It’s not to say that I know everything, oh god no. But here’s what I’ve come to understand so far in my senior year.
There are a lot of causes. Muscular, bony, disc, nerves (which could be from the disc). I’m definitely best at understanding muscular problems, that’s my favorite. Thankfully, at my level, if there are bony/disc/nerve problems, I’m not the only person to deal with it. Meaning, I do have to know when to identify that it’s not muscular), but I can send them for diagnostics and I work with doctors to figure out what to do. With muscles, it’s all me. So I have to understand the non-muscular things more, but it’s more often than not muscular.
So let’s move onto muscular.
- Gluteus medius weakness: Ok, if you’re not using your glute muscles correctly, then you’re going to use your abductors to do everything your glutes do, especially the glute medius because that’s going to be abduction AND hip rotation in different positions!! And when you do that, your abductors become very tight, which messes up your hips in terms of lateral tilting. Which then can cause back pain. Your quadratus lumborum, which acts to sidebend, could be affected because of that.
- Quadratus lumborum: I guess the best way to figure out what’s up with these is palpation! I just know with myself because I’m pretty sore when I roll on a ball or cup my back over the QL. This could be a big piece to the puzzle! I haven’t figured out exactly why yet, but I’m exploring that. It goes from your iliac crest → last rib and TP of vertebrae, so if it tightens or is weak, it could cause pelvic tilting, or…yea, still figuring it out.
- SI joint: This definitely isn’t muscular, but I’ve found that doing general hip exercises really helps, namely hip extension/abduction and rotation exercises. A lot of the back/hip extensors attach very closely to the SI joint, so if any of those are tight or dysfunctional, those might be pulled and very irritating to the SI.
- Tight psoas: So everyone knows the psoas as a hip flexor, which, if tight, leads to an anterior tilt. Correct, but people might forget that the psoas attaches to the lumbar vertebrae, so if tightened, it can lead to even MORE of an anterior tilt and back pain. I’ve learned two releases and a great stretch! The first release is to find the lesser trochanter, which are right between the adductor longus and the sartorius muscles pretty high up on the thigh. The second is the area between your umbilicus and your ASIS, you just feel around a bit til you find it. With both of those, you can have them actively or passively flex the hip, as well as rotate the hip when in a flexed position. The stretch is hard to explain, but basically — lay prone, with the affected side hip internally rotated, and the other side abducted to the side. When you push up into a cobra, you’ll get an amazing stretch on the psoas of one side. So try those!
My general exercise progression with back pain is definitely the glute bridges, with different varieties of hip/knee extension. I do some sort of dead bug/bird-dog/crawl that involves core stabilization as a sort of secondary. I do monster walks because the hip really needs to be strengthened a lot of the time, and then also fire hydrants and donkey kicks, making sure to stabilize the lumbar spine and not bend too much (using the core!!). That’s more SI joint, but hey, it’s still going to help them.
It’s very important to stretch the hamstrings, but here’s something fun I learned this year — let’s say you have tight hip flexors. So, your pelvic tilts anteriorly, which creates a pull on your hamstrings, leading you to think that you have extremely tight hamstrings, but you may actually not with a perfectly level pelvis. I mean, you might, but if your hip flexors are tight too, it’s way worse. So, that’s why I always suggest to stretch the hip flexors before the hamstrings. I also really like hamstring/sciatic nerve flossing, it really helps, and within a few pumps of my foot I really feel a difference.
Something I like to do is work on my hip hinges. I’m not sure if that’s entirely applicable to athletes, but it’s really helped me with my pain and helped me with my hamstring flexibility. Also, working on my lumbar spinal segmentation has been incredible. I used to have some more lordosis, but with the hip hinges/spinal segmentation practice, I’m way better, and I’m more pain-free. That doesn’t work for everyone, though.
Ooh, also — I’m stepping away from doing supermans and extensive/forceful back extension stuff, which is what my athletes tend to go to, instead of control. I should probably look into it more since I just heard one guy at a conference mention how bad they are, but hey, it’s worked so far.
I tend to forget that I’m pretty in tune with my body at this point. If I’m at the gym and my SI joint starts going (when it gets very point tender), I try to fix my hips by squeezing a swiss ball, then I do a ton of hip stuff and it usually gets better after. I tend to forget that when working with athletes, so instead of thinking emotionally, I need to think practically and logically. That’s something to work on for me, as well as doing more research, although I’m a bit lazy to do so prior to 2 big exams, so we’ll see after.
