Hip Mobility for Spinal Health

We hear health and fitness professionals rave on about the importance of hip mobility all the time, but rarely hear much of an explanation for it. The ability for your hips to move through range of motion is crucial for the structural stability of the spine, though. I'll speak on the two most major movements at the hip - flexion and extension - and how dysfunctional range of motion here may negatively affect the back.

Flexion

An inability to reach optimal flexion at the hips is the most-commonly pointed out issue on this subject. Flexion is the movement that occurs at the hip when you bring your knee to your chest. When lacking in range, it can heavily impact your ability to properly perform many exercises at the gym, resulting in the amount of notice it receives.

The most major example of poor hip flexion affect the spine is during the squat. Normally, when sinking into a squat, the spine should maintain it's neutral lower curve. However, if the hips are not able to complete the movement themselves, the spine will compensate and round out into flexion itself - the entire pelvis rolling forward - to reach the bottom of the squat. We commonly know this as "butt wink".

 

This is the most obvious example of this dysfunction, but the thing to realize is that if this large mechanical error occurs at the gym, it's probably occurring at a lesser - but much more frequent - degree as well during the rest of your day. That means you have excessive spinal flexion when bending down to pick up boxes, when seated in chairs, and possibly even walking and running. 

(Let's side-step and remember that genetics may play a role here, and you may simply be anatomically unable to flex your hips as far as others. In these cases, you still want to work on maximizing the range you have, but may need to accept that your squat won't be as deep as some.)

Extension

The other major movement we see at the hips is extension - the leg pushing back and behind you. Just as with flexion, which a lack thereof can increase flexion of the spine, lack of extension at the hips can make the back compensate in the same way.

This habit isn't as often caught in your typical gym setting, as increased spinal extension isn't often perceived as looking dysfunctional like flexion. However, excessive compensatory extension of the back (most often seen with running athletes) can lead to lower back pain just the same; compression of the vertebral spaces and hyperactivity of the erectors of the spine being significant causes.

Increasing Mobility and Precautions

When it comes to hip flexion, the limiting factors of range tend to be soft tissue and bone. Restrictions of the ligaments as well as tension through the hamstrings are frequent barriers, as are the anatomical limitations that are discussed in the article that I linked to previously.

As for extension, there isn't so much a barrier to the movement, rather there being a lack of muscular stability for it. When the core isn't stable enough to hold the spine steady during the force created by extension of the hip, this is the case where you'll see the form break down and the spine move to follow. However, this is trainable.

As a final note, if you're thinking that you need to work on your hip mobility more now, let's remind ourselves to be gradual and that over-mobilizing can quickly lead to more injuries than it corrects for. Take it gradual, people!

Your Tight Hamstrings

It seems like every other client and athlete that I see has a complaint about their tight hamstrings.

The tension that a lot of people feel is relentless and just won't let go. They stretch and stretch all day long. Bending down to touch their toes, sitting and reaching, on their backs with a band, but nothing works!

Why are these things so tight and why can't we get them to be flexible?!

Hamstring Tension

I read this excellent article by Eric Cressey on the true reasons for hamstring tightness. One of the most enlightening points that it makes is the fact that your hamstrings are very unlikely to be truly shortened.

You see, the hamstring muscle group performs two major actions: knee flexion and hip extension. If our hamstring tension was really caused by shortening of the muscles, then that would essentially require us to be in both of those joint positions (simultaneously) on the regular. Do you spend every day on your knees for hours? (No jokes, please.) No? Then you probably don't have a hamstring lengthening/shortening issue.

So that being said? What causes hamstring tightness? There are three main things: Protective tension (compensatory tightness), neural tension (most significantly, sciatica), and an injury to the muscle (whether it's an acute strain or tendinitis).

Most of my clients who have this issue have it due to the first option; protective tension. More often than not, they're lacking proper activation of the glute muscles to initiate hip extension and stabilize the hip joint. As a result, the hamstring has to not only compensate for the ability to extend the hip, but it also has to increase in tension to try and make up for the lack of stability that the body senses at the joint. As the fix, I spend a lot of time reeducating the action of gluteal hip extension. Obviously, this isn't the only compensatory mechanism for why the hamstrings are tight, but it's the most common one that I find.

Similarly, if the reason for the tension is neural or due to injury, we need to fix the root of the problem in these cases as well before the hamstrings will truly be able to release their tension. If there's sciatic involvement from either the hips or the lower back, then some sort of intervention to relieve the stress on the nerve is required. If there's been an acute hamstring strain or built-up scar tissue, then time, manual massage, and proper strengthening will help accelerate recovery. If there's a chronic tendinitis, then that brings us back to the compensation issue which needs to be corrected.

Hamstring Stretching

In the meantime, is there anything we can do to help decrease hamstring tension while attempting to correct these mechanics?

Well, from my experience, I'm finding that static stretching for this area is less and less effective. Like I touched on before, if the hamstring isn't truly shortened, then why bother trying to truly lengthen it?

Instead, I'm starting to employ more dynamic stretching (even after exercise) in order to promote the muscle to neurally relax under tension and let go during repetitive stretch rather than prolonged. My clients have reported feeling that these methods have made them feel like the muscle is under decreased tension and have relieved pain more than holding the stretch ever did.

 

All in all, this goes back to my philosophy that simply stretching and mobilizing is never the answer to the problem. The base mechanics always need to be addressed before the issue is resolved. So, if you fall in this category of someone plagued by chronic hamstring tightness, take a moment to consider the reason for it.

How Your Eyes Relate To Your Head and Neck Pain

Try this at home: Sitting comfortably, find the muscular soft spot at the top of your neck, just below the base of your skull. Use the pads of your finger tips to slowly strum through the tissue and gently sink into the tissue. Now, move your eyes around. You should feel the muscles twitching underneath your touch. Fascinated now? Keep reading.

I've treated clients with concussion symptoms and whiplash quite a few times now. To some degree, there's always some involvement of the eyes in their symptoms, whether it's pain, disorientation, or inability to focus. Most of us would never have thought about the importance of the eyes with these movements before, but when you think of it, it makes sense.

Wuuuuhhh?

Eye movement, like every other movement of the body, is initiated by muscles. The muscles of your eyes are small and sensitive, due to the fine control needed for sight. Of these many muscles, the suboccipitals in your neck (sub=below; occiput=the base of the skull) are of high clinical significance.

I've talked before about how pain and spasm work. You experience an injury, your brain senses pain and instability, it causes spasm of the muscles to protect the area, more pain results, and we cycle through over and over again.

When it comes to the topic at hand, when the neck or head experience trauma (such as a concussion or whiplash from a car crash), the suboccipital muscles are among the structures that are sent into this protective spasm. As well-meaning as your body is by doing this, this contributes greatly to the symptoms that follow. As tension increases and the strength and motor control of those muscles is lost, many people will become plagued with symptoms such as migraines, vision problems, eye pain, neck pain, and more.

So to alleviate your symptoms, what can be done. Massage? Yes, but also no. How many of you with these conditions have tried that with only semi-successful results? The pain may go away for the rest of the day, yet it returns soon enough.

Like with any other injury, massaging those suboccipital muscles is only half the work. Remember, the problem is that these muscles are spasming, weak, and lacking motor control. Manual therapy will take care of some of the spasm, but strengthening and reteaching control of the eye movements is mandatory to fully rehabilitate the condition.

Since cluing into these relationships, I've since incorporated eye-tracking assessments and exercises into my rehab programs for clients with neck and head injuries, and these methods have had the most drastic effect on patient recovery over anything else. Once we're able to restrengthen the eye muscles, the spasm and tension in the neck settles down, and symptoms start to subside.

Like I said, the relationship between the eyes and these conditions is not an obvious one, but it's very understandable once brought to light. I'm happy to have found these conclusions, as being able to relieve these life-altering symptoms in shorter time has been very rewarding.

Why Planks Are Not Enough

I've seen and talked to numerous people with complaints of low back pain that can't seem to understand why they are afflicted with such; after all, they always do planks to strengthen their cores.

I've seen many people with severe low-back pain who figure that it must be due to something other than muscular strength. They can hold a strong plank for minutes on end and keep going forever. It couldn't possibly a core problem. Well, I'm sorry to say to everyone, planks are not enough. Why?

Strength vs. Endurance

After the first couple minutes of holding a plank, it is no longer a core strength exercises; rather, it's a core endurance one.

Now, core endurance is an essential aspect to health, but more often than  not, the need strength exceeds the need for endurance in these muscles. Whether it's picking boxes up, lifting weights, or nearly any other activity, the core needs the strength to stabilize the spine under these shorter, higher-resistance loads rather than needing to stay activated under excessive lengths of light-resistance.

Planks for muscular strength are a beginning level exercise only. As soon as a client can maintain a strong plank for 1-2 minutes, they are well-past the point of this exercise being useful. It's time to move on.

Single vs. Multi-Plane Movement

Planks also have a bit of a disadvantage in that they address stabilization in a single plane of motion only. Sure, you can flip onto the side and side-plank for the oblique muscles as well, but the benefits here have limits as well. By training stabilization using resistance at only one angle, you're training your core to only be strong and stable at that angle. As soon as you experience any resistance coming at you from a diagonal direction, you're no longer conditioned to bear the load.

Joint Movement

Again, planks on their own are a beginner-level exercise only. They do the job at an early stage to teach us how to use those core muscles to stabilize the spine and prevent movement against resistance.

However, the demands on the core system drastically change and increase as soon as we add joint movement into the picture. Adding arm or hip movement to the mix increases the level of activity required by the core muscles due to change in joint position transferring additional kinetic forces towards the spine. That being said, if you're not training your core to stabilize during joint range of motion (such as with the deadbug), then you're not training your core to be effective as soon as you try to transition to any functional activity.

To reiterate, I very rarely give planks to clients except in the case of very low-function individuals (or if it's an additional part to a larger workout plan that is already challenging the core). It should be considered a first step only.

Clients always require an increased demand as they progress towards returning to activity or higher performance. With that in mind, they require a highly-varied core routine just like every other muscle group does (as the gym-rats out there will understand). Adding weight to the plank, adjusting core exercise angles, throwing in joint and limb movement, and even progressing to plyometric-type impact exercises to challenge the core are are essentials at some point in the plan. It doesn't matter if the individual is a rehab client, an experience gym-goer, or a high-performance athlete; these principles remain sound.

Do You Need Traction?

I recently had someone ask me if I thought it'd be worth it for them to purchase their own traction table for at home.

I've also talked to clients who said that they previous paid their last clinic for weekly traction - and almost no other treatment. Sometimes, the timeline went all the way up to nine months! Did this form of treatment help them to resolve their back pain?

Mmm...kinda.

Weeeeeeeeeeeee!

Mechanics

Traction can definitely help to relieve back pain. Is it going to cure it for good, however? Will it correct the mechanics that caused the pain? Likely not.

There are a number of ailments that can afflict the spine. For example, a disc bulge may be pressing on a nerve root. Arthritis may be developing between the vertebrae. There could even simply be a strain to one of the muscles supporting the spine. Any number of things.

Now, traction can be a fantastic tool for relieving the pain experienced by these conditions. Decompressing the spine would relieve how much the disc bulge is pushed on the nerve root. Arthritic changes inside the joint would become spaced apart and less agitated. Traction is even reported to alleviate muscle spasm.

So yes, spacing the vertebral joints apart can absolutely relieve symptoms of a myriad of back issues. However, has this done anything to correct the problem that caused those symptoms in the first place? Of course not. You haven't actually changed anything within the joints.

Spinal Rehab

Recovery from spinal conditions involves restrengthening of muscles, retraining proper motor habits, and stabilizing the joints to prevent future recurrence. True, traction is a great in helping to relieve pain just long enough to be able to move oneself through the recovery stages, but if the posture and biomechanics are not addressed, then recovery will not occur.

That being said, it should be important to know that, firstly, you need much more than traction to fix your back. Other aspects need to be considered. Secondly, once we address the roots of the pain and correct for them, there should be no reason why month upon month of traction is ever necessary. By moving through a proper rehabilitation routine, more results will be achieved in shorter time. In fact, research shows that traction is most effective in treating short-term, acute injuries.

In brief, traction is not a one-shot magic bullet. It's simply more of a painkiller. A painkiller that takes fifteen minutes to swallow while you're hanging upside down. Once in a while, it's worth it, but like morphine, don't abuse it. (For your wallet's sake.)

Acute Injury and Exercise - Don't Delay!

By this point, we all know that exercise is an important part of rehabilitation. However, many people seem to believe that exercise doesn't belong in the recovery process until a later stage in the healing process after the initial injury. I talked before about why resting hurts, but let's discuss this more.

It's fascinating to me to think that exercise shouldn't be priority in any injury state. If you think about it, it's really the only form of recovery that we, as human beings, are technically evolved to utilize. Cavemen didn't have massage and ultrasound. Heck, as recent as a few hundred years ago we were still putting leaches on our skin to cure fevers. At the end of the day in human history, people recovered because they continued to work their bodies and force their muscles, bones, and joints to adapt and heal. Modern-day modalities are fantastic, but they are just tools to aid the process. Movement, inherently, can do much more than these tools can.

Maintaining Motion

When we have an acute injury, no matter how simple or severe, continued movement and muscle contraction is key to recovery. If you tear a muscle or ligament, immobilizing the injured area is going to lead to further complications due to allowing the muscle to atrophy and inhibiting circulation to the area. Furthermore, avoiding movement does little to discourage your body to cease its spasm response.

Always, when I see a new injury occur, whether it's an ankle sprain, should sprain, or groin tear, I initiate an early-rehab process involving basic movement of the joints. If you roll you ankle, for instance, then you should still be flexing your foot up and down (within whatever range is pain-free) to promote proper scar tissue alignment and allow blood flow to the area.

When All is Gone

But wait, you say, what if the pain is so severe that any joint movement at all is agonizing? Well, then we modify. If  pain is severe, inflammation is incredible, and function is non-existent, then we still want to initiate the body's inherent healing response.

For example, if you have a massive groin tear and can barely move your leg at all, then we simply don't move it. That doesn't mean that we're not going to work it. If it takes putting a few pillows between your legs just to have you give them even the most minute squeeze with the legs to have some contraction in the injured muscle, then that's what we'll do. 

And what that will do, is more than you may think. Those contractions, regardless of how small, will allow the tissue to know which direction to align its healing fibers in. The pumping of the muscle will bring circulation to the area and help move excessive fluid and swelling out. Activating those muscles will also help and minimize the amount of muscle tone that is lost while movement isn't possible, decreasing the amount of secondary complications and rehab time later on.

Don't Wait

Hopefully you can see why delaying on exercise when an injury occurs will, certainly and absolutely, delay your recovery. By not partaking in some form of movement for rehab - no matter how big or small that movement is - you're allowing disorganised scar tissue to develop, letting the muscle atrophy and lose tone, and inhibiting blood flow and nutrients to the area. Exercise is always medicine. It always has been and always will.

Treat the Whole Chain - Necessities of Recovery

There's no manual on the human body. You can't just open a troubleshooting guide to find out how to fix a piece that's not working properly. As such, I'm not a fan of calling the body a machine. Rather, it's this moist, fleshy mass of tissue and organs that sometimes comes together to work properly. (Yes, "moist". Deal with it.)

How do I look?

That being said, when a piece breaks down and pain is experienced, we don't have the luxury of focusing our attention on that piece alone to try and correct the issue like car mechanics do. If one segment is out of whack, then, guaranteed, others are as well.

Compensatory Mechanics

We all know by now that, when injury occurs or bad motor habits are left unchecked, that the body will compensate by lengthening, shortening, tightening, and restricting in other spots; thus, maintaining functional integrity.

Because of this type of mechanism, spraining an ankle, for instance, means that the overall issue won't stay isolated at that one joint. Because of that sprain, the body will favour one side with a limp, resulting in a lateral hip weakness on the opposite side. That weakness can then be cause for poor knee tracking, SI joint instability, spinal tension, and more. And do these things require years of being unchecked to occur? No. Try a week or two instead.

Intervention

With that knowledge, how can we expect to correct the issues by only targeting the site of the most pain? Here's a good example of how working globally is a necessity when it comes to correcting dysfunction.

I have one client who had discomfort in their hip. We determined that there was an imbalance around the hips that resulted in one side becoming stuck in a hypomobile position. What we did, for the first treatment, was mobilize the joint manually, provide mobility exercise prescription, and then started working on stability for those lower-chain muscles surrounding the area.

So the hip felt great. However, what happened next was that the spinal erectors tightened up by the time of the next treatment. As we promoted more movement through the pelvis and began activating the hip and core muscles to stabilize the area, we were promoting more movement through the rest of the kinetic chain and creating more mobility through the entire spine at the same time. Thus, even though we were strengthening the core, we were also forcing the back muscles to start activating more than they were used to. As tone and tension increased in the lower back, the tension creeped up all the way to the top, exacerbating neck tightness as well.

Sidenote: When we're talking about headaches and 

pressure, we're usually looking at these guys here.

Does that mean we did something wrong during that first treatment? No. It just shows that the body can very effectively compensate for a dysfunction, but when you suddenly intervene in that dysfunction and start to return a joint to its proper mechanics, you need to keep providing similar retraining to the entire chain, both above and below that area.

Significance for Self-Help

These thoughts hold more significance that just for clinicians who are treating a client's injuries. The principals apply to every individual who is trying to address their own fitness and health. 

I talked about "foam roller syndrome" before and how a reliance on self-releasing only the site of pain on a daily basis signals that there are mechanical errors not being addressed. That's exactly what I'm talking about again here. If you are constantly experiencing lower back pain, then constant work on your lower back along will not fix the problem. Neck pain? You need to do more than simply stretch the neck muscles all the time. 

The point here reiterates the time-tested rule that you can't chase pain and expect to chase it away. When there is a dysfunction, it's important to look up, down, and away from the dysfunction and correct the kinetic chain as a whole. Zoning in on one spot will feel great on the first day, but if you stop the efforts there, you can expect the pain to return just as bad - or even worse - soon after.