Knee or low back pain? Check your hips.

For some reason, people often don’t notice a loss of mobility in their hips. As a result, I frequently find that patients coming to see me with knee or back pain also have problems with their hips lurking in the background that they were unaware of. Some work to restore hip mobility often pays dividends with regard to knee and back pain.

The knees are primarily designed to act as shock absorbing hinges, and they aren’t really that well equipped to withstand too much rotation (twisting). The joint in the lower body that is really designed for rotation is the hip, and when patients begin to lose this range of movement, their knees can begin to suffer as they pick up the increased demand to rotate. Similarly, the low back often has to compensate for a loss of forwards and backwards movement in the hip, and can become strained as a result.

A common pattern I see with hips is that they are held in a fixed turned out (externally rotated) position. This can just be due to muscle tightness or sometimes as a response to arthritic change in the joint.  

If you want to see if your hips might have this problem, stand normally and look down at your feet. What you should see is both of your feet pretty much pointing forwards. With hip problems, one or both of the feet are often pointing off at an angle. The photos below illustrate what I mean.

Feet pointing forwards - neutral hip position.

Feet pointing out - hips turned out.

If the hip is held in this turned out position it impacts both foot and knee joint biomechanics, as they aren’t designed to function well in this position. Over time, this will then put undue stress on the joints, and eventually predispose them to injury. With the low back, the altered biomechanics in the foot, knee and hip will also impact negatively on its ability to function properly.

Another common hip problem that can lead to back pain is a loss of extension - the ability to move the hip joint backwards. This loss of movement can again be due to wear and tear in the hip joint, but more commonly it develops as a result of spending too much time in a sitting position. When sitting for extended periods the hip joint is held in a flexed position which leads to certain muscles permanently shortening and tightening. This then limits the ability of the hip joint to move backwards, and the low back has to compensate. This can then predispose the low back to strain and injury. The photo below illustrates the problem.

Sitting - Hip Joint Held in a Flexed Position

What can you do about it?

I often achieve excellent results with my patients just through basic loosening off and rebalancing of the muscles around the hip and pelvis. I use specific exercises to restore the range of movement in the joint, and recommend certain exercises which patients can do at home to maintain the improvement. 

I have a page on my website with my favourite patient exercises, where I recently posted a guide to how to perform two simple hip stretches. If you click on this link or the image below, it will take you to the exercises. 

These exercises look specifically at improving hip flexion, extension and internal rotation. I find that occasionally patients need to improve their hip external rotation range, but this is less common. 

Click on the image for the hip stretches.

As always, if you experience anything more than mild discomfort during these exercises or you are not sure that they are right for you then please discontinue them and seek some guidance.

If you have a foot, knee, hip or back problem then don’t suffer, book an appointment for your problem at Osteo Studio.

Cliff Russell, Registered Osteopath

Osteo Studio serving the areas of East Grinstead, Forest Row, Lingfield and the wider West Sussex area.