Ever had low back pain?  80% of the population has had it at least once in their lifetime or will have it at least once.  It is one of the most common diagnoses out there. It can range from people who are sedentary and don’t exercise to those who are very active.

The list of causes is very long, and typically, there is never one cause and effect for low back pain.

You may have lifted something heavy off the floor at the gym, and you “tweaked” your back, but that one instance probably had multiple precipitating factors over the past week/month, etc. that lead up to that point.

For those who are active, whether it be an organized sport, recreational sport, or those just looking to move and feel better by going to the gym, it is very common to experience.

In this 4-part series, we will discuss 4 Unconventional Tips to Help Bulletproof Your Low Back.

For today’s post, I wouldn’t say this is “common knowledge”, but one that is more familiar than the rest of the posts in this series.

Mobility

Now, before the DM’s and emails start rolling in about how even people with great mobility can experience low back pain, this is only a piece of the puzzle.

There are athletes and people…

• who can have the worst mobility and not experience low back pain.   

• who can have the best mobility and experience low back pain.

• who can have the worst mobility and experience low back pain.

• who can have the best mobility and not experience low back pain.

With all 4 of those statements, you’re probably asking, “Then Why Does Mobility Matter?”

Studies have shown a correlation with limited hip and thoracic spine mobility to low back pain.

Anecdotally, those with low back pain are MORE common to have limitations in hip and thoracic spine mobility.  Not all, but it is very common.

With that being said, what are the areas at the hips and spine that we want to look at it/assess for sufficient mobility?

Now, this is going to vary from person to person depending on what they want to accomplish. Whether it being able to go to the gym and train or perform at a high level in a specific sport, there are certain mobility prerequisites.

For the brevity of this series, we will keep it to the general population.  If you are an athlete who plays a sport, you are most likely going to need more mobility, but you need to be able to control that mobility as well.

Thoracic Spine Mobility

With the thoracic spine, sufficient mobility in this area is key to being able to twist and rotate.  If the thoracic spine can’t move, physical stress will be delegated and concentrated to other areas of the body, i.e., low back, etc.

When looking at the thoracic spine for mobility, I like to look specifically at Quadruped Extension Rotation.

With this test, I like to see the angle of the trunk achieve approximately 45-50 degrees compared to the horizontal/vertical.  So when you start the movement, that is considered 0 degrees. Completely vertical would be 90 degrees. Approximately halfway is sufficient.

Now, someone may look like this:

But, have full mobility:

This is a conversation for a separate post on thoracic spine mobility.

If there isn’t sufficient mobility, then drills such as:

Sidelying Rib Roll

Sidelying Thoracic Rotation

A-Frame Thoracic Spine Mobilization

Now that the thoracic spine has been addressed let’s make sure we look at hip mobility.

Hip Mobility

The hips have many motions ranging from flexion/extension, abduction/adduction, circumduction, and internal/external rotation.

All the motions have their place in an assessment, but for today’s post, let’s look at flexion/extension and internal/external rotation.

Hip Flexion is the movement where you are bringing your knee towards your chest.

Hip flexion is important when squatting and deadlifting.  Sufficient hip flexion is needed to be able to get into normal daily life movements as well as for sport.  Someone may not need full hip flexion for a particular sport or to be able to train, but someone should account for mobility limitations and adjust their training accordingly.

If full hip flexion isn’t present, make sure to seek out a licensed medical practitioner to see if it is something that can be addressed.

To structure your training program accordingly, squatting to a depth that you have available mobility in.  Limited range of motion squats or using a box can help with that.

Goblet Squat to a Box

Low Bar Back Squats to a Box

Or any other squat movement to a box that allows you to use your available range of motion but doesn’t have you driving into ranges of motion that you currently don’t have.

The opposite of hip flexion is hip extension. Hip Extension mobility is important as you are finishing a squat or deadlift OR when propelling oneself in a sport.

To assess hip extension, I like to use the Thomas Test.

Thomas Test

Key Points:

• Bring one knee up over your hip.

• Relax and let the other leg drop down towards the ground.

• Thigh should reach the table, knee in line with the hip, and knee bent to 90 degrees.

If you can’t achieve this, try performing self-myofascial release to your hip flexors, quads, etc.

Self Myofascial Release

Mobility Drills such as:

½ Kneeling Hip Flexor Stretch

Key Points:

• Maintain a straight line from your ear to your shoulder, hip, and knee.

• If you can’t feel a stretch, squeeze your back glute, press down into your front knee with your hands, or tuck your tailbone.

½ Kneeling Couch Stretch

Key Points:

• Maintain a straight line from your ear to your shoulder, hip, and knee.

• If you can’t feel a stretch, squeeze your back glute, press down into your front knee with your hands, or tuck your tailbone.

Two other directions of importance are Hip Internal and External Rotation.

Hip ER/IR

Hip Rotation in either direction is key to allowing the hip to be able to move during daily life movements as well as when training in the gym.

This is a little bit more challenging to measure on oneself, but I typically like to see 40 degrees of external rotation (ankle going towards opposite leg) and 30 degrees of internal rotation (ankle going away from opposite leg.

An easy when to check for hip external rotation is to see if you can bring your heel halfway up your opposite shin. That is a rough estimate for 40 degrees.

If you find you are limited in either direction, self-myofascial release to the posterior gluteal musculature and the lateral gluteal musculature can help.

Self Myofascial Release Hips

Mobility drills that can address these areas consist of:

90/90 Hip ER/IR

Key Points:

• Front Leg should be at 90 degrees at the knee and hip, same with the rear leg.

• Keep an upright trunk position. Stretch should be felt deep in the hip.

• When working on the rear leg, don’t lean back. Open up chest towards rear leg.

• This can be done dynamically for 5-8 reps x 5 sec holds or 30 sec holds.

Quad Hip ER Mob

Key Points:

• Place ankle behind the opposite knee.

• If the left ankle is behind the right knee, keep a flat back and push your hips towards approximately 7 o’clock. 5 o’clock if going the other way.

• This can be done dynamically or statically, as mentioned before. If you don’t feel a stretch, try going towards 6:30, 7:30, 8, etc.

Those few areas of mobility, hip extension/flexion, and thoracic spine mobility, are just a few of the important areas for mobility.  Hip rotation is also key, but make sure to check these first to help.

If you are dealing with low back pain, make sure to check your hip and thoracic spine mobility so that your body isn’t delegating that stress to just the low back vs throughout the chain.