There are thousands of low back pain books — what’s special about this one? The problem is that 90% of doctors and therapists assume that back pain is structural, in spite of mountains of scientific evidence showing … exactly the opposite. Only a few medical experts understand this, and fewer still are writing for patients and therapists. Supported by 462 footnotes, this tutorial is the most credible and clarifying low back pain information you can find. Ships with a free copy of PainScience.com’s trigger point tutorial! Buy it now for $19.95 or read the first few sections for free!


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.
Why does it tighten down so much when overworking as a spinal stabilizer? Remember that length tension relationship we talked about? Well, if the psoas is tight, it can compress the spine easier, thus providing spinal stability. Plus, it has to work a lot to stabilize the spine. When you don’t have correct functioning of the diaphragm and abdominals, the psoas holds a great deal of tension to do the job. This tightness or tension makes it a very ineffective hip flexor.
With a roster of muscles ranging from the powerful glutes to the small and agile abductors, the hips control practically all your movements. Almost every endurance athlete overworks some hip muscles while underworking others, causing severe imbalances: Runners are infamous for having weak hip adductors—the muscles on the side of the hip that help you step laterally—while cyclists tend to have massive quads and tiny glutes.

Place a mini band around your ankles and spread your feet about shoulder-width apart. Keeping your legs relatively straight (you want the motion to come from your hips) and toes pointing forward, walk forward 10 steps, then backward 10 steps. Take a short break and then walk to the right 10 steps, then to the left 10 steps. Again, focus on keeping your legs straight and toes pointing forward.
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.
“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.
It’s a common issue, says Prevention advisor Rob Danoff, director of family and emergency medicine residency programs at Aria Health in Philadelphia. "For people who sit a long time at work, the hip flexors and rotators become tight, and the gluteal muscles become weak," he says. "This combination negatively affects our ability to walk, maintain proper posture, and the stability of our spine."
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.
These issues tend to be more rampant in women because they generally have wider pelvises than men, Ali Kotek, M.A., A.T.C., P.E.S., a performance enhancement specialist and fellow endurance program manager at Athletico, tells SELF. So to keep the thighs vertical, rather than angled in toward each other, the outer hips have to be even stronger. That’s especially true for women who are bounding from one foot to the other as they run down trails and treadmill belts.
3. Hug it out. Start the supine hip flexor stretch the same as the glute bridge, but keep the right leg relaxed on the floor. Pull shoulder blades down and back to lift hips. Grab the back thigh of the left leg and pull the knee toward the chest. Keep the right leg straight and push its heel into the floor (to feel it in the butt). Hold for 30-45 seconds and switch legs.
Although some of us are familiar with a pinched nerve, which is associated with sciatic-like pain in the leg, irritation or inflammation of nerves in the low back region can also cause a sensation in the upper leg or hip region. It is important to realize there are many things that can go wrong in the spine. Remember, sciatica is not a diagnosis but, instead, a symptom of an underlying problem. It is possible to feel back-related pain in the hip region and upper leg as well. It depends on the nerves involved and ultimately the actual diagnosis. Back pain or hip pain is not a diagnosis but simply an explanation of the area of pain. Symptoms are correlated with physical examination and confirmed through x-rays and similar tests.
Ankylosing spondylitis is a type of arthritis that specifically affects the spine. Ankylosing spondylitis causes a severe inflammation of the spinal vertebra that can cause debilitating pain throughout the back region. This condition can cause stiffness and pain not only in the spine but also inflammation, pain and stiffness in the ribs, shoulders, ribcage, hands, and feet as well. Symptoms include a dull pain in the lower back and buttocks, stiffness and lack of mobility in the hips, back, and legs, loss of appetite, fever, and general malaise. Treatment includes physical therapy, medication, hot and cold therapy, and exercises that reinforce good posture practices.
The sciatic nerve is the largest and longest nerve in the body. It arises from the spinal cord as a collection of fibers from the lower vertebrae. This nerve is responsible for the sensation of the skin of the foot and entire lower leg except for a small area on the inner side. It also supplies muscles in the anterior, lateral and posterior compartments of the leg.
At the very least, the tension and/or spasm in muscles that cross over the hip and attach onto the pelvis can contribute to imbalance, in terms of how strong and flexible each muscle group is in relation to the others. But muscle imbalance in the hips and the spine may make for pain, limitation and/or posture problems. It can also increase the healing challenge put to you by an existing injury or condition, for example, scoliosis.
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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