Social media will always be a funny entity to me. I know I sound like the really old guy telling kids to “get off the lawn”, but it isn’t that I’m against social media, more like, it can be a great tool but you need to know how to ask the RIGHT questions in regards to information you see.
For example, I was sent a recent post by a physiotherapist sharing a very interesting study review. This paper looked at the association of hip mobility and low back pain. More specifically, the way this particular post was suggesting, does lack of mobility cause low back pain?
What this physiotherapist was suggesting, based upon the conclusion of review 248 studies on hip mobility and low back pain, there wasn’t a strong correlation!
“There is very low-quality evidence to support an association between limited hip range of motion and non-specific low back pain.”
Whoa! That should send people into a whirlwind questioning why do we focus on so much hip mobility in the fitness industry if there isn’t a strong relationship in the literature? Well, that is where asking the right questions and looking at things with a critical eye comes into play.
So, should you ditch your hip mobility training, especially for those with low back pain? Let’s examine what we need to consider…
-Non-specific low back pain: This particular review specifically looked at those with what is known as non-specific low back pain. Such a diagnosis is rather common and tells us there is no structural issue that is causing the pain. No disc herniations, stenosis, degenerative disease, etc. that would result in low back pain. This is VERY different than those that do have these conditions and we need to keep this in mind.
-The paper also said the relationship was poor because the manner in which the assessments were done could have been somewhat biased by those doing the measurements. Now this doesn’t mean that it was, but just points out a consideration that this could influence the measurements.
Understanding how measurements are taken is important. To me, the most important aspect is to know if the measurements of hip mobility were taken passively or actively. For example, if you are lying on a table and someone is moving your hip this could create a VERY different result than if you are asked to move the hip yourself. In passive measurements we may get a more accurate idea of the joint itself (as well as some of the soft-tissues) because we are purposefully taking away the contribution of the nervous system to coordinate the movement.
An example of passive is someone trying to stretch your hamstring and lifting your leg up versus you trying to lift your leg up.
This can be helpful, but overall I am typically more concerned with the ability of the individual to control the range of motion of an area. The ability to control the movement of a joint is more important when we are talking about how our mobility training relates to how we perform movements like hip hinges, squats, lunges, etc.
-Pain Is Complicated: One of the hardest things to do is to study pain because pain is VERY complicated as many variables can contribute to the experience of pain for someone. Especially if we are discussing non-specific pain (but this doesn’t eliminate these strategies applying to mechanical types of pain) that is why practices like mindfulness, pain reprocessing therapy, yoga, tai chi, and qigong are often recommended treatment options as this study “Yoga for chronic pain management: a qualitative exploration” explains…
Trying to correlate particularly non-mechanical issues to any sort of just part of the body is quite difficult to do for many reasons. However, that is how most of us are taught to think about our pain and why so many even fitness pros still tend to focus on isolating a joint, a muscle to stretch, or even to strengthen when the literature on pain science doesn’t seem to be pointing us this direction.
So, should you give up your hip mobility training efforts? I would give you a resounding NO! For one, it does depend on how you approach hip mobility. We know from A LOT of reputable studies that including core stability into our hip mobility efforts does improve our hip mobility.
That doesn’t necessarily guarantee we will lower pain levels because that depends on a lot of variables. However, as far as what we can do in training, improving the ability to move well and understanding why someone COULD be struggling with hip mobility (often due to core stability issues) then we can definitely improve our chances of helping pain levels.
Physical therapist, Jessica Bento, gives some higher level examples of how we combine core stability and hip mobility efforts.
Translation, that means addressing many ways people interact with pain, they view pain, and also how they deal with various stressors in their lives can all greatly impact their experiences of pain. Again, that is why as far as training goes, using methods like yoga, tai chi, and qigong consistently pop up in the literature in pain science studies.
As fitness professionals, it is impossible to do things like cognitive behavioral therapy (that is outside our scope of practice), but we can use specific, movements, breath work, and visualization to teach people HOW to manage their stressors and improve their pain perception.
Understanding this can be transformative for a lot of people, but also help us improve a lot of people’s not only movement quality, but lives overall. That is what motivated me to create both our Myofascial Integrated Movement (MIM) program and our new Breath Work course (where we break down in detail the science and coaching of breath work and movement) so that we had both a better understanding of the true issues people face and how we can use our tools to help them pretty dramatically.
As someone who was told they would be disabled for the rest of his life by doctors after some severe spinal surgeries, I can tell you how powerful such strategies can be!
You can get our new Breath Work Program AND Myofascial Integrated Movement program for a VERY special price with code “breath” HERE and you can get 30% off our MIM program with code “breath” as well HERE
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