Try These Exercises if your Back Hurts

As a long-time board-certified sports and orthopedics physical therapist, I take a lot of pride in providing personalized care. I shy away from giving people cookie-cutter advice because injuries are often complex and layered. With that being said, there are some stretches and exercises that are so effective and broadly beneficial that I feel comfortable encouraging you to try them out. While they may not completely alleviate your symptoms, they’ll get you moving in the right direction until you can see a skilled provider. Important: this is not medical advice! If you want my personalized medical advice, schedule an appointment and I’d be so thrilled to help you out – backs are one of my favorite body parts to treat. 

Ok, with all of that out of the way, first things first…

It’s all in the hips. 

Did you know that when you bend down to tie your shoe or pick something up off the floor, you’re supposed to be getting half of your mobility from your hips and half from your back? One of the most common things I see in folks with chronic back pain is a real limitation in their hip mobility and flexibility. During one of my first jobs as an embedded PT with a Marine Infantry Unit, this was the case pretty much across the board. 

When your hips are tight, it requires your back to give a little bit more in terms of mobility. Instead of a 50-50 split, your back ends up doing 75-80% of the work in moving you around. Why is that? Well, you’ve probably heard of the SI joint. That’s the place where your hip and pelvis fuse to your spine with thick, strong ligaments. 

The most common offenders I see in hip tightness are the hamstrings, attaching all the way up to your sit bone and down past your knee. They go hand in hand with hip flexors, attaching from your lower abdomen across the hip joint into your thigh. Both of these muscle groups tighten with prolonged sitting, cycling, stair climbing. 

Back pain is a result of something throwing off a delicate balance of strength and mobility. In the setting of chronic lower back pain, it is very common to see tightness in the hips and simultaneous core weakness – and when this occurs together, it’s a recipe for disaster. 

Try incorporating these stretches into your daily routine: 

-Hamstring stretch: I can’t tell you how many times people tell me they’re already stretching their hamstrings because they touch their toes from time to time. Although it is a stretch, this won’t cut it to address the hamstrings. See the below image for my favorite two ways to stretch the hamstrings. Make sure you stretch for 3 sets of 30 seconds, morning and evening. 

Make sure you keep your knee as straight as possible. Don’t have a stretch out strap? Try a dog leash or belt!

-Hip flexor stretch: you can do this stretch off the edge of your bed or in a half-kneeling position. If you aren’t feeling a stretch in the front of your hips, adjust the position of your pelvis with a little tilt forwards and backwards. 

A couple of other favorites of mine are child’s pose, and a good roll on the muscles that run along your spine, seen below.

Make sure you roll to a slight angle to keep the foam roller off of your spine, this should be on the muscles next to the spine.

Pseudosciatica

Another term you’ve almost certainly heard of is sciatica. Sciatica is described as pain in the lower back that radiates through the hip and buttock, down the back of the thigh and into the foot (following the course of the sciatic nerve). True sciatica is associated with numbness, tingling, or weakness in that same area, and, when severe, can cause problems with your bowels and bladder. 

Sciatica occurs after an injury, lifting something heavy, a disc herniation, etc. It is also a very common diagnosis used by doctors for “back pain into the leg,” regardless of the exact location, mechanism of injury, or symptoms. 

Pseudosciatica is caused by an overuse or traumatic injury to the gluteal muscles - specifically gluteus medius and minimus. These are deep muscles in your hip that live underneath the gluteus maximus and are responsible for hip stabilization during gait and rotation. 

Just like any other muscle, when these muscles are overused or weak, they develop triggerpoints – knots in the muscle tissue that radiate symptoms elsewhere. The gluteus medius tends to radiate symptoms into the lower back and hips, and the gluteus minimus radiates symptoms down the leg and into the foot. 

If you have pain that has been diagnosed as sciatica, it is perfectly safe to try a gluteal stretch and rolling routine to relieve your symptoms. I like to stretch for 3 rounds of 30 seconds in the morning and evening and roll for 1-2 minutes, once per day. 

Once you’ve released your hip stiffness, stretched out your gluteal muscles, and used the foam roller, you should be feeling much better. Your next step is to add a good core regimen to your workout routine to balance all of that newfound mobility. In order to get a full core regimen, see a physical therapist local to you who can assess your strength and perfectly tailor the routine. 

Stay tuned for a future blog post dedicated to the muscles of the core and how our view of them has changed over time!