Ways to avoid back pain: Part 2
Hip strength and the walking conundrum
Walking is good for us. Isn't it?
Yes, it’s true: for cardiovascular health, walking is
great. It’s good for our circulation, our mental
health and general well-being.
And lots of my patients with back pain will say:
‘but I do lots of exercise: I walk everyday’.
I hate to be the bearer of bad news but unfortunately walking isn’t the perfect exercise. The problem is that it’s uni-directional. You swing one leg forward and push off, then the same on the other leg, and repeat. And repeat. And repeat. Ad infinitum.
Which is fine, but it’s only building strength in one direction: forwards.
The hip has a girdle of muscles around them, designed to support the hip in all directions of movement. One of the most common weakness I see in the clinic is the outer hip muscles: particularly ‘Gluteus Medius’.
Used to lift the leg sideways (‘abduction’), such as when side-stepping or getting out of the car, it plays a very important role in walking: it holds the weight- bearing leg and hip stable so that you can lift the other leg off the floor.
If the gluteus medius is weak (perhaps from an old back or pelvis injury, poor posture, or just chronic under-use), the pelvis is not held stable during walking.
We can still walk perfectly well, because we have other big ‘forward’ muscles to drive the movement, but the pelvis rocks around more whilst we’re doing it. This causes excessive movement and strain on the ligaments and joints of the pelvis and lower back, and over time, starts to cause irritation. As with tight hip flexors (see Part 1), you can live with this for quite a long time without noticing, then suddenly one day you go to get out of the car, or walk up a steep hill or, very commonly, do a new movement in the gym or exercise class, and your lower back says ‘enough!’. It’s already coping with daily strain, and it can’t manage the new challenge.
If you’re a gym-goer, it’s a good idea to incorporate work on your gluteus medius strength with exercises such as isolated hip abductions, wide squats or side-steps with an exercise band. If you’re not, or these names mean nothing to you, this simple exercise will get you started.
Lie on your back, and with your knees together, tie/place an exercise band* around your knees
Set your knees to hip-width so you have taken up any slack in the band
Tighten your lower abdominal muscles to help the pelvis stabilise
Slowly push the outsides of your knees against the band so that you’re creating an ‘opening clamshell’ effect
(Make sure you use equal pressure on both sides of the band: if one hip is stronger than the other it’s easy for it to dominate, so pay attention to what you’re doing: watch and feel for the movement. If it seems more challenging on one side, that’s the weaker one, so focus your effort on that side and practise making it move smoothly, evenly and with equal power to the stronger side)
Push out as far as you can, then slowly bring your legs back to hip-width. Repeat, still keeping your lower abdomen muscles engaged.
Repeat 3 sets of 8-10 repetitions, 3-4 times per week.
Continue, gradually increasing band resistance and adding in a 4th set, for 6 weeks. If it begins to feel easy or your legs are going very wide, it’s time to change to a heavier duty band.
*If you don’t have an exercise band, you can get them at sports shops, some supermarkets and online. I recommend getting a variety pack so that you can increase the resistance as you get stronger.
If you’d like help with back pain, hip or pelvis stability or other joint or muscle problems, email firstname.lastname@example.org or call 07710 466880.
Blog by Alex Davies, Registered Osteopath at Body for Life Osteopathy ©