Does Hip Range Of Motion Correlate to Low Back Pain? Maybe Not in Everyone
The 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.
When 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
Recent 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.