Back, Hip, & Knee Pain? Oh my!

It’s all about that base —  THE HIPS 

One of the most common areas of the body that patients come to me with concerns of pain include the low back, the hips, and knees. 

Although each of these areas can be delved into individually and specifically based on individual injury or type of pain, I feel like a broken record as I explain to patients how these areas of the body are intimately connected. Without looking at how a patient moves and controls all of these areas, I’ve missed a vital component of why an individual may be struggling. How people move through the hips (the pelvis) and how one stabilizes their lower extremities, starting at the pelvis, influences everything. 

I’ve been hard pressed to find an individual that couldn’t benefit from some TLC to the hips. The hips (this includes the pelvis and all the muscular attachments to it) are the body’s base and are the largest muscle groups that control body movement. These muscles are often very underutilized due to compensatory movement patterns, a rise in inactivity, a lack of focus on multiplanar muscle movement and strengthening, and can be an area of the body that harbors stress. The hips are under-appreciated in both recovery from pain and in activity performance. 

So if you are coming to me with low back, hip, and/or knee pain, (and even foot pain!) I will assess your movement and control of your hips while you are walking, squatting, lunging, and jumping (or balancing on a single leg). These activities clearly demonstrate to me your ability to access your pelvic mobility and utilize hip stability in functional movements.  Most often I observe patients utilizing a quad dominant movement pattern vs. a hip dominant movement pattern and lack single leg stability and or core stability. I then try to figure out why your body prefers to move in these patterns and how it is contributing to your pain experience. I do this through more focused joint assessments, muscle length and strength tests, assessing stress management and breathing patterns. Although each patient has a slightly different “why” and manifestation of pain, I continue to come back to the hips. 

Relief for low back, hip and knee pain is not far if an assessment considering how all of these areas impact another is performed and addressed accordingly. There are multiple strategies for how this looks: 

Treatment should include a personalized approach to:

• Manual therapy, which includes massage, or use of dry needling or cupping to decrease muscle tension, improve circulation, and reset imbalanced nerve muscle patterns. 

• Joint mobilization to upper and lower back, hips, and ankles to facilitate new movement patterns. 

• Breathing techniques to assess patterns contributing to tightness and weakness imbalances and integrate techniques into practices for stress management

• Postural unloading exercises to integrate throughout the day to offload overworked muscles and engage underutilized muscles to regain balance of the body (see Instagram @rembodypt for videos of exercises)

  • Finding neutral pelvic position

  • Anterior hip mobility

  • 3D hip matrix

• Muscle activation exercises to re engage under utilized muscles and reinforce new movement patterns

  • Glute squeezes

  • Hip hikes

  • Standing rotation pivots

  • Chair crunch

• Progressive strengthening and stability exercises

  • Squat–double or single leg

  • Dead lift–double or single leg

  • 3D lunge matrix

  • Resisted side stepping

• Address other symptoms related to low back, hip and knee pain including other lifestyle factors that can contribute to systemic inflammation and pain. 

• Plan for independent management of exercises and techniques to avoid return of symptoms. 

Do you have specific questions about your back, hip, or knee (or even foot!) pain? I offer FREE 20 minute clarity calls to determine if I would be a good fit to help you start moving freely and forget pain.