Does Hip Range Of Motion Correlate to Low Back Pain? Maybe Not in Everyone

hip range of motion back painThe correlation between hip range of motion and low back pain is commonly discussed, though most people tend to agree that limitations or asymmetries in hip motion is a contributing factor to low back pain.  You can read a summary of some research on the correlation between low back pain and hip range of motion in a previous post of mine.  But while there are several studies that show this to be true, there are also some studies that show no correlation at all.  To me, this isn’t very surprising as you really need to assure adequate control of study methodology when designing a research project like this. Grouping several different body types, activity levels, and handiness (righties and lefties) as well as poorly defining “low back pain” can surely throw a wrench in your project and possible allow some false assumptions.

 

Does a Small Loss of Hip Motion Matter to Everyone?

Biomechanically, a loss of hip motion contributing to low back pain makes perfect sense.  Any lack of mobility of the hips needs to be compensated for elsewhere, and unfortunately this will likely occur in the lumbar spine.  The knee is pretty stable, I can see the foot and ankle also contributing, but realistically moving at the lumbar spine is probably going to achieve the person’s goal of rotating the pelvic region the easiest.  This is unfortunate as we would all rather rotate from our hips and thoracic spines rather than lumbar spines.

hip range of motion contribute to low back painWhen looking closely at the research studies that show correlations between lose of hip motion and low back pain, subjects with low back pain had ~5 degrees less motion of their hips.  That is a decent amount of loss of motion, but I’m not sure 5 degrees is limiting for all people.   What if the person you are working with doesn’t need to use their body in the end range of rotation very often?  I bet that the majority of sedentary people don’t really need full hip range of motion to perform their everyday activities.  Walking, for example, only requires approximately 15 degrees in hip and pelvic rotation, no where near full motion.  Yes, a large deviation in hip range of motion will likely be a problem in everyone, but would a small amount of loss of hip rotation impact everyone’s chances of suffering from low back pain?  Maybe not.

 

Hip Range of Motion and Low Back Pain in Rotational Athletes

hip range of motion correlate to low back painRecent studies have assess the correlation between hip range of motion and low back pain in rotational sport athletes, sports like tennis, racquetball, and golf.  To me, this is a much better study design using a specific population of people that need to function at their end range of spine, pelvic, and hip rotation.  One particular study that I thought did a great job with research design, methodology, and subject selection was by Van Dillen in a 2008 issue of Physical Therapy in Sport.

The authors examined 48 subjects that participated in rotational sports.  When comparing those with a history of low back pain to those without, subjects with low back pain exhibited significantly less motion of their hips and significantly more asymmetry between their two hips.  The rotation of their left hips were more limited than their right hips, though only 1 subject in the group was left handed, so I’m not sure if this finding is significant to me or not.

So far, studies looking at rotational athletes have all shown a positive correlation between hip range of motion and low back pain while other studies with less specific patient populations have showed less consistent findings.  So does this mean that tight hips correlate to low back pain?  In rotational athlete it looks like the answer is yes, but in sedentary people, maybe not.

Photo by StuSeeger

Assess All Factors

Regardless, I agree with the thought process of “why not” work on everyone’s tight hips anyway, but just food for thought when working with your next person with low back pain.  Resist the urge to go with what is trendy now and bark up the wrong tree.  Don’t just assume that because they have 5 degrees less hip IR on one side that this is the main contributing factor in their back pain.  Thoroughly assess each person before assuming that their loss of hip range of motion contributes to low back pain.

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  • Nick

    Hey Mike,
    Just thinking about your thoughts on the sedentary section and hip ROM. From memory, during sit-to-stand activities we can get close to about 30 degrees hip IR from low to moderate chair height. I would think a lack of 5-10 degrees in this situation with today’s lazier society in and out of chairs all day (including car seats) with weak glutes can cause some problems on the back and SIJ when we repeat it several times a day. Any thoughts? Guessing you might have some better reliable numbers of hip IR during sit to stand.
    Thanks again,

    Nick

    • http://barefootrehab.com Christopher

      I was thinking similarly Nick. First thing I thought of was sitting activities such as on a chair or on a toilet.

      Isn’t the real question, “Does your movement (whether ADL or sport) engage past an end-range muscle to further load another area of the body?”

      For example, many people can’t squat to 90 degrees without the “butt wink,” when hip flexion STOPS and lumbar flexion BEGINS. If their chair doesn’t engage excessive lumbar flexion to load the lumbar spine, then it may not be an issue.

      It seems to me that tennis or other rotational sports would engage the end range if hip rotation.

      Thoughts?

  • http://www.chrisjohnsonpt.com Christopher Johnson

    Mike,

    Great topic! We obviously need lots more research when it comes hip rotation and low back pain especially in light of all the emerging pain research. I do think that we need to be very careful using a 5 degree loss as a critical value as the research that we conducted at NISMAT (http://www.ncbi.nlm.nih.gov/pubmed/20557263) on the shoulder (albeit a different region of the body) showed that a 5 degree difference could easily be due to measurement error based on the limits of agreement. Nonetheless, assessing for hip rotation should be a routine part of the evaluation process for patients presenting low back complaints. Keep up the good work and it’s good to see the Sox pitchers on fire. Hope it continues.

    Cheers

  • http://KevinNeeld.com Kevin Neeld

    Mike-Great point about the need for separating specific populations to extrapolate research indications appropriately. I agree with the idea of working to improve hip ROM and function in everyone if any restriction presents, especially in high velocity rotation-based athletes. I also think it’s imperative to assess thoracic rotation ROM. While hip rotation restrictions will drive compensatory lumbar rotation in bottom-up movements, a similar relationship exists between the thoracic spine and lumbar spine in top-down movements. I see this a lot with our hockey players; the lumbar spine gets caught between two restricted areas and takes a beating in all rotation-based movements.

  • Tyler

    Great post! I have found clinically that patients with pathologies distal and proximal are missing hip IR ROM. While placing an emphasis on examination and assessment is important, I find it very confusing when choosing an intervention to address this deficit. Can anyone recommend some manual, ther ex, and/or HEP programs to help patients gain hip IR?

  • Steve Polley

    Love posts that get us thinking!
    When looking at specific groups of individuals… ie rotational athletes we must also ask ourselves why the deficit exists? Pitchers for instance will have considerable differences in rotation at the throwing shoulder compared to normal and left to right. I bet this is true of their hips. With athletes “normal” values have be used carefully.