gait & Posture, 2008 Jul; 28 (1): 135-43..
“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!
Keep it a one joint stretch.  Many people want to jump right to performing a hip flexor stretch while flexing the knee.  This incorporates the rectus and the psoas, but I find far too many people can not appropriately perform this stretch.  They will compensate, usually by stretching their anterior capsule too much or hyperextending their lumbar spine.
Squats. Using a squat machine will strengthen your quadriceps muscles on the front of your thigh and the hamstring muscles on the back of your thigh, both of which attach to your hip and give it support. The squat machine may be vertical, in which case you’ll start in a standing position and bend your knees until your thighs are parallel to the floor, or it may be on a sliding incline board.
Physical activity can also help you feel better. “Along with boosting your overall health, exercise can improve your OA symptoms” like pain, stiffness, fatigue, and even depression, says Leigh F. Callahan, PhD, associate director of the University of North Carolina Thurston Arthritis Research Center. One study found that people with knee OA who worked out regularly lowered their pain by 12% compared to those who didn’t.
Even though it seems like your legs are moving forward and backward when you’re running, in reality, the femur (your thigh bone) both rotates and tilts in the hip socket, Kalika explains. It’s the hip adductors—most notably the gluteus medius—that keeps the femur sitting in the socket as designed. (The hip adductors are the muscles that move your legs inward.) Any weaknesses make the joint unstable, and can contribute to poor running mechanics, hip drop (when the pelvis drops to one side), too-narrow stances, and aggravated tissues throughout the entire body, Sauer says.
A basic bodyweight glute bridge is one of Lefkowith's favorites. Want to try it? Lie on the ground with your knees bent and your feet flat on the floor, and push your hips up toward the sky, squeezing your glutes at the top. This will not only help get your glutes in the game, but it also gives your hip flexors a chance to stretch out. (Try these five hip openers, too.)
Kneel with a wall or pillar behind you, knees hips-width apart and toes touching the wall. Arch your back to lean back while keeping your hips stacked over your knees. Take your arms overhead and touch your palms into the wall behind you. This bend does not need to be extremely deep to feel a great stretch in the hips and strength in the lower back.
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.”
Treatment for arthritis focuses on relieving symptoms and improving mobility. Your doctor may recommend anti-inflammatory medications and/or pain relievers. They might also prescribe disease-modifying antirheumatic drugs (DMARDs) — drugs meant to slow or stop your immune system from attacking your joints. Your doctor may also recommend physical therapy to strengthen your joints and increase your range of motion. For more severe cases, surgery may be required.
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.
The most common cause of sciatica is a herniated disk. Disks act like cushions between the vertebrae of your spine. These disks get weaker as you age and become more vulnerable to injury. Sometimes the gel-like center of a disk pushes through its outer lining and presses on the roots of the sciatic nerve. About 1 in 50 people will get a herniated disk at some point in life. Up to a quarter of them will have symptoms that last more than 6 weeks.

While you can’t choose where the weight comes off, you can eventually slim your hips so long as you stay consistent in your training. Cardiovascular exercise can help you lose some fat, but strength training serves a twofold purpose, burning fat while developing muscle for all-over tightening. “The more you build a muscle, the more [that part of the body] is going to firm up,” Braun says.


If you've been working out hard, playing football or other sports, or moving a lot of heavy furniture and are suddenly suffering with radiating lower back pain, chances are you have pulled muscles or strained muscles in the back. Often, strained muscles will cause a burning sensation in the lower back a feeling of having limited movement ability. Doctors prefer to limit prescribing of opiate pain medications and may give you an alternative medication with less risk of becoming dependent.
You can use over-the-counter remedies such as Motrin or Advil (ibuprofen) or Aleve (naproxen) to help with pain and swelling. Tylenol (acetaminophen) works for pain relief, but it doesn't treat inflammation and swelling. If you have heart disease, high blood pressure, kidney disease, or if you've had ulcers or internal bleeding, check with your doctor before taking any of these medications.
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