A Simple and Easy Hip Mobility Drill for Low Back Pain

Low back pain continues to be one of the most common health complaints that limit people, especially as we age.  Rehabilitation of low back pain has transition from simply focusing on reducing the local pain to emphasizing a biomechanical approach of how other areas of the body, such as the hips, impact low back pain.

Essentially we have done a great job moving away from simply treating the symptoms and working towards finding the movement impairment leading to the low back pain.  Sure, using something like a TENS device may have a role to neuromodulate pain, but it is now common knowledge that the improvements seen are transient at best and not addressing the real dysfunction.

One area that has received a lot of attention, and rightfully so, is looking at limitations in hip mobility as a cause of low back pain.  Much of the research to date has focused on looking at the loss of hip external rotation and internal rotation mobility.  In fact, I have an older article on the correlation between hip mobility and low back pain.

I can say that my own ability to help people with low back pain has greatly improved as I’ve learned to focus on hip mobility over the years.


hip extension mobility low back painHip Mobility and Low Back Pain

A new study was recently published in the International Journal of Sports Physical Therapy that adds to our understanding of the influence of hip mobility on low back pain.  In the current study, the authors evaluated hip external rotation, internal rotation, and extension mobility in two groups of individuals, those with and without nonspecific low back pain.

While using a Thomas test to assess hip extension, the authors found the follow:

  • Hip extension in those with low back pain = -4.16 degrees
  • Hip extension in those without low back pain = 6.78 degrees

That’s a total loss of 10 degrees of hip extension in those with low back pain.


A Loss of Hip Extension Correlates to Low Back Pain

So now in addition to rotational loss of hip rotational mobility, it has been shown that a loss of hip extension correlates to low back pain.  To me, this has always been something I have focused on and makes perfect sense, especially as we age.

The vast majority of our society sits for the majority of the day and becomes less and less active as they age.  Among many things, this results in tight hip flexors and an anterior pelvic tilt posture.

Putting recreational activities like sports and running aside, this anterior pelvic tilt posture with tight hip flexors causes a loss of hip extension mobility and the low back tends to take the load but hyperextending.  This happens while simply walking and in a standing posture.

Think about the results above, people with low back pain have negative hip extension, meaning they can’t even extend to neutral!

As we all know, the human body is amazing and will compensate.  Hips don’t extend?  No problem, we’ll extend our spine more.

So a pretty easy step to take to reduce back pain is to work on hip extension mobility.

One drill that almost everyone that trains at Champion PT and Performance gets is what I named the “True Hip Flexor Stretch.”  I’ve talked about it at length in past articles, but I am a believer that most of our hip flexor stretches commonly performed in the fitness world are disadvantageous and not actually stretching what we want to stretch.

The True Hip Flexor Stretch is a great place to start to work on hip extension mobility:

As you can see (and feel), this gets a great stretch on your hip flexors without causing any compensatory low back extension.  And by focusing on posterior pelvic tilt, we gear this towards those with a lot of anterior pelvic tilt.


I really believe that the “True Hip Flexor Stretch” is one of the most important stretches you should be performing.  [Click to Tweet]


Next, Focus on Reducing Anterior Pelvic Tilt in People with Low Back Pain

Updated Strategies on Anterior Pelvic TiltI’m not a big believer that static posture is the most important thing we should all be focusing on when outline our treatment and fitness programs, but it’s a start.  Someone in an anterior pelvic tilt static posture isn’t always evil, and can be the result of many things such as poor core control, poor mobility, and even excessive weight.  I tend to care more about how well people move.

But based on the current evidence, it’s a great place to start.

Once you’ve started to gain some hip mobility, there is a ton more work to do.  We also have to work on glute and core control, among other things.  If you’re interested in learning more, I have a hugely popular Inner Circle webinar on my treatment strategies for anterior pelvic tilt that goes into detail on what I recommend:


In summary, we now have a nice study that shows people with low back pain have 10 degrees less hip extension that those without.  This makes sense, and focusing on hip extension should be one of the key components of any low back pain program.



4 Ways to Improve Overhead Shoulder Mobility

4 Ways to Improve Overhead Shoulder MobilityOne of the most common areas we attempt to improve in clients at Champion PT and Performance is overhead shoulder mobility.  If you really think about it, we don’t need full overhead shoulder mobility much during our daily lives.  So our bodies adapt and this seems to be an movement that is lost in many people over time if not nourished.

I’m often amazed at how many people have a significant loss of overhead mobility and really had no idea!

That’s not really the issue.  The problem occurs when we start to use overhead mobility again, especially when doing it during our workouts and training.  Exercises like a press, thruster, snatch, overhead squat, kipping pull up, toes to bar, handstand push up, wall ball, and many more all use the shoulder at end range of movement.  But here are the real issues:

  • Add using the shoulder to max end range of overhead mobility and we can run into trouble
  • Add loading during a resisted exercise and we can run into trouble
  • Add repetitions of this at end range and we can run into trouble
  • Add speed (and thus force) to the exercise and we can run into trouble


4 Ways to Improve Overhead Shoulder Mobility

In this video I explain the 4 most common reasons why you lose overhead shoulder mobility and can work on to improve this movement:

  1. The shoulder
  2. The scapula
  3. The thoracic spine
  4. The lumbopelvic area

The first three are commonly address, but not so for the lumbopelvic area, which is often neglected.  I’m going to expand on this even more in this month’s Inner Circle webinar.  More info is below the video:


Improving Overhead Shoulder Mobility

This month’s Inner Circle webinar is going to expand on this topic and discuss how and why you want to improve overhead shoulder mobility.  In this webinar I’ll discuss the importance of overhead mobility, how to assess the 4 most common causes of loss of mobility we discussed above, what corrective exercises to perform, and tips for manual therapy.  The live webinar will be on Monday April 20th at 8:00 PM EST, however will be recorded for those that can not attend live.




Updated Strategies for Anterior Pelvic Tilt

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Updated Strategies for Anterior Pelvic Tilt

strategies for anterior pelvic tiltThis month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt.  This is actually an update on one of my most popular webinars in the past.  I am doing a couple new things and wanted to assure everyone has my newest thoughts.  In this webinar I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises.  To me, it’s all how you put the program together.  My system builds off each step to maximize the effectiveness of your programs.

Are We Missing the Boat on Core Training?

A lot of attention has been placed on core training over the last several years, both in the rehab and fitness industry.  I recently watched my friend Nick Tumminello’s latest product Core Training: Facts, Fallacies, and Top Techniques and it made me think (more on Nick’s product, which is on sale this week, below).

We’ve made exceptional progress in our understanding of the core and have shifted away from isolated ab training to integrated core training.  My DVD with Eric Cressey on Functional Stability Training for the Core discussed this at length and showed a nice system to effectively train every aspect of the core.

However, the more I read on the internet the more I wonder if we are still missing the boat a little bit.  I’ll chalk this up as a another pendulum swing, but while we have progressed away from isolated abdominal exercises like sit ups, I wonder if we have swung too far to an extreme and started to focus only on isometric anti-movement exercises for the core.


Anti-Movement Core Exercises

Realistically the core helps stabilize the body and allow a transfer of energy.

Anti-movement exercises, such as planks for anti-extension, should be the foundation of the basic levels of core training.

Plank - core training

Once your baseline ability to maintain an isometric posture with the core is obtained, the next progression is to control limb movement with a stable core.  This involves combining upper body and lower body movements while maintain a stable core.  An example of this would be an anti-extension drill with TRX Rip Trainer.

However, the core does need to “move” during normal function.  It rotates, bends, flexes, extends, and all of these at once!  Should we train this?


Don’t Forget the Trunk is Designed to Move

I would say we should.  I think the difference here is to train these movements within a stable range of motion.  We should be training the body to work within it’s normal mobility, but to stabilize at end range of motion.

We get into problems with core movements, like rotation, when we depend on our static stabilizers, like the joints and ligaments, to control end range instead of our muscular dynamic stabilizers.

Perhaps the goals should be to train to control the core at end range of motion.


End Range Core Stability

These types of drills would include chops, lifts, push-pull movements on a cable or Keiser system, and medicine ball drills.  You are probably doing these already, right?

They all involve a transfer of energy from the limbs through the core.  The core needs to move during these exercises, but you are working in the mid ranges of motion and controlling end range.  These should also progress to include functional movements patterns like swings, throws, and kicks.

In the video above, I combine the act of throwing and decelerating in the half kneel position.  This takes the lower half out of it and requires the core to stabilize.

I guess the point is that we shouldn’t be afraid to move the core.  That is not beneficial to teach our patients, clients, and athletes.  Rather, train the core to move and stabilize at end range of motion to take stress off the structures of the spine.


Core Training: Facts, Fallacies, and Top Techniques

If you want to learn more about training the core, Nick’s program Core Training: Facts, Fallacies, and Top Techniques is on sale this week.  I watched Nick’s presentation last week and enjoyed it.  Nick does a great job discussing some of these concepts.  Click below for details:


Base of Support and Core Stability

I work with with a lot of youth athletes, especially baseball players.  I am often amazed at how some of our younger athletes have such poor movement skills.  Many are 6 inches away from touching their toes!  I’m sure this is a trend this is not going away as our society spends more and more time staring at our iPhones and less on long term athletic development.

The body is great at compensating and finding the path of least resistance.  Here is a quick tip that you can apply to many different exercises to enhance core stability.


Base of Support

When the core and entire lumbopelvic region has poor motor control and stability, especially in the transverse and frontal planes, a way the body likes to compensate is by widening the base of support.  Here is an example of a young athlete performing a medicine ball chest pass.  Notice his base of support in the first photo.  This was his natural set up position.

Base of Support


By widening his base of support, he can likely generate more power during the exercise by making it more stable in general.  However, in a training environment, I want to assure that we develop both power and control.

By narrowing his base of support, as you can see in the second photo, he has to stabilize his core during the exercise and work on developing power while controlling the force of the ball.  This is going to have a more functional carry over into his sport.

Building athletes isn’t always just about strength and power, it’s also about movement quality and control.  Watch for compensations at the base of support for signs of poor lumbopelvic and core stability.



A New Exercise for Shoulder, Scapula, and Core Control

Today’s post in a guest post from my friend Tad Sayce, who is a strength coach in the Boston area that specializes in swimmers.  Tad shares a great exercise video that works shoulder, scapula, and core control.  I’m a big fan of “big bang for your buck” exercises that promote strength and stability in one exercise, which is something we talk a lot about in Functional Stability Training.  Tad came up with one that I am going start trying with my athletes.

Band Resisted Horizontal Abduction with a Press

As a former competitive swimmer, I can closely relate to the overhead athlete and the complications that can arise at the shoulder. As a strength and conditioning coach working predominately with swimmers, I am constantly looking to improve the durability of the shoulder. It is widely accepted that the shoulder operates at maximum efficiency in the presence of a stable base at the core. While I am a believer in the use of isolated exercises, today’s focus will be that of a more integrated effort. The video below demonstrates an exercise that facilitates shoulder, scapular and core activation: Band Resisted Horizontal Abduction with a Press. 

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As the name implies, the exercise combines resisted horizontal abduction with an anti-rotation press. It is encouraged to first master each exercise in isolation before attempting to combine them. This exercise is great for educating athletes about proper scapular movement, and also demonstrating the ability to maintain position in the presence of increasing tension. I particularly like this exercise because it incorporates both dynamic and static efforts. I typically program this exercise for sets of 5 holding for 5 seconds, or sets of 8 holding for 2 seconds.

About Tad Sayce

tad-sayceTad Sayce, Head Coach and Owner of Sayco Performance Athletics, located in Waltham, MA. Tad is a Strength and Conditioning specialist with a strong interest in the sport of swimming. Formerly, Tad was a competitive swimmer in the Big 10 Conference and Olympic Trials qualifier, as well as a USA Swimming club coach.  For more information please visit

Cueing the Core to Enhance Shoulder Elevation

cueing the core during shoulder elevationFor today’s post, I wanted to show a video of a correction I performed on a recent patient during his shoulder program exercises to engage his core and improve his ability to elevate his arms. Many people are hyperlordotic. Combine this with stiffness in some of the glenohumeral muscles (like the teres major) and the thoracic spine, and you often see people compensate during arm elevation by hyperextending the lumbar spine.

Here is a quick video showing how someone may hyperextend the spine with simple arm elevation exercises, such as a full can exercises, and how cueing them to engage their core corrects the movement.  By cueing the core, this will allow the shoulders and scapulae to full engage and begin to upwardly rotate, instead of just elevating and letting the lumbar spine allow the rest of movement.

Look for this in your impingement patients too, as this may be part of the faulty movement pattern that is associated with their superior humeral head migration.

Many people will want to perform an abdominal crunch, but there should be no lumbar spine flexion. Rather, simply engage the core and not allow lumbar extension from it’s neutral starting position.  Needless to say, you will have to follow up on this with some ant-extension exercises in general, but this is a great cue to integrate into your shoulder exercises.

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5 Mobility Issues Preventing a Consistent Release Point

consistent release pointMost people know that one of the keys to successful baseball pitching is a consistent release point.  This is a point that is driven home by coaches all the time.  Most people focus on your arm slot, for good reason.  Many times inconsistency in your arm slot can be the major cause of poor biomechanics and difficulty repeating your delivery.   I see this a lot in young baseball pitchers that are trying to tweak their mechanics and pitchers that may have discomfort in their shoulder or elbow and are trying to take some pressure off the sore area.

However, the act of throwing a baseball is a sequence of kinetic chain events that ultimately lead to your release point.  There are several factors with your lower body and core that may be altering your arm slot and  leading to an inconsistent release point without you even realizing.


5 Mobility Issues That May Prevent a Consistent Release Point

In this article I will discuss 5 issues that may be preventing a consistent release point while pitching.  There are several areas that can be causing inconsistency,  but I wanted to focus on mobility and stability issues that you can address.

If you have mobility or stability concerns in your lower half and core, your body is going to make the adjustment with your arm in order to throw a strike.

This is far too common and one factor in injuries in my opinion.  These compensations are going to lead to wear and tear as well as decreased performance.

It is going to be difficult to make adjustments to your mechanics before cleaning up and mobility or stability concerns.  Otherwise, you are kind of running up hill (or should I say throwing up hill?) trying to make mechanical adjustments on top of dysfunction.


Inconsistent Lead Knee Flexion and Trunk Flexion

release pointA very interesting biomechanical study was conducted by ASMI that looked at biomechanics over the course of a game to see if arm slot and a consistent release point changed.  What they found was pretty interesting.  Over the course of a game as the pitcher became tired, there was no change in arm slot at all biomechanically.  In fact, there were relatively little biomechanical changes over the course of a game.  However, they did find two things – a decrease in lead knee flexion and a decrease in trunk flexion.

As baseball pitchers get tired over the course of a game, their bodies are more upright.

This leads to a higher and inconsistent release point, but it has nothing to do with the pitcher’s arm slot.  Their arm slot was the same, but their release point was higher.  This is a very important factor in understanding why a pitcher leaves his pitches up and has trouble getting the ball down in the zone late in the game.

This really demonstrates the importance of a few things:

  • Lead leg quad  and hip strength
  • Lead leg quad and hip endurance
  • Lead leg single leg stance stability

In addition to strength and endurance, I will also incorporate basic lunges onto an unstable surface, such as below, and progress to more dynamic activities over time.

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I also work on low back and posterior chain endurance and stability.  Here is an example of a drill to work on a consistent trunk flexion angle.  The bands create a force trying to pull the trunk forward, creating a need for the body to stabilize.

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Restricted Lead Hip Mobility

Another issue with the lead leg involves mobility as the baseball pitcher’s body rotates and transitions their body weight from the rear leg to the front leg during arm cocking and acceleration phases of throwing and then release the ball and travels into the arm deceleration and follow through phases.

During this movement, the body must rotate over a planted lead leg into a position of hip flexion, adduction and internal rotation.  This is a challenging position to achieve and goes against our postural adaptations, so many baseball pitchers struggle to “get into their lead hip” in this fashion.

Any limitations in lead hip mobility is going to prevent the pitcher from closing their body.  This can cause them to fly open, become more rotational, have their arm drag behind their body, or to decelerate with more of their arm and less of their lower half.  All of these are not good things!

I use several drills and emphasize this “getting into your hip” position.  Here is one basic mobility drill to encourage this hip mobility.  The athlete stands in a split stance similar to their release point and rocks in and out of their hip.  The coaching cue here is to pull your lead leg back into your hip.

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For those that have more restrictions and can’t get into their hip well, they may need more posterior hip stretches, such as shown below.  One thing of note is that I want the lead leg that you are stretching close to neutral rotation.  It’s hard to get into this position without going into hip external rotation, but I do not want the hip externally rotated like you see in many common runner stretches.  You can alter the area of mobilization but changing your body angle to the side and forward until you feel it in the rear of your hip.

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Restricted Rear Hip Mobility

Most pitchers realize that stride length is going to have an effect on release point.  While stride length often times is due to other biomechanical and timing issues, there is a potential for rear leg adductor tightness (groin) altering your stride length.

In my experience, this tends to occur more when there is a groin or hamstring injury in the rear leg or in the pitcher with hip impingement.  I have even seen some pitchers with chronic MCL issues on their rear leg, especially in those with aggressive toe drag.

These concerns will obviously have to be addressed, but there are some general hip mobility drills that you can perform to maintain and enhance adductor mobility in the rear leg.  Here are two basics that are easy enough to add to your movement prep and dynamic warm up, adductor foam rolling and mobilization.

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Poor Rear Leg Stability

In addition to restricted rear hip mobility, the rear leg also has to stabilize the weight of the body at the top of the wind up when the lead leg reaches peak height.  While this seems fairly basic to most people, it could be the equivalent of doing 200 single leg stance exercises for a starting pitcher if you include warm up.  Your balance point at the top of the wind up is essential for the proper sequencing of the rest of your delivery.

Top bring physics into the discussion, your balance point is also where you start developing potential energy and transitioning to kinetic energy.  To illustrate, when you draw back a bow you are building up potential energy to shoot an arrow.  The more you pull back, the more energy you develop and eventually transfer to the arrow.  Losing rear leg stability is the equivalent of drawing the bow back half way.  You will lose some of that energy and force that you want to put behind the ball and direct towards the plate.

So, any issues with rear leg stability could lead to issues with power development, timing, and sequencing through the rest of the delivery requiring your arm to “catch up” to find the correct arm slot.  This can be seen in people drifting and even some that drop-and-drive.

In addition to lower half strengthening exercises, I try to incorporate balance as well.  Here is an example of just some basic single leg balance on an unstable surface.  The foam pad simulates the decline of the mound.  The goal is to pause at the top, maintain balance, and then control your body lowering back down to the start position.  This is a quality over quantity drill.

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Poor Core Control

As you are probably noticing, developing force towards the plate is a common theme in this article.  Any energy leaks away from the plate are going to alter your mechanics and take away from your potential.  Poor core control is one of the most common energy leaks I see, especially in young and/or loose pitchers.  Core control seems to take longer to develop in young athletes, even as they get strong.  Perhaps it has to do with growth spurts, but regardless, it appears that younger athletes have difficulty controlling their core during functional activities.  Add the speed of pitching into the mix, and this core control is challenged even further.

For the loose athlete, they tend to rock back onto their joints to gain stability to make up for poor core dynamic stability.  In the core, this is often seen in pitchers that arch their back significantly while pitching.  This is often lack of anterior core control, taking your momentum away from the plate and becoming more rotational.  This can alter your arm slot and put significant stress on not only your arm, but also you low back.

There are a lot of anti-extension exercises, such as planks and dead bug sequences, that should serve as the basic foundation for this core control.  But once baseline core control is established, I tend to try to get the athlete in more specific positions.  Here are a couple of anti-extension exercises in the stride position.  The bands are pulling into extension, requiring the body to provide anterior core control.  I will progress to then use a TRX Rip Trainer so that I need to prevent a combined extension and rotary force.

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Before you start focusing on your arm slot to train a more consistent release point, make sure you have adequate mobility and stability below.  I always recommend a thorough evaluation combined with manual therapy and some of the corrective strategies above (My Functional Stability Training series has many more examples of these drills and more).  Don’t forget that you may have some mobility and stability issues with your lower body and core that may be causing and inconsistent release point and making it difficult to repeat your mechanics.





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