Jeremy W. Przybylo, PT, DPT, DMT
Physical therapists are often called upon to evaluate and treat patients with low back pain (LBP). These patients have already been examined and cleared by their physician and referred for physical therapy (PT). Our job as a physical therapist is to evaluate for muscular imbalances that might be lending to a patients pain and dysfunction. As a clinician, we look at the patient’s entire body in order to define areas that might need strengthening. For patients with LBP, we often find that hip weakness may be lending to their problem. What causes hip weakness? There can be many reasons for hip weakness, but some common causes include poor postural habits, disease of the hip joint itself, or nerve problems involving the spine. Hip weakness can lead to functional deficits, such as a limp, that effect your LBP. This article will clearly define some common causes of hip weakness, it’s relation to LBP, and possible treatment options.
Poor postural habits, in a standing position, can easily cause hip weakness. At a young age, people can learn to conserve energy by electing postures that require the least effort. We often discover these positions by observing others or simply discovering the posture on our own. One common standing posture that can lend to hip weakness involves the individual “hanging on one hip”. Individuals will often shift weight to one leg resulting in poor pelvic alignment. This posture results in muscular imbalance and ultimately weakness. These weaknesses can lend to poor stability while walking or performing other dynamic activities. Again, this poor stability can bring about symptoms associated with both LBP and hip pain.
After visiting your physician, you may come to learn that you have a disease involving the hip joint. Osteoarthritis and rheumatoid arthritis are just a few of the very common diagnoses that can lend to hip weakness. While one can argue to no end whether the chicken came before the egg, or vice versa, the fact still remains that these conditions are often accompanied with significant hip weakness. Part of the weakness that develops may be due to a pain avoidance posture. Pain avoidance presents much like the posture described in the previous paragraph. Individuals will shift weight to the pain free leg, again, resulting in poor pelvic alignment and ultimately weakness. Aside from having a total hip replacement, often time there is little that can be done to reverse the effects of arthritic conditions. On the other hand, weakness is something that can always be addressed.
Up to this point, we have outlined different ways hip weakness can increase LBP. It is also likely that your LBP maybe causing hip weakness. If your physician discovers that you have a pinched nerve in the low back (specifically the lumbar spine), the pinched nerve could potentially be causing your hip weakness. In this case, your physician may recommend medical or surgical treatment in adjunct to a comprehensive PT program. Once the pinched nerve has been released, it would then be appropriate to consider strengthening the weakened hip.
If you are suffering from low back or hip pain, it is important to see your physician first. He or she can rule out serious diseases that would require specific medical treatment or surgical intervention. If your physician feels it is safe, you may be referred for PT. It is customary for any patient seeking help from PT to undergo an initial evaluation by a licensed physical therapist. This will allow the therapist to examine your posture, functional status, range of motion, and strength prior to developing a comprehensive treatment program. The therapist may use: modalities to control pain and inflammation, manual/hands-on therapy to improve ROM and manage pain, and exercise to develop strength. The goal is to improve your ability to function with as little deviation and pain as possible.
While hip weakness may be lending to your LBP, there are many other pieces of the puzzle. Once you have addressed your pain and found relief, it will be up to you to help maintain your progress. Depending on your diagnosis, you may need to continue with regular exercise to prevent reoccurrence. This may be done in the form of a home exercise program prescribed by your physician or therapist, or it could be in done in the aquatic environment as well. Treating LBP and hip pain often requires a team approach involving the patient, their physician, and a knowledgeable physical therapist.