According to the NIH, Americans spend at least $50 billion each year on low back pain. Additionally, back pain is the most common cause of job-related disability and a leading contributor to missed work. Now, I’m not sure how many of your hard-earned dollars make up that $50 billion or how much of your PTO you want to use for your busted back, but I figured I’d share some basic knowledge on how to avoid both situations.
In previous MOTWs we’ve discussed at length the different curvatures of the spine and the important role they play in posture, force transfer, and overall functionality. Today we will address how proper utilization of the hips and posterior chain muscles (spinal erectors, glutes, hamstrings, calves) can spare the spine from injury.
One of the reason that so many people end up in the doctor’s office or on a PT treatment table is because we’ve adopted improper movement patterns, and our hips and spine have begun acting like they don’t even know each other. While it’s possible to injure your back while performing any number of motions, I want to discuss the dreaded forward bend. Remember back many moons ago when you were actually able to touch your toes? Yeah, that’s a forward bend. Forward flexion of the spine is not in and of itself dangerous, it’s when we perform this movement repeatedly, improperly, and under load that things start to get messy. The common tale of woe that we as PTs hear is that of the low back blow-out from picking up a pair of socks, or a pencil, or some other seemingly innocuous but apparently deadly item. Clearly it wasn’t the weight of that single pencil that did you in, so what the heck happened?
An analogy I like to use is the paperclip. As kids, we all attempted to bend and mold paperclips into one shape or another, fashioning lock picks that never worked or retainers that really shouldn’t have been in anyone’s mouth. Certain portions of that paperclip bent easier than others, and we’d focus our efforts on those points of weakness. Your spine does the same thing. When we bend and extend, our body takes the path of least resistance. When poor movement patterns develop, the force is directed at any weak points that may exist in the spine, and like the paperclip, it bends until it breaks. These weaker areas tend to be at the ‘transitional zones,’ aka the three areas where the different regions of the spine meet; cervical-thoracic junction, thoracic-lumbar (thoracolumbar) junction, lumbar-sacrum (lumbosacral) junction. This is why so many people report injuries such as disc herniations at L5-S1, the lowest lumbar and highest sacral vertebra. Whether or not this is actually causing their pain will be left for another article. If you consider the number of times we bend forward to brush our teeth, wash our face, or pick up anything, you immediately see how easy it is to get injured over time if poor movement strategies are employed.
Here’s where the hips come in. We have HUGE muscles on the back-side of our body, along with an incredibly sturdy ball-and-socket joint at our hip, that when used properly are capable of generating tremendous amounts of force and allowing for safe forward flexion movement. Despite what Kim Kardashian might tell you, big booties are good for more than just making money and garnering Instagram followers. Enter: the hip hinge. The hip hinge is a fundamental movement that allows for safe forward flexion. It restores the appropriate relationship between the spine and hips, and recruits muscles that are better suited for the task. A proper hip hinge is initiated from the hips, requiring no spinal flexion, and places the majority of the stress on the large, strong posterior structures of the legs and back (glutes, hamstrings, calves, and spinal erectors). This shifts the burden away from the smaller stabilizing muscles and structures of the back that are often strained when that pencil suddenly takes on the weight of Thor’s hammer. Additionally, load is shifted from away from the knees and onto the hips, as the hips become the axis of rotation. To perform a proper hip hinge, the spine remains in a neutral position, braced by the core and spinal erectors, as the trunk moves forward via bending at the hips. This neutral positioning of the spine is imperative in order ensure back safety. During this movement the knees are relatively silent, maintaining the same amount of bend throughout and not moving forward at all. In order to not fall on your face as this hinge is performed, the hips are pushed backwards (in a squat the hips would go down via hip and knee flexion) to offset the weight of the torso. It is this posterior weight shift that places tension through the large muscle groups of the back of and legs.
Now, I’m not trying to teach you proper deadlifting technique in this article, though correct hip hinging form is undoubtedly a pre-requisite for safe and successful completion of the deadlift. I am however attempting to teach you a basic fundamental movement pattern that we should employ every day, whether we’re washing our face or at the line of scrimmage anticipating the next play.
Check yo’self: Grab a broomstick or the like (swiffer stick, PVC pipe, dowel, etc) and hold it behind your body as pictured in Image 1. Your top arm should be in contact with the back of your neck while holding the broomstick, and your opposite arm should be bent behind your back, holding the broomstick and maintaining contact with your lower back. In this position the broomstick should be touching the back of your head, your upper back, and your sacrum, and your head should be in a neutral position with your chin slightly tucked. By keeping the broomstick in this position for the duration of the hip hinge you are ensuring proper spinal alignment and preventing rounding of the low back. I don’t care which arm goes behind your head and which goes behind your back, although shoulder joint restrictions may dictate which arm you place in each position. If you’re in that busted shoulder category, read my post from last week and get in to see someone before your arm falls off.
Once you’ve got that broomstick positioned appropriately I want you to slightly bend your knees; you’re going to keep them in this position for the duration of the hip hinge. They should not bend (past their starting position) or track forward as you perform the movement. From here, you’re going to initiate the hip hinge by pushing your hips and butt backwards, ensuring that contact is maintained between the dowel and the back of your head, your upper back, and your sacrum. Your hands should remain in contact with the back of your neck and low back, and your head should remain in that neutral alignment, slightly tucked. If contact is lost at any of these points it means that you’ve lost that neutral spine and you’re setting yourself up for a trip to Painsville. I cannot emphasize enough the importance of maintaining that neutral spinal alignment and preventing your low back from rounding. To return to an upright position, use those glutes and maintain a gentle contraction of your abs. As we discussed last week, you should be able to breathe freely throughout this entire movement.
I challenge you to adopt this hip hinge throughout the day while doing things like washing your face, brushing your teeth, or setting the dinner table. It’s going to feel weird, a bit like you’re trying out for Beyoncé’s next video, but stick with it. It only feels weird because we’ve all been moving incorrectly for so long. Don’t believe me? Reread that statistic I dropped earlier and remember that back pain affects 8 out of 10 people at some point during their lives. We’re doing it wrong, folks. Make that hip hinge your default pattern for bending forward. Your body will thank you.