Hip Openers for Lower Back Pain

Research shows that around 75-85 percent of the American population experience back pain in their lives (Neurol Clin.,2007;25(2):353-7). Contrary to much investigation into inflammation (such as arthritis) and more serious conditions, most of the root cause is understood to be structural and mechanical in nature – affected by the way we move, live and use our bodies day-to-day.

Those with sedentary jobs have higher incidence and less when they move around regularly (Indian J Occup Environ Med. 2016;20(3):125-128). Much sitting on chairs can shut down the natural outward range of motion (ROM) in the hips and alter the natural ‘C-curve’ of the lower back, creating a compression into the discs of the lumbar spine (the lower back) whether we tend to sink into a forward or backwards placed pelvis. Chair sitting and sofa slumping has replaced sitting on the floor, often cross-legged or with legs bent to one side on the ground in ways that our musculo-skeletal system evolved.

These body settings on the ground work alongside our most comfortable and efficient distributions of force, where healthy hip rotation is part of how the upright weight of the upper body is spread most easily down the legs. We are designed to walk for long distances, with a naturally rocking, figure-of-eight motion throughout the lower back, our leg motion dropping into a natural rhythm with the hips and pelvis.
When we consider the known stress-relief that walking naturally brings, as well as strengthening the relationship between the lower back and hips, there are double physical and emotional benefits to avoiding sedentary habits. This can be getting up often when we have to sit to work, but also limiting the time that we do.

A 2005 study had followed a group of 46 patients (and a control group of 49), that through disc injection and magnetic resonance imaging (MRI) they had predicted who were most likely to develop back pain, simply according to structural evidence. All were pain-free at the beginning and over four years, they were followed closely – both physically and psychologically. This was the first such research to follow asymptomatic subjects (in terms of back pain; some had chronic fatigue syndrome and some had undergone cervical surgery) and the results surprised the researchers; psychological factors more accurately predicted who would develop lower back pain than the two diagnostic techniques. Those patients with poor coping skills - as measured by psychological testing - or with chronic pain were nearly three times more likely to develop back pain compared with those with neither (Spine J., 2005;5(1):24-35).

This correlates with the yoga system, where it is viewed that we store much of our trauma and unresolved issues into the hips and belly. It is anecdotally known amongst teachers and practitioners that opening the hips can create an emotional and even transformative release, which needs to be held with compassion and awareness of gentle, progressive opening. ‘Hip openers’ in yoga can often be practiced with an ambitious attitude that forces hips beyond their natural ROM, so finding a teacher that allows individual exploration can help work alongside the needs of your lower back and your emotional landscape, so very often intertwined.

Within sport, there can be less of a focus on the hips. Our hip flexors are the group of muscles that allow the rotational movements of the top of the thigh bone into the pelvis. They tend to receive less attention that other muscles groups in sports as they cannot be seen, but motion that dominates forward eg running or cycling, with little attention to hip flexibility can create tightness that pulls on the lumbar spine (vertebrae L1-L5).

Tight hip flexors can destabilise the lower back and create pain in many ways, one common route is via a forward pull on the pelvis known as an anterior pelvic tilt or ‘banana back’. This can turn off the opposing muscle group, the gluteus maximus (buttocks) leading to muscle imbalances. Creating length in the surrounding muscle and fascia (connective tissue) has shown to reduce back pain and hip ROM (J Can Chiropr Assoc., 2014;58(4):444-55).

Hip lubricating sequence

You’ll notice this practice session hasn’t been named a ‘stretching sequence’. This is a clear choice; rather than simply pushing into the joint complex and forcing an opening that may well increase tension held there, coaxing out movement creates deeper release without compounding stress or injury.

In this mainly floor sequence, the body is held instead of the downward pressure of having to standing ourselves up through the hips against gravity. This can be a great precursor to stronger standing exercise or yoga practices, where this intelligent preparation can lead to space up through the pelvis and lower back that can be felt as a lightness lifting up from the ground.

Loosening and exploring the hips and lower back

Laying on your back, draw your knees into your chest, placing your hands onto each knee. With knees together, move them away from your head and out to the side, then drawing back up together at the chest. Then rotate in the opposite direction; out at the chest and back in and up the mid-line. Feel free to explore in any way that feels loosening, releasing in the face and jaw at the same time for whole-body tension relief. From the initial position, you can then roll and massage the lower back with your body weight in any way that feels right.

Following the feelings

From the first position (Constructive Rest) spend a good few minutes allowing the lower back to settle, feeling the breath dropping into the belly to foster awareness around the pelvis. Then take one foot off the ground – feeling rooted with the other – and begin to move the leg in any way that feels lubricating into the hip socket. You can lift up the other side of the pelvis to move in any way at all. Take as much time as feels right before lengthening the leg up above its own hip, bending the knee as you need. Move to the other side and feel out how that may have different needs for freeing up the tissues and creating pliability into the hips and lower back.

Full fascial rolls

Come back to centre and stack the arms up above their own shoulders. Then let the right knee drop out to the side without adjusting the foot, whilst lifting the left arm and shoulder up to the ceiling and turning the head to the right. Move back through the central position and to the other side, then alternating to create full motions through the fascia up through inner legs, hips, spine, shoulders and neck. In this way we can free how the body organises itself naturally – in unison, rather as separate parts as we can do when stress makes us more rigid and less fluid. Feel free to explore whatever movement feels good along the way.

The piriformis

Stretching muscle can be more beneficial after moving around joints, here we deepen into the piriformis, one of the rotator muscles around the buttock that hold much tension, particularly through running or cycling. From the side, it is midway between the base of your spine and the front of your hip. You can start doing this lying close to a wall with the left foot onto the wall, knees into the chest as far as comfortable in the hips here. Then lift the right leg to bring the outside of its ankle to the top of the left thigh. Rather than twisting the hips to move the right knee away from the head, rotate out the right thigh bone in the hip socket within your natural range of motion. A piriformis stretch can feel very deep, so breath with any intense sensations to allow them to move through, instead of tensing against them and then move to the other side.
A deeper version is drawing the knee closer into the chest and interlinking the fingers around the front of the left shin (or back of that thigh for a less intense stretch) when moving into the right buttock. You may need something under your head if tightness in the hips translates up into the shoulders and make your head tilt back.

Opening across the front of the hips

Opening the front of the hips after rotating helps to encourage happy sitting of the pelvis when upright.
• From a sphinx-like position, elbows under or forward of the shoulders (where you lower back does not feel ‘pinched’), spend some moments breathing to lift the chest and up through the shoulders.
• Inhale in the first position and then exhale to draw up on knee – inner leg on the floor – to look at that knee and open through the front of the opposite hip and side body.
• Inhale back to the centre and then exhale to the other side, alternating with the breath and coming back to the position up on the elbows.

Child pose

After a backbend, lengthening out the spine in downwards-facing dog (inverted ‘v’) also creates length at the sides of the hips. From all fours, tuck under the toes and press up from the hands and draw back the tops of the thighs. From here you can drop into a child pose for a passive drop into the hips, where the lower back is broadened by the thighs dropping down. You can come right to the ground with head forward or support your chest with bolsters for a longer stay – head to one side here and changing direction halfway through. Fully breath into a sense of surrender and release.

Charlotte Watts runs regular workshops. Click here for further information.