One of the most unfortunate and frustrating things that I see, whether its online or with clients, is that the same protocol is given to anyone with low back pain.

The issue, I believe, is that many solely look at how the back moves or focus on the muscles around the area where pain is.

However, we need to look at the body as more of an integrated system that coordinates many joints and muscles to manage gravity, forces coming from the ground (i.e., ground reaction forces), environment (repetitive job, asymmetrical sport, training program), and how other areas not moving well may impact the load going to the lower back.

All of this is to say that an inability for areas like the foot, knee and hip/pelvis can have a major impact on how the spine has to react (which we will address).

With all of this in mind, in this article we will discuss:

• How other areas of the body can impact the lower back
• Compensations related to low back pain
• Exercises to address movement limitations 

How The Pelvis Impacts Lower Back Positioning

It’s important to understand that the position of the pelvis and movement at the hips have a significant impact on the lower back.

The lumbar spine (low back) is connected to the pelvis via the sacrum (as shown in the photo below).

When the spine flexes, the sacrum performs a movement called counter-nutation which is essentially your tail bone tucking under. 

This is also associated with external rotation of the hips - think of squatting.

On the other hand, if we were to internally rotate our hips, that would be associated with nutation of the sacrum.

Think of hinging movements or hip extension.

Now what if our hips and pelvis can’t create these shapes?

This is when our lower back comes in.

Compensations At The Pelvis

If I don’t have the ability to internally rotate the hips then the pelvis may hike, dump forward (anterior pelvic tilt) by extending the spine, or rotate to the other side.

This will inherently limit my pelvis’ ability to manage forces coming from the ground (absorb/accept force) and require the low back to take on that job, which it isn’t equipped to do.

Therefore, we are now creating movement and absorbing force in an area that doesn’t have the ability to do so to make up for a lack of motion happening at the pelvis and hip.

All of these compensations are created to accomplish a few things:

• To allow for movement 
• To absorb and produce force (propelling) 

How To Reduce Load On The Lower Back

Our objective should be to restore motion at the pelvis, hip, knee and foot so that force can be distributed better instead of localizing in one area that doesn’t have the capacity for it.

Internal rotation of the foot, all the way up the chain, is how we can manage this.

When we land while walking and the full foot plants on the ground, a phase called mid-stance, our body is accepting the force traveling up through the body. This is when internal rotation happens. If you want to learn more about these concepts, then check out my EVOLVE Biomechanics Course

This is generally the phase that people are missing and is where the compensations discussed above show up, meaning, this is where we need to focus.

We can gain this information by assessing supine hip internal, rotation which you can see is illustrated below: 

Exercise Principles

Of course, each injury and pain is unique, so I won't pretend that these are the only exercises that help you or your client's specific case. 

However, by understanding these principles, which have helped many of my clients, we can start to discuss strategies that may help set you up for success.

When we are thinking of exercises, we need to accomplish what we discussed: Improve hip internal rotation, through the foot, knee, hip, pelvis etc, shift the centre-of-gravity back on one or both sides, while teaching the body how to distribute force better.

Let’s review a few exercises: 

The first exercise is one of my favorites that I call the Pelvic Decompressor 

This is a great way to restore internal rotation of the pelvis by using a foam roller to help decompress the hips and position the pelvis in a way that allows for better access to internal rotation. 

For the full breakdown, watch below:

The second exercise really focuses on shifting the centre-of-gravity back, and allowing gravity to help restore motion.

This Inverted Frog puts the hips in a position where it can better access internal rotation of the hips and shoulders among other areas.

Watch full breakdown:

To further understand how to assess compensations like this and more, then join my EVOLVE Biomechanics Mentorship!