Dr. Marc here, I just wanted to tell you about a patient I had this week who was 6’8″ and an avid basketball player. He was visiting family from out of town, but came in because he spent Easter laying on the floor with excruciating back pain. He presented to my office holding his wife’s shoulders as he attempted to ambulate safely, and he was completely shifted off to the side. This typically signifies a disc problem. As I further assessed his low back and dug a little deeper, I found out he had very limited hip mobility. Normally when in a seated position and we rotate our foot out, we should get about 45 degrees of rotation each way. Well, the gentleman had limited internal rotation on the one leg, and very limited external on the opposing leg. So, he also said that he always crosses one leg over. He’s only really able to get the one leg over to cross, but the other leg, he can’t do. This is another sign that there’s a hip mobility problem. […]
He also likes to run for exercise. He’s 6’8″, I think 240 pounds, and he’ll run about three to five miles at a time, three to four days a week. If you can imagine the stress all that weight will put on the hips that are already not functioning right when he’s not under load. This stress extends out into the spine too that is also under extreme load. So, if you can imagine running three, four, five miles, and every time I step, I’m always on one foot at any given time for a split-second. Then with lack of any hip mobility, it’s going to start taking its toll, and drive a lot of the force is into the spine most specifically the lower back.
Your lower spine needs to remain a series of very stable joints. If the hips are not moving properly, then the low back will start to become unstable and consequently, we’re going to get these disc injuries, we’re going to get these facet joint injuries, we’re going to get muscle spasms and nerve-type pain that ultimately will come out of these compensation patterns.
Other than working on him to reduce his low back pain, we brought to his attention that he’s going to need to start working on some hip mobility, and that’s going to be composed of working on stretching tight muscles, or short muscles. For him, when I tried to bend his heel toward his butt, we couldn’t get the heel there, so that tells me he’s got real tight hip flexors and quadriceps.
Part of his rehab, is going to be to stretch out the quadriceps. We’re going to work on some range of motion of the hip joint itself. We can do things called swivel hips. (Please see attached video for demonstration). But then it’s going to be important, as he gets more range of motion, we want to lock that range of motion. So, now I’ve worked the range and I have more range. Now, how’s my body going to know what to do with it? It hasn’t had that range of motion in weeks, months, years. So, now we’ve got to make sure we do some final things to kind of lock that in and of course reinforcing it all with spinal and hip/extremity adjustments to ensure the mechanoreceptors are working well within the joints.
These are all things to keep that in mind when you’re dealing with low back issues. You can’t just look at the low back. You’ve got to look at the joint below and above. Tis patient also had a thoracic spine that was also extrememly rigid, restrictive, very tight. because again, he sits in a car, teaches, sits at a desk, flexing forward and doesn’t do a whole lot of rotating of his thoracic spine. So, you’ve got to also look into that area of the spine which may also be contributing to your low back condition.
There you have it, Folks! Hopefully, this enlightens you on the many causes of lower back pain. If you have questions, email me, check out the YouTube channel, and I look forward to speaking with you soon.
Yours in Health,
Marc Fondino, DC