When it comes to the low back pain patient, it’s common for the muscles that attach to the hip and pelvis (hamstrings, psoas, piriformis, and tensor fasciae latae) to be overly active or tight, while at the same time, the core muscles are deconditioned and weak. When it comes to managing low back pain, should patients focus on stretching the hip muscles or strengthening the core?
In a study published in 2020, researchers recruited 66 low back pain patients and assigned them to one of three groups: core stability exercises; hip muscle stretching; or gentle massage (control group). Participants performed their exercises three times a week for six weeks. While both exercise groups outperformed the control group in pain intensity, disability, balance, and quality of life, the stretch group had the greatest improvement in low back instability and hip muscle flexibility. However, the authors recommend patients engage in both forms of exercise to manage current neck pain and to reduce the risk for recurrence. So, what are some of the exercises/stretches one might use to strengthen the core and stretch the hip muscles?
Core strengthening exercise include: 1) Abdominal bracing: Tighten up the abs “like someone is about to punch you” 2) Side Bridge (Plank): Lay on the left side of your body with your left elbow/forearm on the floor under the shoulder (use padding), raise your pelvis up, supported by the forearm and feet. Repeat on the right side. 3) Supine Bridge: Lay on your back, bend your knees while keeping your feet on the floor. Raise your buttocks off the floor supporting your weight with your feet and midback (avoid head/neck pressure). 4) Straight Leg Raise from Prone: Laying on your stomach, place your head on your arms/hands. Contract your gluteus and hamstring muscles of the right leg and then raise your leg as high as comfortable toward the ceiling. Hold and then slowly lower the leg. Repeat on the other side. 5) “Bird-Dog” Quadruped: From four-point kneeling, contract your abs to stabilize the spine and then raise one arm and the opposite leg (parallel to the floor/ceiling). Alternate sides. 6) Prone Bridge: Laying on your stomach, bend you elbows with forearms on the floor arching the low back. Raise the pelvis into a front plank (or “push-up”) position balancing on the toes and forearms, keeping the body in a straight line.
Hip muscle stretching exercises include: 1) Hamstrings: Laying on your back, passively raise one leg with the aid of a helper (or actively on your own) until you achieve a firm, pain-free stretch. Switch sides. 2) Iliopsoas: Start by sitting on the end of a table, hang one leg toward the floor while bringing the other leg’s bent knee firmly to the chest. With the assistance of a helper, lower your body into the supine (on your back) position and then push the hanging leg further toward the floor to a firm stretch. Repeat on opposite side. 3) Piriformis: Laying on the back with hip and the right knee flexed at 90 degrees, push the leg inward as far as you can. Repeat on opposite side. 4) Tensor fasciae latae: Starting on all fours, extend the right leg backward so it is parallel with the spine. Rotate the foot outward and then move the leg left so the foot crosses the centerline of the body. Hold and then repeat on the other side.
Your doctor of chiropractic may recommend some of these exercises with or without modifications for the management of your low back pain.