This is a follow on from Part 1 where we discussed the fundamental benefits of postural balance and keeping the spine in a neutral position. The concept often over viewed in most back care programmes and core training workouts is that specific postural issues such as pain, tightness or discomfort in movement are often not associated with spinal position.
The pull of the muscles around the hip and the shoulders have a profound effect on posture. This means that performing a lot of crunches, back extensions and unnecessary rotational work can be counter intuitive for those looking to reduce pain or get yourself back in to more optimal alignment where all the muscles are holding the body in the right way. Commonly, most core, posture or back pain programmes are combined with a lot of unnecessary lower back stretching. Hip, scapular and head position will dictate spinal position. Therefore trying to rotate the lumbar spine in to stretch for pain relief is not that clever. With only a total 13 degrees of rotation at the lumbar spine it highlights why unstable rotation combined with flexion (forward bending) is one of the major causes of disc injury.
So what can we do specifically around the hip area to relieve lower back pain and improve general posture to help improve balance further up the body? It is at this point it is useful to understand basic anatomy. The major muscles that act around the hip are the hamstrings which extend the hip and lengthen when forward bending from the hip. The gluteals which extend the hip as well as externally rotate the hip (turn the knees out) play a major role in movement as well as stability of the legs. The hamstrings and glutes are commonly termed hip extensors. If the hamstrings and glutes are tight we will see posterior tilt of the pelvis, often this will also present when someone stands up straight that they lock out at the knees. If both weak we will see anterior tilt of the pelvis, this is not to say they will not present tight in this case though- a lot of people will indicate they have tight hamstrings often though they have weak and inhibited muscles that are in major need of proper focussed training!
At the front of the thigh you have the quadriceps including rectus femoris which acts as a hip flexor (forward bending of the hip) as well as the iliopsoas group which play a role in lifting your leg up above 90 degrees- vital when sprinting… or indeed walking up stairs for those non-sprinters. The hip flexors can play a dual role in pelvic alignment if tight at the rectus femoris you may see a greater anterior tilt (forward) of the pelvis causing a bigger curve at the lower back. The psoas major plays a large role in anterior pelvic tilt also causing lumbar or lower back extension- which if excessively tight can lead to back pain from faulty spinal alignment. If the iliopsoas though are not strong enough to pick up the knees above 90 degrees then we may again see more of a flatter back posture which is commonly screened as tight hamstrings but may indeed be weak hip flexors. A lot of the time tight hip flexors or tight hamstrings are buzz word that is used by a lot of people who may not have assed hip flexor function properly.
The abdominals also play a role in hip alignment if they are tight they can posteriorally tilt the pelvis (flattening the back), if they are weak it can anteriorly tilt the hips sometimes placing strain on the lower back. If in anterior tilt the inner thigh muscles (the adductors) may present tight. We find this commonly in people with anterior tilt who are “front of the body dominant” as being opposed to having sufficient “posterior” chain strength. In laymen’s terms the front of the body is too strong for the back of the body.
In the next update we will look at building strength in to the right areas and strategies to improve postural balance.
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