Your Lower Back Pain Might be Coming from Your Hips

When I was in college, I loved to jog two–three times a week. One morning I woke up with pain in the lateral side of my knees and I barely could walk. Today I know this was caused by my weak gluteus medius muscles (the gluteal muscles are a group of three muscles: the gluteus maximus, gluteus medius and gluteus minimus). When gluteus medius is weak, there is no proper control of thigh bone (or femur). When this bone falls in too far towards the midline of the body, it can cause stress on the knee. You can be sure I don’t escape my squats and glute bridge exercise anymore!


Or maybe my pain was caused by so called “Iliotibial band syndrome“ which is also caused by weak hip muscles. Iliotibial Band Syndrome (ITBS) is one of the most common injuries among runners. The weakness of the gluteus medius places stress on the IT band (tensor fasciae latae) that runs down the outside of the thigh. This causes inflammation of the IT band and as a result – pain.

The same is for those of you who experienced pain in the lower back at some point in your life. Because of a sedentary way of life, the muscles inside the hip become tight with time. This tightness of the anterior hip muscles pulls the lumbar spine forward and cause the pelvis to tilt forward. This causes the lack of hip mobility and that can lead to the lower back pain.

So problem in one part of your body, usually shows up as pain in the joint below or above.

Many fitness professionals are very familiar with this approach. It is called “the joint-by-joint approach” and was developed by physical therapist Gray Cook and strength coach Mike Boyle.

In his book “Advances in Functional Training” Mike Boyle describes this “process” as simple:

  • Lose ankle mobility, get knee pain.

  • Lose hip mobility, get low back pain.

  • Lose thoracic mobility, get neck and shoulder pain (or low back pain)

The theory behind “joint by joint” is categorized like this: each joint or series of joint has a specific function and tendencies toward dysfunction. The method suggests how joints interact with each other and provide shortcuts to identifying problems in a joint’s functioning in the cause of pain, injury or poor movement patterns.

The joint alternate between mobility (the ability of a joint to be moved through its range in different planes) and stability (the ability to maintain or control joint movement or position).

The ankle needs increased mobility, the knee needs increased stability, the hip needs mobility etc.



Primary Need
Ankle Mobility
Knee Stability
Hip Mobility
Lumbar Spine Stability
Thoracic Spine Mobility
Scapula Stability
Gleno-humeral joint Mobility

Let move back to the lower back pain mentioned before; if the hip lost his specific mobility, during a movement like lifting an object off the ground, the lumbar spine will. But the problem is the hips are designed for mobility and the lumbar spine for stability. When the joint intended to provide stability throughout the movement is forced to move as compensation, it becomes less stable and eventually painful.

It’s worth to mention here the thoracic spine and a need for mobility in this area. Poor posture and modern lifestyle (prolonged sitting) can lead to stiffness and poor movement of the thoracic spine which can lead to pain. The natural rounded curve in the thoracic spine area increases and the spine’s ability to straighten up and rotate decrease. The neutral position of the spine is lost and with time due to changes in the natural curves of the spine (the spine has natural curves that form an S-shape) person can start to experience pain in the neck and/or the lower back. Decreased thoracic mobility also decreases the range of shoulder movements like lifting the hands over the head.

I am not sure how many people are aware of this theory, but I think it is a good ground to start from when the knee pain occurs after running or some other activity. Or when you woke up with pain in your lower back after last night’s training in the gym. Putting ice on the knee and medications will help for a short period of time, but it will not address the real issue (the problems with the ankle or the hip).

If you are interested in this topic and you would like to find out more about “joint-by-joint approach”, I suggest you to visit Gray Cook’s website

There are many ways to improve mobility and stability of your joints. If you already experience pain in some area of your body, it is recommended to visit a physiotherapist or a fitness professional who will assess your movement patterns and posture. Treatment can include soft tissue massage (foam roller or massage with a tennis ball), joint mobilization exercise (I suggest to check the Kelly Starrett’s You Tube channel), postural exercises, strength exercises and stretching (passive stretching is recommended only AFTER workout).


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