Linking Hip Biomechanics to Low Back Pain

Low back pain (LBP) is a common condition that affects millions of people in high-, middle-, and low-income countries (1). LBP can be classified as acute (lasting up to 6 weeks), subacute (6 to 12 weeks), or chronic (greater than 12 weeks). The cause of most (> 85%) cases is unknown and is consequently diagnosed as non-specific LBP of musculoskeletal origin.

LBP treatment guidelines generally recommend physical activity, manual therapy, and supervised exercise for patients with acute and subacute LBP along with exercise (without specifying the best type of exercise) for patients with chronic nonspecific LBP.

Many studies have been conducted on the biomechanical behavior and changes in various body regions during episodes of LBP and several of these studies have focused on the hip and its relationship to LBP. Topics that have been investigated thus far include:

• the association between hip range of motion and non-specific LBP;
• lower limb muscle strength of patients with LBP compared to strength in healthy individuals;
• kinematic analysis of the hip during sitting and lifting movements in patients with LBP; and
• activation of hip muscles in patients with LBP while standing, movements in the sagittal plane and during the prone hip test.

The results of these studies have been variable, so these authors performed a systematic review of published studies that used biomechanical hip assessment in patients with non-specific LBP.

The ultimately analyzed results from 54 studies and summarized what we know about this important clinical relationship.

Note from Dr. Thistle:

I have always felt that the hips are an under-recognized contributor to low back pain, particularly in chronic patients (so, my bias is now fully disclosed!). However, as seen even in this more recent paper, it remains a relatively understudied concept. When managing chronic low back pain patients, it is common for me to start a treatment program by addressing hip mobility and function (strength, motor control etc.). In my experience, chronic LBP patients almost always have at least one dysfunctional hip (often the worst one correlates to the side of LBP, if there is one!). Chiropractors and many other clinicians focus heavily on the spine (and/or pelvis) and there is nothing wrong with that, but in my experience, chronic LBP patients respond much faster and in a more sustained manner when the hips are addressed as indicated, in conjunction with other relevant areas. Remember, low back pain AND hip osteoarthritis are extremely common, and often coexist as people age! Given the hips’ central importance to human movement and daily function, the relationship to low back pain should be apparent, but this paper serves as a reminder of this important relationship.

RESEARCH REVIEW: Linking Hip Biomechanics to Low Back Pain

This paper was published in BMC Musculoskeletal Disorders (2024)

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