While the content and materials contained in the articles on this website have been written & researched by Sally Ann Quirke, a professional, practising & fully qualified Chartered Physiotherapist (Physical Therapist) based in Ireland, they are provided for general information and educational purposes only. They do not constitute medical advice on any particular individual situation. Please see your Chartered Physiotherapist or other medical practitioner for full and individual consultation.
Arthritis is a common cause of radiating lower back pain. Symptoms include back pain that fluctuates, coming and going throughout the day and night and numbness in the neck area, as well as stiffness and lack of mobility. Recommended treatment for arthritis of the back includes heat, ice, rest, exercising and stretches, and over the counter anti-inflammatories. In severe cases, patients seek surgery but sometimes, surgery does more harm than good.
Surgery: If nonsurgical treatments and joint injections do not provide pain relief, your physician may recommend minimally invasive SI joint fusion surgery. Through a small incision, the surgeon places titanium (metal) implants and bone graft material to stabilize the joint and promote bone growth. The surgery takes about an hour. The patient may go home the same day or following day. For several weeks after surgery, the patient cannot bear full weight on the operated side and must use crutches for support.
In this study, one patient with sciatica was sent for ten MRIs, which produced 49 distinct “findings,” 16 of them unique, none of which occurred in all ten reports. On average, each radiologist made about a dozen errors, seeing one or two things that weren’t there and missing about ten things that were. Yikes. Read a more detailed and informal description of this study.

But how can you tell? It can be tricky. This is a concise, readable guide to symptoms that need better-safe-than-sorry investigation with your doctor. (It’s basically just a plain English version of clinical guidelines for doctors.9) In other words, this article explains the difference between “dangerous” and “just painful” as clearly as possible. Tables, checklists, and examples ahead.
A thorough history and physical examination is a good start when sorting out symptoms. X-rays will attest to specific bony/cartilage changes but x-rays don't always correlate with the pain. It is possible to have little pain and much damage on the x-rays or visa versa. It is important to treat the patient, not the x-rays alone. Secondly, x-rays of the back can reveal degeneration of the discs or small joints in the spine but the person does well. Contrary, the back may look degenerative and because of the subsequent bone spurring and symptoms as arthritis progresses, it is important to obtain an MRI to confirm nerve impingements that are suspected. X-rays alone will not show nerve impingement. As you can see, it is important to undergo the history and physical examination and tests that can confirm your diagnosis before treatment begins.
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.
Wrapping a Thera-Band around your ankles before you perform Lateral Walks or Shuffles increases resistance, strengthening your hip abductors and gluteus medius. When you perform this exercise, you will quickly find out if you have weak hips. This is most beneficial for basketball players, who are required to be in a crouched defensive stance and shuffle when playing defense.
A thorough history and physical examination is a good start when sorting out symptoms. X-rays will attest to specific bony/cartilage changes but x-rays don't always correlate with the pain. It is possible to have little pain and much damage on the x-rays or visa versa. It is important to treat the patient, not the x-rays alone. Secondly, x-rays of the back can reveal degeneration of the discs or small joints in the spine but the person does well. Contrary, the back may look degenerative and because of the subsequent bone spurring and symptoms as arthritis progresses, it is important to obtain an MRI to confirm nerve impingements that are suspected. X-rays alone will not show nerve impingement. As you can see, it is important to undergo the history and physical examination and tests that can confirm your diagnosis before treatment begins.

The piriformis muscle connects the top of the femur to the spine, and it’s the main one that supports the outward movement of the hip, upper leg, and foot. The sciatic nerve can sometimes pass through this muscle and thus cause sciatica symptoms, otherwise known as piriformis syndrome, characterized by pain in the lower back and hips, poor movement, and balance. Therefore, the main cause of sciatica is the swelling or constriction of the piriformis muscle, but it can also be a result of some other factors as well.

But mobile hip joints don’t just relieve pain. They’re also essential for walking, hiking, running, jumping, dancing, playing sports, and pursuing virtually any fitness goal safely and effectively. Want to develop stronger, more muscular legs? Hip mobility allows you to lunge and squat more deeply so you can reach your muscles’ potential. Want to avoid injury? Hip mobility improves range of motion so you can perform exercises more safely.
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.
Symptoms may worsen with sitting, standing, sleeping, walking or climbing stairs. Often the SI joint is painful sitting or sleeping on the affected side. Some people have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements (going from sit to stand), standing on one leg or climbing stairs.
This standard recommendation reinforces the alarming idea that low back pain that lasts longer than a few weeks is Really Bad News. It’s not. It’s a clue. It’s a reason for concern and alertness. But many cases of low back pain that last for 6 weeks will still go away. Once again, see the 2009 research published in the British Medical Journal, which showed that more than 30% of patients with “new” chronic low back pain will still recover without treatment. BACK TO TEXT
How to do it: Stand up tall while holding onto a sturdy object like a chair, or rest your hands on a wall. Keeping your back straight and core tight, raise one leg up and lift it out to the side and away from your body, keeping your leg straight. Pause for one to two seconds, then return to the start position. That’s one rep. Repeat this movement, alternating sides each time.
The story of actor Andy Whitfield is a disturbing and educational example of a case that met these conditions — for sure the first two, and probably the third as well if we knew the details. Whitfield was the star of the hit TV show Spartacus (which is worthwhile, but rated very, very R17). The first sign of the cancer that killed him in 2011 was steadily worsening back pain. It’s always hard to diagnose a cancer that starts this way, but Whitfield was in the middle of intense physical training to look the part of history’s most famous gladiator. Back pain didn’t seem unusual at first, and some other symptoms may have been obscured. Weight loss could have even seemed like a training victory at first! It was many long months before he was diagnosed — not until the back pain was severe and constant. A scan finally revealed a large tumour pressing against his spine.
How to do it: Grip the barbell so you’re standing straight with the barbell at arm’s length in front of your thighs. Kick your left leg back so it’s just off the floor. Bend over so you’re hingeing at the hip while allowing only a slight bend in the right knee, and lower the barbell to the floor while keeping it close to your body. Pause at the bottom, then reverse the movement back up to the top. That’s one rep. Repeat this movement, alternating sides each time.
How to do it: Put a 20- to 36-inch box behind you. With your feet hip-width apart, lift your leg and place the instep of your rear foot on the bench. Lower your hips toward the floor so your rear knee comes close to the floor, keeping your back straight. As you descend, make sure you don’t bend the torso excessively forward and your front knee does not pass your front toes. Pause when your rear knee is close to the floor and your front quad is parallel with the floor, then drive through your front heel to return to the start position. Repeat this movement, alternating sides each time.
Some back pain is caused from a "ruptured disc". This pain is often experienced in the gluteal region of the body. Many people call this the "hip" region although it is not usually indicative of a hip joint problem. This is actually behind the hip, an important anatomic thought when considering hip pain, rather than in the hip itself. A condition related to degeneration of the lower back creating narrowing of the spinal canal or adjacent areas is called spinal stenosis and frequently causes pain in the hip region. The history of stenosis has to be compared with hip joint pain. Spinal stenosis can cause leg pain while walking as well as fatigue in the legs even when rising from a chair. Stenosis pain is relieved with sitting and will re-occur when walking is resumed.
Piriformis syndrome is not considered a serious injury—so RICE is in order for pain caused by triggers, like sitting too long. RICE is Rest, Ice, Compression, and Elevation. Also, see a primary care doctor or neurologist (nerve specialist), who can recommend physical therapy exercises and exercises for hip pain and other specific types of pain that will help you feel better. Also, a physican therapist can suggest ways exercises that provide pinched nerve relief, as nerve pain relief is what is primarily needed here.

The hips are the fulcrum point for all lower-body movements. Weak hips can cause an antalgic gait, leading to knee, foot and ankle problems that can keep you off the field and out of the game. Although building your legs with compound exercises like Squats and Lunges is important, you need to set some time aside to focus on your hip muscles by performing hip-specific strengthening exercises. Incorporate these hip-strengthening exercises into your routine to make sure your hips stay strong and injury free.
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.
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.
I use this for people that really present in an anterior pelvic tilt, or with people that appear to have too loose of an anterior hip capsule.  In fact, this has completely replaced the common variations of hip flexor stretches in all of our programs at Champion.  This works great for people with low back pain, hip pain, and postural and biomechanical issues related to too much of an anterior pelvic tilt.
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.
Ischiofemoral Impingement is a common but widely unrecognized cause of hip and back pain. It is caused by a narrowing of the space between the pelvic bone and femur bone, which pinches soft tissues between these boney protrusions. Symptoms of ischiofemoral impingement include front hip pain or feeling of stretched muscles in the hip or hip tendonitis, pain in the hip socket, hip pain at night lying on side, and a feeling as if there is a hip out of place. Treatment for ischiofemoral impingement includes rest, anti-inflammatory drugs, NSAIDs, such as ibuprofen, and physical therapy aimed at strengthening the gluteal muscles so the patient can better control the pelvis.

There is controversy and scientific uncertainty about trigger points. It’s undeniable that mammals suffer from sensitive spots in our soft tissues … but their nature remains unclear, and the “tiny cramp” theory could be wrong. The tiny cramp theory is formally known as the “expanded integrated hypothesis,” and it has been prominently criticized by Quintner et al (and not many others). However, it’s the mostly widely accepted explanation for now. BACK TO TEXT
While the content and materials contained in the articles on this website have been written & researched by Sally Ann Quirke, a professional, practising & fully qualified Chartered Physiotherapist (Physical Therapist) based in Ireland, they are provided for general information and educational purposes only. They do not constitute medical advice on any particular individual situation. Please see your Chartered Physiotherapist or other medical practitioner for full and individual consultation.
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.
Meanwhile, it’s extremely common for non-life-threatening low back pain to be alarmingly severe and persistent — to have a loud bark! Your doctor may not appreciate how true this is, and may over-react to all persistent low back pain, even without other red flags. In most cases, you shouldn’t let them scare you. Being “freaked out” about persistent back pain is the real threat: it can make low back pain much worse, and much more likely to last even longer (a tragic irony).

Correct posture and a protected spine requires strong muscles, and strong muscles require exercise. Rather than sit around waiting for lower back pain to fix itself, keeping active and exercising regularly can actually help it recover and stay in shape much more quickly. Not only that, regular exercise will help you lose weight which, in turn, will take pressure off your legs, hips, and back.
I had compromised range of motion in my hips. I am a runner and I couldn’t increase my speed. Using this program – http://certifiedtreatment.com/hipflexors I adjusted my back and relieved the pain the tightness in my hips and lower back which allowed me to run harder and longer. Not only do I have less pain on a daily basis, but I also have more energy and stamina when I run. I find myself with better movement and sleep, and I have maximized my performance.
If you have a stiff, tight or painful hip then http://www.HipFlexors.info will unlock your hip flexors and restore movement the way it should be. Unlocking your hip flexors instantly breathes new life, energy, and strength into your body! I experienced immediate results. I’ve been able to loosen up my hips, decrease back tightness, and even workout harder. With so many people suffering with hip pain out there, this program is a great tool for anybody that wants to reduce pain while improving strength, performance, and overall health. Hip flexibility, mobility and strength is one of the most important things you can do to keep your overall body healthy. The video presentation and visuals in the exercise program give me confidence that I am doing the exercises correctly which for me is key with no personal trainer. The website is very complete in listing the possible causes of tight hip flexors and other factors that can lead to the issue. It has detailed, descriptive information regarding the anatomy of the hip, causes of such injuries, and a very progressive and well explained exercise and stretching schedule that will assist to re-balance the hip and pelvic region, safely stretch and strengthen the muscle group. Best of luck to you! :)
The hip is a very stable ball and socket type joint with an inherently large range of motion. The hip contains some of the largest muscle in the body as well as some of the smallest. Most people lack mobility due to a relatively sedentary lifestyle. Periods of prolonged sitting results in tightness of the hip flexors and hamstrings. Tightness in the muscles and ligaments can created joint forces that result in arthritis, postural problems, bursitis, and mechanical back pain.
Enthoven WT, Geuze J, Scheele J, et al. Prevalence and "Red Flags" Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice. Phys Ther. 2016 Mar;96(3):305–12. PubMed #26183589. How many cases of back pain in older adults have a serious underlying cause? Only about 6% … but 5% of those are fractures (which are serious, but they aren’t cancer either). The 1% is divided amongst all other serious causes. In this study of 669 patients, a vertebral fracture was found in 33 of them, and the chances of this diagnosis was higher in older patients with more intense pain in the upper back, and (duh) trauma. BACK TO TEXT
This pose is one of the most comfy ones for the lower back and hips. It will also stretch your neck, shoulders, and chest. Lie on your back and hug your knees into your chest. Breathe in deeply, and then exhale completely, lowering both legs to the floor on your left (keep your knees higher than your hips). Position your arms out to your sides, or place your left forearm on your right thigh (as pictured) to encourage a deep stretch, relaxing both shoulders to the floor. Shift your gaze over your right shoulder. Close your eyes, take 10 deep breaths, and then release. Repeat to your other side.
Putting the exercise in writing do not help me, I need to watch them doing them so, I can figer out how to do them, or if I should even try to do them. I use the flex extendors, lifting my legs one at a time from the flor to strengthen my thys, hip and buttox. And I try to remember to do the bridge excerise. I have had 2 total hip replacements , 7 months a part, in 2013. Trying to get stronger with cold weather will be 70 in Feb. Linda
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.	

A thorough history and physical examination is a good start when sorting out symptoms. X-rays will attest to specific bony/cartilage changes but x-rays don't always correlate with the pain. It is possible to have little pain and much damage on the x-rays or visa versa. It is important to treat the patient, not the x-rays alone. Secondly, x-rays of the back can reveal degeneration of the discs or small joints in the spine but the person does well. Contrary, the back may look degenerative and because of the subsequent bone spurring and symptoms as arthritis progresses, it is important to obtain an MRI to confirm nerve impingements that are suspected. X-rays alone will not show nerve impingement. As you can see, it is important to undergo the history and physical examination and tests that can confirm your diagnosis before treatment begins.

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.
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