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.

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. 

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.