Hips are not born to be “tight”, but with the amount of frequency that people lambast about feeling like their hips have more in common with rusty gears than Stretch Armstrong I can see how you think they might.  I’m here to tell you that, for the most part, your hip mobility woes can be a thing of the past with some different perspective on identifying what might be contributing to your outcome of perceived or restricted motion.  Let’s look first at the anatomy of the hips and then break down how we can identify different areas to focus our efforts at making change here.   Anatomy Think of the pelvis as the house around your hip. It’s two wing-like structures called “innominates” connected by a bone called the sacrum. Not shown in Figure 1 is how your lower back is continuous with the topmost aspect of the sacrum, to form a complex between your spine, pelvis, and hip bones.  [caption id="" align="aligncenter" width="877"] Figure 1: Bony Anatomy of the Pelvis[/caption] In a previous post, I talked about why “stretching” a muscle that has the perception of tension, or that might be a contributor to a reduction of joint motion might be a simplistic, reductionist way of viewing how the body creates movement. Muscles are attached to tendons, which then attach to bones. If we just chase a feeling of a stretch in areas that we perceive to have tightness, we might not meaningfully be addressing an issue that could be driving that perception. So first, let’s start to make some buckets for figuring out what could be going on.  Bucket 1: What Does my Total Hip Rotation Look Like?  An easy way to figure out if you’ve got a loss of motion in your hips is to examine your total range of motion between Hip External (Hip ER) and Hip Internal Rotation. (Figure 2).  [caption id="" align="aligncenter" width="882"] Figure 2: Hip ER and IR measured on an examination table.[/caption] A good benchmark to shoot for in most individuals is to have around 100 total degrees between the two measurements. This means that you most likely have good freedom for your innominate bones to move relative to your sacrum, and that you have the potential to get into a lot of different positions. Nice!  If you’re missing quite a bit of total hip rotation in this range, one of the easiest places that we start clients is with learning to move with less tension, and to start to recapture some of the relative motion between their innominates and sacrum, is with some simple rolling.  This Sidelying Rolling with Lateral Compression exercise is a simple and effective way for clients to begin to recapture some of their hip rotation and decrease their muscular effort used to move. It’s also a phenomenal move to start to build some sense of self around how your hips are able to move, to leverage that kinesthetic awareness to be successful in more challenging exercises!  [embed]https://youtu.be/oeLwLrrsSI4[/embed] Figure 3: Sidelying Rolling with Lateral Pelvic Compression Two other popular activities we might use to help clients and patients restore their total hip rotation that also revolve around improving your ability for your hips and pelvis to move relative to each other are the Cross Connect and the Hooklying Two Arm Reach.  [embed]https://www.youtube.com/watch?v=TcsiqnDrd0g[/embed] Figure 4: Supine Cross Connect [embed]https://youtu.be/C7hLRzrWF_4[/embed] Figure 5: Hooklying Two Arm Reach  Like mentioned in the previous Stretching (feel free to adjust whatever the abbreviation for my previous article is, Mike) article, both of these activities do a good job of helping to re-orient the pelvis as a unit and give it the potential to start to recapture a TON of hip rotation quickly!  Bucket 2: What are my Tissues “Calibrated” to Do?  Guitar strings get the tension on them adjusted through use and playing. Each guitarist has their preference for the tension on their strings. Our body is more than just bones and tendons and muscles, it is a network of different connective tissues that are adaptive to the demands put upon our body. Our connective tissues are a significant player in helping our bodies absorb and transmit the forces involved with movement!  Were you just in the camp of missing a lot of total hip motion, but now your hips are incapable of lying after working on the above activities? It’s time to tune your connective tissue tension to facilitate your desired motion.  Try an activity like the Goblet Squat to a Rockback first. It’s an activity where you’re doing the same thing on both sides of the body, so it’s easy to perform, and the relaxation and hold back on the box forces your connective tissues to have to absorb more energy and reduce their stiffness to accomplish that.  [embed]https://youtu.be/R26W48oflok[/embed] Figure 6: Goblet Box Squat with Rockback After working on that, activities like the Lateral Lunge with Hold force the same kind of stiffness reduction, but with an emphasis on side-to-side motion.  [embed]https://youtu.be/wXljK0b7vhM[/embed] Figure 7: Lateral Lunge with Static Hold If you’re missing a bunch of your total hip rotation, work on helping your pelvis get into the shapes it needs to for you to be able to express that first. This helps to restore your potential to be able to move in many directions freely!  Once you’ve got more potential to move, it’s time to start to tune your body’s proverbial springs to get better at what you want it to do: absorbing force and creating more motion or putting on the brakes and stopping motion from happening. I’ll give you a hint: we need to be able to do both to crush all of our active pursuits.  Give these activities a shot to have more success with improving your hip motion without just hanging out and catching a stretch! 

“My hip flexors are always so tight.”  “I always stretch but my hips just feel stiff again later.”  “My foam roller is my best friend, why aren’t my hips more flexible?”  Stiffness or feelings of tightness around the hips are one of the most frequently described problems that I hear from friends, family, and patients. Stretching is also what most of these people describing their hip muscle tightness tell me that they need to do more of.  At first glance it seems like stretching makes sense to do. Something feels tight, getting a good stretch seems to scratch the itch of that tight sensation, I need to do more of it!  But what if that’s an incomplete view of what is happening? All these statements and questions have something in common: the methods being used aren’t addressing what is driving the issue.  To begin to understand what better strategies are for addressing this, it’s important to appreciate how muscles do their jobs to create movement.  Kinesiology 101 – What’s the Job of Our Muscles?  Muscles are attached to tendons, which are then attached to our bones. Muscles are simple – when they contract, they squeeze and change their shape to shorten, flatten, and compress.  When they are not contracted, they are relatively more lengthened, and expanded than their compressed state.  It’s important to note what terms are missing there – tightness. Muscles can’t be tight – they can be relatively more compressed or expanded, squeezing or not, changing their behavior in part by the positions that their attachments are in.  [caption id="" align="aligncenter" width="718"] Source: https://dannyomokha.blog/tag/hip-complex/[/caption] Let’s use an example of this to help build some clarity on how the positions of the bones that muscles are attached to can drive muscle behavior. In the diagram above, you’ll see the large muscle Psoas Major. This is your largest hip flexor, and what’s called a “biarticulate muscle” because it runs from your lower back, across the pelvis, down to your femur. That is relevant because, if we are thinking about bony positions that can affect muscular behavior, we now must consider the position of the spine, pelvis, and hip bone itself.  Now, let’s consider a position that would drive psoas major to be more shortened, or compressed. If you glance down at figure 2, a lower back and pelvis that is oriented towards the front side of your body like this would absolutely bring the two attachments of psoas major closer together, making it have more leverage to be shortened, or to contract.  [caption id="attachment_1669" align="aligncenter" width="408"] Figure 2: An Anteriorly Oriented Lower Back and Pelvis[/caption] One of the most common ways I see people attempt to reduce their front of the hip or hip flexor tension is by performing a movement that looks like the following:  [caption id="" align="alignnone" width="1200"] Source: https://evofitness.ch/hip-flexor-stretch/[/caption] The additions of my masterful neon yellow editing to this picture illustrate that this individual didn’t address the position of the lower back and pelvis in a way that would give their hip flexors a reason to be able to get into a more lengthened position. This actually reinforces the issue because it magnifies the lower back strategy moving the spinal attachment of psoas major closer to the femur attachment, simulating that muscle contracting.  While you might feel a stretching sensation in the front of your hip, what’s happening is the front of your hip joint is being pushed against the front most part of the hip capsule. Not getting your hip flexors into a lengthened or expanded position, just loading the front of your hip.  Clinically, we can usually skip these more stationary stretching movements all together, and use an activity like the Hooklying Two Arm Reach to address the position of all three of the regions that the psoas influences. I love this activity because it takes the spine away from traditional extension into a relatively flexed position, puts the pelvis into a relative posterior orientation to the spine, and starts to extend the hip. Hitting every aspect of joint position that influences the muscles we are trying to influence!  [embed]https://www.youtube.com/watch?v=C7hLRzrWF_4&t=3s[/embed] We can use the same principles in an activity like this Half Kneeling Cable Press  to get the pelvis and hip into a position that would drive length in the bottom leg’s hip flexors, and use the pressing action to reinforce a lower and middle back position that will influence the upper parts of the psoas as well. While at the same time building fitness qualities and not spending extra time outside of your training to improve your mobility. [embed]https://youtu.be/DJJI28xT5og[/embed] The takeaway is simple: muscles don’t get tight; tightness is a sensation. Muscles exist on a behavioral spectrum of relatively compressed to expanded based on the position of the bones that they are attached to. Want to more meaningfully get muscle behavior to change? Start respecting position and watch your efforts start to return major results. 

Many people are told that their knee pain, hip pain, or low back pain is due to weakness in their hips. This is often determined after strength tests show weakness in the ability to use muscles like your glutes, which are important for hip and pelvis stability. The fix is often doing banded hip strengthening exercises, such as putting the band around your legs and doing sideways steps, or exercises such as clamshells. However, these exercises often fall short and don’t actually help reduce pain. Let’s dig into why that might be, and what would be a more appropriate and successful approach.  The first thing to understand is that all muscles have what’s referred to as a “Length-Tension Relationship”. What this means is that the amount of tension that a muscle is able to produce (aka force or strength) is dependent on its length. An easy way to think about this is to imagine you’re doing a pull up. If you start from a dead hang at the very bottom, it is difficult to initiate the force required to start your pullup. However, if you “cheat” and start with your arms already bent, you’ll notice it’s much easier. At the top of the pullup, you will also notice the last 10% tends to be the hardest, when you are fighting to get your chin over the bar. Here it is clear to see that the range in the middle of the movement is the easiest, and you feel the strongest. The reason for this is when you’re at the bottom of the pullup hanging, your muscles are fully stretched and in as long of a position as possible. At the top, they are fully contracted and shortened. Neither fully stretched or fully contracted are ideal positions to generate force from. Just like goldilocks – something right in the middle is ideal to produce as much force as possible.  The science behind this is simple if you understand how a muscle contracts. Within muscle fibers, there are tiny filaments called actin and myosin. These filaments lie parallel to each other, creating the “fiber” of your muscle. Small arms called “myosin heads” reach forward from the myosin and attach to the actin, then pull the actin together to cause the muscle to shorten and squeeze. The picture below will help demonstrate this.  If a muscle is stretched out there will be less overlap between the actin and myosin, and therefore there cannot be as many cross bridge connections and it is harder to contract the muscle. Likewise, if a muscle is fully shortened or squeezing, there is not much more room for the myosin to pull the actin together, as it is nearly all the way together. In either case, this results in lower force production even with higher efforts. The chart below demonstrates the highest force production happens around the middle point of a muscle length.  Now let’s go back to looking at your “weak” hips. While sometimes there are true weaknesses in the hips, this can easily be exacerbated by the position of your hips. If your glutes for instance are extremely tight and rest in more of a contracted position, it will be hard for them to squeeze any further, and will present as “weak”. Likewise, if your glutes are in a more stretched position there won’t be enough overlap to create a strong contraction. These resting positions are influenced not by “tight” or “loose” muscles, but rather tight or loose muscles are a result of the underlying position that they are held in based on the position of your pelvis. This is something that can be easily assessed and screened for in a discovery session at Next Level.  If we do find that the position of your hips is contributing to your “weakness”, the solution is not to just add a band around your knees and try to strengthen your glutes. If anything, this may even contribute further, especially if you are someone who is already in an over contracted state; this old-school strengthening approach may actually be further exacerbating your inability to create force from your hips.  Instead, the first priority should be getting your hips in that nice middle ground, like the goldilocks example, so that your hips will feel like you’re at that mid range of a pullup – strong, healthy, and supported. The right exercises to do this will require a deeper assessment to determine the position of your hips, where we can determine if the muscles are starting in a contracted or relaxed position, from which we can determine the best next steps to get you back to neutral. After that, then we can reinforce this position with strengthening exercises that will help not hurt you, and get you back to 100%. Whether you have knee, hip, or back pain, or are just feeling like you aren’t able to perform at your highest level, addressing these restrictions can help unlock your ability to finally progress. 

Stretching is something a lot of us do, but have we ever thought about why? Of course we have. The muscle is tight, so to fix it we stretch it. That makes sense, if the only reason why a muscle is “tight” or “restricted” is because it was shortened and we have to stretch it to elongate it. What happens if the reason why it’s “tight” is not because the muscle is actually shortened. If that’s the case what good is stretching it. Hear me out. To help illustrate this and help this make more sense, let’s use the hamstrings as an example.  And don’t worry at the end of this I will show you my Top 3 Exercises To Fix “Tight” Hamstrings.  Almost everyone has tight hamstrings and stretches their hamstrings. Common tests we use to assess the hamstrings are the active straight leg raise or the toe touch. We all probably remember the sit and reach test in physical education class as kids too. Do they still do that?    Anyways, if you couldn’t lift your leg straight, touch your toes or reach far down the ruler, you were told you have tight hamstrings and you had to stretch them.  Just because it’s tight doesn’t mean the solution is stretching!  How many of you have stretched and stretched, but never saw much change or any real lasting change? If stretching doesn’t change it, maybe the muscle isn’t shortened and stretching isn’t the answer. What is it then? “Because I really do feel tension and tightness in the back of my leg when I try to touch my toes or when someone lifts my leg up”. I believe the tension and tightness individuals feel are real, I’m not saying it isn’t, but the reason is not because the muscle is shortened.  One thing we need to look at and appreciate is POSITION. To understand this, it comes back down to anatomy and neuro, like most things do. Let’s take a look at the hamstrings... The hamstrings originate on the ischial tuberosity of the pelvis, or the “sit bone”. They insert across the knee joint at the tibia or fibula, the lower leg bones.   Think of the hamstrings as a rubber band that extends from the butt down to the back of the lower leg.  When you bring the leg up, like in the straight leg raise, we can see how you put tension on, stretch, or elongate the hamstring. Remember though, while it inserts into the lower leg, it originates at the pelvis, so the position and orientation of the pelvis will have an effect on tensioning the hamstrings as well. Pelvis Position: Let’s say someone starts in an anterior pelvic tilt. That means the pelvis is tipped and rolled forward. If the pelvis is rolled forward and anteriorly tilted, that will put the hamstrings on tension. If an individual naturally stands, sits, or lays down with an anterior pelvic tilt, that means their hamstrings are already on tension, and the rubber band is stretched. So when you go and try to reach for your toes or you go and lift the leg up, you feel a pull before you’re able to touch your fingers to the floor or straighten your leg out. This is because your brain and your body is stopping to protect you!  Figure 5: The picture above illustrates the influence of pelvis position on hamstrings. On the left, the pelvis is neutral and balanced. On the right the pelvis is anteriorly tilted and tipped forward. Observe how the black line (hamstrings), is longer. Again, based on your pelvis’s position (anteriorly tilted), your hamstrings are already on a tension and “stretched”, so when you try and ask your body for more and more, eventually it will stop and not let you. If you haven’t found success with stretching, before you stretch and stretch, or have someone jump on your back and push your down, please take a look at and appreciate position.  Get your body into a better position and then check and see if you still have the problem. If this is you, correcting something like an anterior pelvic tilt or getting out of an over extended posture, will not only help your mobility, but probably your pain if you’re experiencing any, and your risk of injury.  Disclaimer: I’m not saying stretching is bad. There are many benefits to and it is necessary to have good tissue quality, elasticity, and durability, but if you aren’t having success with improving your mobility by stretching, you may be attacking your issue wrong. Click here to learn my Top 3 Exercises To Fix “Tight Hamstrings”

If you’re here to read about your knee, you’ve come to the wrong place. We’re not here to talk about your hips and ankles either. Ok, that’s not ENTIRELY true, but we’re here mostly to talk about your diagnosis; patellofemoral pain syndrome, or PFPS for short, which typically describes pain in the front of your knee. Unfortunately, PFPS is more of a description than an actual diagnosis. Before we dive any deeper, let’s talk quickly about the relevant anatomy. A joint exists anywhere that bones meet, and your knee is no different. The knee joint is where your femur (thigh bone) and tibia (shin bone) meet. From the outside it might look like your knee bends and straightens like a door hinge, but it doesn’t. Your knee, just like every other joint in your body, works via rotation. As you straighten your knee the femur rotates inwards while the tibia rotates out; bending your knee goes the other direction. The top of your tibia is a relatively flat plateau, and the bottom of your femur looks like two big knuckles resting on top. How does your knee stay together? You can thank your ligaments and muscles for that. There are a lot of muscles that control the position and orientation of your knee, but the group most commonly discussed in PFPS is the quadriceps. That’s because the patella, or kneecap, literally floats within the tendon. Now that we know what we’re looking at, let’s discuss how none of that really matters. What really matters is force management. As your foot hits the ground the shock must travel up the leg and through the body, you then drive a return force back through the body and into the ground so you can push off. This is called walking, and when you do it really fast, running. The same rules apply when lifting weights, even if your feet never leave the ground. How efficiently you absorb and redistribute forces determines how much strain the joint, muscles, and ligaments take on. Don’t go worrying about “wear and tear”. Tissue strain is a completely normal part of being a human and is critically important for building a strong body. One of the hallmarks of being a living organism is the ability to self-heal. In a typical scenario you would use your body to move around in the world, tissues get stressed out, and then you heal and recover with food and rest. The problem is when the stress you take on begins to exceed your ability to recover from it. You can think of it like a budget where you’re slowly going into debt. This debt, over time, is what leads to the pain you’re feeling. When you started reading this article I said that PFPS is a description and not a diagnosis. What I meant was that PFPS tells you what hurts, it doesn’t tell you why it hurts. The diagnosis itself therefore has little to do with how you treat it. Typical advice for PFPS is to strengthen your quadriceps, hamstrings, calves, and glutes. The idea is that stronger muscles will both help you to resist force better and allow you to take on more strain before going into debt. For many reasons that go beyond the scope of this article, that approach is short-sighted. Strength training is an essential part of the rehab process, but it needs to be applied at the right time and for the right reasons. The strongest muscles on earth don’t mean a thing if they don’t turn on at the right time, in the right sequence, and coordinate with muscles throughout the rest of your body. There are a lot of people who get complete relief through strength training alone, but if you’ve gone the strengthening route and are still having pain you missed something. Even if you have an old injury - a torn meniscus, arthritis, an injured or missing ligament - it might not matter when it comes to your pain. Address and improve the way you manage forces through the knee, and you will be surprised at how much you can improve. If you’re reading this and have anterior knee pain that just won’t quit, I hope you now see that you don’t have to be stuck with it forever. All mechanical pain has a source, and with the right approach you can absolutely solve it.

If you’re going to be pushing the envelope on strength training and challenging your limits to produce force or handle a substantial amount of exercise involving a high amount of force, you’re not always going to be feeling great physically.  Exercise is a stress on the body. Stress can be both a potential positive, and a potential negative, based on how the body responds to it.  Everyone’s ability to take a physical stress from exercise and adapt to it is different based on a whole host of variables. This is why not everyone has the same response to the same exact fitness or training program.  In the case of chasing improved ability to squat heavier weights, something that may arise is symptoms in and around the knee with increased loading or periods of intensity. This might commonly be called an “overuse injury” – which is just an over-accumulation of physical stress on an area of the body that is larger than it can buffer and have a positive reaction to.  If your symptoms seem to improve with rest but come back as soon as your intensity (the amount of force you are having to produce) or volume (the total amount of pounds lifted), only resting will NOT help you continue to chase your ability to train intensely. Rest WILL give your body more time to recover and heal, but it will not help your knee learn to handle increasing amounts of force, or to be able to absorb and produce force in different ways.  Here are some of my go-to methods, and my reasoning for why we are applying them, to help someone’s knee become more resilient when returning from a training related knee injury.  1) Use cable assisted split squats to improve the ability for the knee to absorb force [embed]https://www.youtube.com/watch?v=n1p8nYAR4zM[/embed] Split squats are a useful way to train loading each leg with a bias towards the front leg. They aren’t true single leg loading because both feet are on the ground, but split squats bias loading towards the front leg.  The front foot elevated version shifts some of the weight off of the front leg to make it more of a 55%, 45% distribution of weight between the front and back legs.  The force of the cable helps to reduce your body weight slightly and allow you to load your knee in deeper ranges of motion than traditional bilateral squatting can sometimes allow, while assisting in helping to distribute the load between your hips and ankles.  This is especially useful when we need to rebuild your confidence in being able to load your knee and is a very friendly variation when we are first reteaching your knee to absorb force, and to help the structures above and below the knee do their part so less focal stress gets put onto only your knee.  2) Use regular split squats to load the knee more aggressively  A split squat without the lead leg elevated will let the shin move more forward relative to the ankle, which will put more force into your knee.  I’ll start programming regular split squats into client’s programs once they are performing front foot elevated variations without any pain or hesitation with an emphasis on having them being able to do sets of higher volumes (12 to 15 reps) with moderate load.  3) Reintroduce bilateral squatting with an emphasis on absorbing force first  [embed]https://www.youtube.com/watch?v=wjk8LYtZy34[/embed] The box squat is a great way to get back to a symmetrical stance squatting activity and can be tweaked in many ways to change how quickly the knee is loaded.  Starting with a box squat, you can use moderately heavy loads mimicking your training weight and work on a complete rock back onto the box.  A simple way to progress this is to use a progressively smaller box so you use greater ranges of motion over time as your body allows you to.  Come to a complete stop on the box, then push the floor away and return to the starting position.  4) Reintroduce training load of squatting without any constraints Now that we’ve improved tolerance of the knee to loading in several different ways, we must reintroduce the actual movement without any constraints so that, using the principles of Physical Stress Theory, your knee can be exposed to and adapt to the specific forces it experiences when doing your desired squatting movement.  The big takeaway from this article is that experiencing overuse injury type knee pain during a squat can be common. Rest has its place at times, but it is no substitution for making sure that your body is able to absorb and create force under many different situations to have a knee capable of doing many different physical tasks.  Try some of the activities we talked about above, and reach out to your trusted coach or physical therapist if you need specific guidance customized to your unique situation! 

If you’re experiencing low back pain, it can be hard to get through general daily activities, let alone workouts, without it stopping you. While these foam roller exercises are not long term solutions, they can at least provide you a window of relief to get your pain to subside and to get through daily activities & workouts until you are able to address the deeper root and solve the underlying problems contributing to your back pain.  Foam rolling in the traditional sense of rolling out “tight muscles” works best as a warm up prior to exercise, or for quick relief of the sensation of tightness. However, we can use our foam rollers in many other ways to encourage pelvis and rib cage mobility, to aid in recruitment of specific muscles, and to decrease an area’s sensitivity. Try the 5 exercises listed below, and pick the few that feel the best during and after completing them.  1. Traditional Foam Rolling: Hip & Thigh Muscles (Glutes, piriformis, quads, hamstrings, IT band) Often, our back pain may stem from restrictions in our hips or thigh muscles, which can pull the pelvis and restrict its motion, leading to pain in the lower back. You may also notice significant tenderness to rolling out your IT band along the outside of your thigh, or any other muscles shown above. This is typically a clear indication that your pelvis is in a position that is increasing it’s load through those areas, and that you likely do not have adequate ROM throughout your hips. While these positional components must be addressed for long term relief, rolling these tight areas out may provide a window of relief.  Use the foam roller on your hip & thigh muscles looking for areas that are particularly sensitive or painful, and spend the most time in the most painful spots to help reduce these restrictions. Eliminating restrictions in the hips can allow for an optimal supportive base for your lower back to start from. 2. Lazy Rolling [embed]https://youtu.be/2rgBt_1D4bU[/embed] Low back pain can come from a loss of relative motion at our pelvis, meaning we don’t have normal motion in our hips and low back area – something we require to walk, run, jump, squat – basically anything with your lower body. This “lazy rolling” variation will encourage small amounts of this “relative motion” at the pelvis. If you have SI joint pain (lower back, where your spine meets your pelvis) this is a great option for you. Try this on each side and notice if one side is more sensitive than the other, and try to gently work through this. This should be minimal effort, and very “lazy” as the title suggests. 3. Wall Supported Hip Hikes [embed]https://youtu.be/jwQc2zq3iMA[/embed] Humans often fall into what we call a “right dominant pattern”. In this pattern, we tend to load into our right leg and hip more than our left, and our pelvis will often shift and orient to follow. This is something that is very challenging to sense yourself, but something that can be clearly identified in our assessments. A key to shift yourself off of your right leg is to be able to use your right glute to push yourself to the left . You may have been told before that you have “weak glutes”, but often this is due to an inability to activate it properly. This activity helps recruit the right glute specifically to counteract the forces from a right dominant pattern. If done properly, you should feel a strong muscle burn in your right glute while performing.  4. Hip Mobilizations: Sit Bone Decompression [embed]https://youtu.be/UA6h5ng74Js[/embed] Our sacrum and sit bones can be a site where the surrounding muscles get very tight and restricted. When this occurs, it impacts how the low back is able to move and manage forces. This sit bone decompression may be surprisingly uncomfortable; if it is, it is likely something you need. Start with a small towel roll to decrease the intensity and make it tolerable, and gradually progress to the foam roller.  5. Rib Cage Mobilization [embed]https://youtu.be/JdF1w3ulrFs[/embed] While the previous recommendations all have to do with what’s going on below the low back, your rib cage can be an area of restriction that contributes to low back pain. Our ribs are meant to expand as we inhale and close down as we exhale, but this is often lost and we get “stuck” in one extreme or the other. Laying over a foam roller will help to close the bottom side of the ribs, while the top side is able to expand. This is another move that may be surprisingly sensitive; if you find you are unable to relax and melt over the foam roller, start with a rolled up towel or pillow folded in half so you can get into the same shape without too much discomfort. Gradually progress to a foam roller as tolerable. 

Low back pain is as much a part of the human experience as is getting the common cold: virtually everyone is going to have a run in with it during their lifetime, and how bad a case of it is unpredictable (all possible traumatic causes aside).  What’s equally as likely as your chances of having low back pain, is to then be told that “strengthening your core” or improving your core stability is the answer.  I’m here to tell you that this reductionist solution may not be the full story and can even be harmful to your longevity and long-term physical function if you’re someone who has had bouts of low back pain in the past or is currently suffering from it.  When people are told that they need to improve their core stability, what is usually being recommended is that individuals learn to adopt a fixed position of their midline, learn to create significant tension in all of their abdominal and back muscles, and then move their extremities without allowing their midline position to change.  Training your midline to resist creating motion IS important. It’s an important function of the body to resist creating motion in some situations. When carrying a heavy object, it’s actually advantageous to be able to create significant tension through your midline to resist motion, because any extra motion created is extra physical work that must be spent to complete that task.  And after having an acute back injury where there could be body tissue strain or sprain that has occurred, your back might not tolerate creating a lot of motion. Exercises where you are learning to resist creating motion might be some of the only activities your back can tolerate for a while and can be a lever to help you capture some of the pain-relieving effects of exercise while not provoking any mechanical sensitivity in your back from your injury.  Want to know the craziest thing about low back pain? Most people that have an episode of it will get better entirely on their own with enough time. You might not have to change the way your abdominal muscles coordinate to resolve your pain. One of the variables that I hypothesize might affect some people in making their recovery is believing that their backs are unstable, and that they have to use a braced midline strategy for everything that they do, or they will hurt their back more.  Picking up your clothes off the floor should not require that your only option is to squeeze your body as hard as possible and try to do your best 2-by-4 impersonation. You shouldn’t have to do the strictest hip hinge ever to brush your teeth in the evening.  If, after the acute and early phase of pain has passed, the only thing you continue to train your spine to do is not create any kind of rotation or forward or backwards motion, you will lose the full range of motion that your spine has access to. And once you stop using all the motion that a spine is capable of, you stop exposing the spine and all of it’s attached musculature and connective tissue to the forces created by that movement, so they begin to decondition and become tolerant of less.  Now a strategy that was adaptive in the short term has become a hindrance in the long term.  If bending over is difficult, it might not be that bending over and letting your back bend is harmful, it might be that you’ve trained your spine to stay rigidly straight all the time.  Clinically, in my patients who present like this, we may start with an activity like the hooklying two arm reach to begin to recapture some of the hip and pelvis motions that correlate with creating a lower back that is capable of flexing.  [embed]https://youtu.be/C7hLRzrWF_4[/embed] Once we’ve worked on building the mechanical prerequisites to using a different movement strategy, we will usually progress to an activity to directly retrain the motion but with an add-on to encourage the bending mechanics possible, like a heel elevated toe touch. This continues to retrain NOT using a braced strategy that doesn’t allow the spine to bend and starts to re-expose the back and its supporting muscles to the forces of creating motion in a different way so that it can begin to adapt to those stresses and not be overly challenged by them.  [embed]https://youtu.be/RQ28YFF8rdg[/embed] A full range of motion Jefferson Curl is an excellent later stage option for getting the spine to bend and use all its possible range of motion. It also is phenomenal for building strength and control through many positions that folks frequently find themselves tweaking their back in – possibly because they don’t regularly expose their spines to load in those specific angles and “awkward” positions.  Training your back to resist creating motion is just one quality that it needs to be resistant to injury in the future. We should strive to have a spine capable of creating enough motion for us to do our daily tasks and activities we love, to resist motion when needed, and to condition our spine to be okay being loaded in “injury prone” positions.  A universal principle is that our bodies adapt to what we repeatedly expose them to and recover from. In this case, retraining your back to bend can be a cure for the function that you lost after your initial back injury. 

Think you have a “bad back”? Maybe it’s time to check your knees and hips instead! Sometimes pain is not always what it seems. The body is a very strange and complex system and each part has an influence on one another. We think of body “parts” but the truth is we always move as a whole. Sometimes when one body part is not moving in the way that it should, a different area can pick up the slack. This term is called regional interdependence, and is defined by Physiopedia as “the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint”.  So, what does that mean in English?! This means that even though your knee hurts, the problem may not actually be your knee, but it’s actually the ankle you’ve sprained 20 times. Or perhaps your low back pain is not a low back issue at all, but the real issue is your hips are not moving in the way that they should!  As you can see in the picture above, certain joints are designed for “stability” while others are designed for “mobility.” What does that mean exactly? Mobile joints, like your hips and shoulders, allow for a lot of movement through large ranges of motion in many different directions. Joints designed for stability, like your knees, have less movement. Think of how your knees primarily move front to back, with limited side to side and rotational movements.  However, when we have an injury to a body part, sometimes this diagram with alternating mobile and stable joints can get flipped. Let’s talk about a soccer player who sustains an ACL tear and how this knee injury might influence movement in the rest of the body. The knee, a “stable” joint, now has one less structure holding it into place. It loses stability, and suddenly there’s movement where there shouldn’t be. This causes the body to create compensations elsewhere to make up for this deficit. If the knee now has more movement, we need to look for stability elsewhere. Here is where we may start to lose movement at the hip, as it tries to make up for the lack of stability now happening at the knee. This chain of events can continue  up and/or down the body. If the hip now has less movement, but we still need to do things like sit, run and jump, which all require significant motion at the hip, what body part do you think will compensate next? If you guessed the low back, you’d be correct! Over time if this pattern continues, we may start to see the low back take up more motion than it should, which means your low back muscles are working overtime. They are placed under a stress that they are just not used to and are not apt to handle, leading to low back pain. Pretty crazy that in this situation, what might be a complaint of “low back pain” could have actually stemmed from a pre-existing knee injury!  Our bodies are  really good at figuring out ways to get around injuries and pain by compensating elsewhere in order to adapt to our lifestyles. As a result, sometimes this means our low back pain or shoulder pain might not be a back or shoulder problem at all. It’s important to zoom out and take a look at the body as a whole in order to find out where your pain is actually coming from. Otherwise, you may get stuck in an endless cycle of  treating a “back” issue that isn’t really a back issue. You’re essentially treating the symptoms but not the disease. If any part of this story sounds familiar, be sure to consult a licensed professional who will hear your main problem and zoom out!  Reference: https://www.physio-pedia.com/Regional_Interdependence#:~:text=Purpose%20%26%20Definition,-The%20purpose%20of&text=Simply%20put%2C%20regional%20interdependence%20is,with%2C%20the%20patient's%20primary%20complaint.