Most of my regular clients will know how much emphasis I place on developing strong glutes. I mean, who doesn’t want a nice, strong booty right? But in terms of function, the Gluteus Maximus (glute for short) is the strongest muscle in the body. If it becomes inhibited (or goes to sleep) then smaller muscles have to take on the load, which gives rise to faulty movement patterns, also known as compensations. Now this isn’t weakness, and I’m very careful when telling a CrossFit athlete they are “weak” – a better way to explain this concept is that the glutes aren’t firing as they should, because a fellow muscle is overworking/taking its place.

Let’s now look at muscle inhibition. What does it actually mean when a muscle is inhibited? Think of it as down regulation. The Motor Control centre in the brain has decreased its input to a muscle (backed off). The muscle still works but it’s not as efficient – therefore it appears weak! The body craves balance so it finds another muscle in the movement pattern to do more. The other muscle now becomes up regulated or facilitated (jacked up).

When this relationship takes full flight, the body throws out some signals that something is up. The most common warning sign is pain, but signals can also manifest as decreased ROM, stiffness, clicking, pins and needles, or numbness. The problem with these warning signals is that we learn to cope with these as life gets in the way, which can further add to our woes.

Lets now take a look at just how important the glutes are to overall body function. This isn’t just limited to the hips!

The glutes…

  • Extend the hip
  • Laterally rotate the hip
  • Abduct the hip (move hip away from midline)
  • Adduct the hip (move hip towards the midline)
  • Posterior tilt the pelvis (tile pelvis backwards)
  • Crucial in walking

Here a some common compensations or signs that are attributed to poor hip function:

  1. Decreased hip mobility. Our hips were not designed to be stiff. They are a mobile joint and only become limited due to poor glute function. The hips will lock up in compensation for inhibited glutes but freeing up the hips won’t do us any favours unless we activate the glutes and teach the body what to do with the new range of motion. This is why the standard for corrective exercise prescription is always an exercise to release an overactive or facilitated structure and one to strengthen an inhibited one.
  2. Back Pain.  Lower backs don’t hurt for no reason. Some GP’s will diagnose their patients with “non-specific” lower back pain, but the truth is there is no such thing. When you lose hip mobility you take more movement from the lower back. Lose movement in one place and you move more in another. The back hurts because it’s over working. The best thing to help your lower back is to activate your glutes.
  3. Knee pain. Inhibited glutes lead to poor knee control and the knees can take a beating. The knee only does what the foot will allow and the hip can control. Recurring and serious knee injuries can also inhibit the glutes, so it’s important to activate them as part of knee rehab.
  4. Locked ankles or chronic ankle sprains. Poor hip control leads to vulnerability in proprioception and gait (walking). Ankles lock to restrict full hip extension. Glutes extend the hip. If the glutes aren’t firing, the brain will find a way to create stability. One way to restrict hip extension is to lock down the ankle. Problem solved. The brain wins!
  5. Plantar fasciitis. Any problem in the feet check your glutes. Stand up and try this. Take off your shoes. Flatten your feet (Pronate) and tell me how your lower back and glutes feel? Pretty average usually. Inhibited glutes go hand in hand with flat feet.
  6. Tight psoas muscles. The psoas is a functional opposite of the glutes. The psoas flexes the hip and glutes extend it. The psoas anterior tilts your pelvis and the glutes posterior tilt it. If the glutes are inhibited the lower back becomes more unstable and the psoas kicks into overdrive to stabilise the lower back. Very common issue in the clinic, especially from desk workers or tradesmen who spend a lot of time bending over in a flexed hip position!
  7. Groin or hamstring pulls. The hamstrings take over the primary work of the glutes to extend the hip. That extra work causes strain. The groin overworks to adduct the hip because the glutes are inhibited. They act as hip flexors, antagonist to the glutes. They are hip adductors, synergistic to the glutes. When the glutei are on vacation the groin muscles have no checks and balances.
  8. Poor performance and durability. Inhibited glutei means you cannot generate force efficiently. Less efficiency means you have to use more effort to accomplish a movement task. More effort equals more energy use in a faster period of time. More energy use leads to faster depletion of durability and stamina. Basically you hit the wall, a lot sooner than most people!

So the take home message is… There are a large variety of factors that contribute to lower back pain! There is certainly no one size fits all approach to rehabilitation. Simply doing pilates or “core exercises” may help, but it’s difficult to prescribe anything until the cause of the issue has been dealt with. However, it does appear that our glutes hold a strong affiliation to back pain, so working on these can go a long way to resolving symptoms long-term.

For more assistance, feel free to book in with one of our Physiotherapists who will be more than happy to investigate your condition further, and provide you with a tailored solution.

Categories: Lifestyle

2 thoughts on “It’s all in the hips! How does hip dysfunction contribute to lower back pain?”

Stacy Lobb · March 3, 2018 at 6:56 pm

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Estrella Amparo · May 22, 2018 at 11:40 pm

I’m so happy to read this. This is the type of manual that needs to be given and not the random misinformation that’s at the other blogs. Appreciate your sharing this greatest doc.

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