Something we see frequently in the world of pain and rehab, is "Lower Cross Syndrome". What this refers to, is an imbalance in musculature surrounding the hips and lumbar spine resulting in less than ideal joint positioning. The most common form of this postural dysfunction is referred to as Type A, which we will be discussing here. Typically we see weakness in the transverse abdominus, rectus abdominus and glutes and greater strength and hypertonicity in the hip flexors and lumbar erectors. This pulls us into the position shown on the right in the image below.
Maintaining this positioning for prolonged periods of time may result in movement dysfunctions, lower back pain, poor shoulder mobility, increased susceptibility to knee injuries and neck problems. The glutes and the abdominals are key muscles for providing stability at the pelvis and spine, and core stability provides the ability to efficiently transfer forces from the lower to upper body.
With this observed imbalance we also see an anterior rotated position of the pelvis, and increased anterior (lordotic) curvature of the lumbar spine. This positioning increases the load placed on inter-vertebral discs at L3/L4/L5, increasing the susceptibility to disc related injury. The overwhelming strength and tightness of the iliopsoas (one joint hip flexor) can also contribute to back pain, as its insertion points are located on the vertebrae on the lumbar spine. Poor glute strength contributes to a valgus or knock kneed positioning of the lower limb, again increasing susceptibility to traumatic knee injury.
How do we help the hips?
Now it's important to remember that everyone's posture is slightly different, and although we can talk about "perfect posture" it may not be all that attainable. Yes there are postural abnormalities such as a lower crossed syndrome that can heavily impact pain and performance. But the key to it all is remembering that what we really need, is the ability to move out of the "bad" posture when needed, not to create an idyllic form. As with most things, a combination of stretching, strengthening and mobility work is required to aid in postural deficiencies such as this. And commitment is key!
Hip Flexor Stretch
Stretching the hip flexors is a great way to start to improve this type of imbalance. To begin, come into a deep lunge position, keeping the hips square to the wall in front of you. You should feel a stretch into the front of the hip on the side where the leg is lengthened behind you. Hold for 30-60s and repeat 3 times per side.
Glute Activation
Begin by lying on your stomach on the ground. If you have a particularly large anterior curvature in the lumbar spine, I would suggest placing a pillow under your hips to flatten the spine. From here, bend the knees. This allows the glutes to take precedence over the hamstrings, which is ideal because we are targeting glute firing here! From the knee bent position, squeeze your glute muscles. To increase difficulty, try to squeeze only one glute at a time, or squeeze one glute and lift the leg upwards. Give 3 sets of 10 reps per side a try. But remember, we want to feel the glutes working. If you feel the hamstrings firing, go back to an easier progression until you can better isolate the glutes.
Transverse Abdominus Activation
Begin by lying on your back with knees bent and feet flat on the ground. With your fingertips, find the boney prominences at the front of each hip bone. From here, slide your fingers towards your belly button so that they are now touching the soft area just inside the hip bone. This is where we will landmark appropriate muscle contraction. From here, try to pull your belly button towards your spine without dipping through the rib cage, holding your breath or tilting at the hips. With your fingertips, we are looking to feel a gentle tightening sensation. If your tummy pushes your fingers away from you, we are activating the wrong muscles. Complete 3 sets of 10 reps, but remember quality over quantity! If you can only complete 5 reps before other muscles compensate, just start with 5 reps!
Good Activation Cues:
Pretend you're about to be punched in the belly. The muscles you'd contract to brace yourself are the ones we're trying to activate
Have you ever laid down on your back and tried to pull your tummy away from your jeans? Those are the muscles we want to activate.
Try and pull your belly button down to the spine, then towards your head in a J shape.
Cat/Cow
Begin on hands and knees with knees under hips and wrists under shoulders. As you breathe out, round the spine upwards focusing on pressing the lower back up towards the sky. As you breathe in, round in the opposite direction, paying special attention to the upper back. Repeat for 6-8 breath cycles.
With this exercise, it is important that we attempt to feel the movement of each vertebrae over the next as we move. Imagine standing up from a forward bend "vertebrae by vertebrae" and applying this concept with the Cat/Cow.
If you've been dealing with lower back pain and tight hips, these exercises may be a great first step to dealing with contributing factors. If you feel like your posture is affecting pain and function in daily life, make sure to reach out to your friendly neighborhood athletic therapist for a full functional assessment and personalized rehabilitation plan.
Kristen Huber BaKin, CAT(C)
Owner, The Gentle Athletic Therapist