Chronic Hip and Back Pain? Perhaps Myofascial release can Help?

Chronic Back and Hip Pain? Perhaps Myofascial Release Can Help?

Lower back and hip pain have to be among the most common reasons clients seek the help of a therapist.

Back and hip pain usually go hand in hand; if there is pain and dysfunction in one then there will usually be pain in the other at some point.

The symptoms often associated with back and hip pain can be varied but some of the most common ones include:

  • Pain across the lower back, stretching from one hip to the other in a band like pattern.
  • Radiating pain running down the back of the leg similar to sciatica pain.
  • Extreme tenderness along the outside of the hip and thigh, often travelling down to the knee and, potentially, the foot and ankle.

When these symptoms are present, it usually doesn’t take much to make things worse. Everyday tasks such as taking a short walk to the local shops can often be enough to bring on symptoms; perhaps the pain is made worse when standing in one position for a period of time – such as when standing in a queue or stopping in the street to talk to a friend.

Many will be familiar with trying to disguise their pain as they try to maintain polite conversation!

Obviously, there can be a number of potential causes of hip and back pain but today i’d like to talk about a common finding which can be overlooked…wonky hips!

Wonky Hips?!

When presented with back and hip pain clients one of the first checks to undertake is to assess the level of the hips. This is because a hip imbalances can often be at the root cause of many hip and back pain issues.

Uneven hips can create pain and discomfort not just in the back and hips but even further afield including the knee and, potentially, the foot.

There are many different ways in which the hips can be imbalanced but for today I’d like to concentrate on one of the more common ones…when one hip sits higher than the other…known as a pelvic tilt.

What Does a Tilted Pelvis Look Like?

The pelvic tilt we are discussing today (where one side sits higher than the other) can often appear as though the hip is being hitched higher on one side. The only thing is, when a client presents with a raised hip they are usually in their natural standing position and completely unaware the hip is sitting higher until it is brought their attention!

As can be seen in the image above, pelvis on the right side is raised.

What Causes The Pelvis To Become Uneven?

One of the main reasons for a pelvis to be tilted is when the muscles on one hip become short and tight and begin to lift the pelvis. The main muscle responsible for creating the pelvic tilt is a muscle called the quadratus lumborum (QL). The QL muscle attaches to the lower ribs, the vertebrae (spine) of the lower back and then onto the pelvis (hips).

Image above showing QL muscle. When the muscle becomes tight, a pull is exerted on the hip and rib cage, often resulting in a raised hip and tilted pelvis. In this image, the QL muscle is shown on one side (the clients right and our left) but the muscle is on both sides, meaning the tilted pelvis can appear on either side.

When this muscle becomes tight it will shorten and begin to lift the pelvis and pull down on the rib cage above. This will often lift the pelvis higher on the side of the muscle tightness.

When one side of the pelvis sits higher than the other this can create a sidebend in the lower back and spine.

Above: When the QL muscle becomes tight, a sidebend in the torso can develop (the side bend is usually much less obvious than the one in the image!).

How Does This Create Hip and/ or Back Pain?

As we mentioned, when one side of the pelvis sits higher than the other, it will create a sidebend in the lower back. When the lower back is placed into a sidebend the joints in the spine will no longer sit straight, resulting in stiffness and restriction.

As we walk throughout the day, our spines need to be able to move freely, side bending and rotating in order to counter act the movements of the hips. If the spine is restricted in anyway and cannot create the movement required for normal gait, the body will often compensate and find the movement required from somewhere else – and in this instance that’s usually the hips. This can often cause the muscles around the hips to overwork, resulting in stiffness and eventual pain.

 

As can be seen in the image above, if the torso is held in a side bent position then the spine will be held in a side bent and rotated position.

 

Short Leg or a Tight Hip?

Another common finding when presented with a pelvic tilt is when the client appears to have one leg longer then the other.

Although leg length discrepancies do exist, true leg length differences are extremely rare. So how does the wonky pelvis come into this?!

Well, remember we discussed earlier how if the muscles are tight above the pelvis (the QL muscle) they will begin to lift the pelvis higher on that side? Well, imagine if the client where to lie down on their backs and you were to look at the length of the legs, can you see how the leg with the tight hip (lifting the pelvis) would create, what appears to be, a short leg?

Above: As can be seen, the right leg appears to be shorter but this could be due to muscle tightness in the muscles between the hip and rib area lifting the hip and creating what appears to be a shorter leg.

Quite often clients can be diagnosed with an apparent short leg when, in fact, it is the pelvis being hitched up on the short leg side which is the issue. Usually releasing the hip, ribs and leg on the tight side can remove the leg length difference.

Leg length differences can create pain issues throughout the body but if the ‘shorter’ leg is not actually shorter then there is potential to improve matters by releasing the muscle and fascia around the hip, lower back and ribs to bring the hips back into alignment and potentially reducing pain as a result.

What Causes The Muscles To Become Tight and Cause The Tilted Pelvis?

There can be a number of potential causes of muscle tightness in the hips which can only be established with accurate assessment. Usually there is a bio mechanical muscle imbalance which needs correcting but restrictions within the lumbar and sacroiliac joints can also cause the muscles of the hip and back to go into a protective muscle spasm.

A tilted pelvis can also be created by how we hold ourselves, including poor posture and how we sit at our desks throughout the day.

Lets look at a couple of common examples which can create tightness in one side and cause a tilt in the pelvis…try to avoid these habits!

1. Posture At Desk.

For many, spending long periods sat at a desk is a normal part of their working day and many will have been told to be aware of their posture. A common concern with desk working is when the head begins to drift forward as we stare at our computer screens for long periods which can often create pain and tightness in the neck and shoulders. This is something many will be aware of but another postural habit which is often overlooked when desk working is how we can favour one side when sitting. This will often result in us shifting more of our weight to one side.

By favouring one side we will begin to side bend and compress the muscles on that side. When this is repeated for many months or years the result can be tightness in the muscles around the hip and ribs which can be the cause of the raised hip.

2. Sitting With Legs Crossed

When we sit at our desks for long periods with our legs crossed we will usually side bend to the opposite side of the leg we are crossing (if crossing right leg then we will usually side bend to the left). Obviously this is not going to create any issues over a short period of time but if this is a habit we have got into and repeated over many years the muscles in the hip and lower back will begin to tighten, resulting in a pull on the hip and a tilted pelvis.

3. Carrying Baby/ Child On One Hip.

This is one which comes up a lot!

Although there can be many factors causing hip and back pain following child birth, referred muscle pain is often an overlooked cause. It’s quite common for many mums to carry a young child on the hip, usually favouring one side. When this is continued for a prolonged period, with the hip hitched up as the weight of the child bears down, the muscle surrounding the hip can become tight, shortened and begin to tilt the pelvis. Back pain following childbirth is a common complaint and can often be linked to a variety of possible causes; ligament laxity and pelvic floor issues are common factors but what if the issue was due to the raised pelvis? Could simply releasing the tissues around the lower back and ribs eliminate the pelvic tilt and go some way to reducing the pain?

Above: By looking at the image above its easy to see how hitching the hip up to carry the baby on one side can often cause the muscles to shorten and tilt the pelvis, potentially causing back and hip pain as a result.

Conclusion

Pelvic alignment, including when one hip sits higher than the other, can have an impact on ongoing back and hip pain. Today we’ve looked at when one hip sits higher than the other, how this can create pain and some of the potential causes.

The key to resolving some of these issues can be to simply release the fascia and connective tissues around the hip to create an equally balanced pelvis. Eliminating some common everyday habits which are contributing to the muscle tightness can also be a way of preventing the issue from reoccurring.

So now you know about pelvic and hip imbalances be aware of your own body. Does one hip seem to be sitting higher than the other? Are you leaning your torso a little more to one side? If so, then perhaps some of your pain is due to that wonky pelvis!

 

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