Today’s post takes a look at Hip Hinging and how we can use the Deadlift movement pattern and Exercise for those clients who present to the clinic with lower back pain. Often clients who present to the Osteopathic, Physiotherapy or Chiropractic clinic for the treatment of lower back pain are only concerned with you being able to reduce pain, improve their range of movement and prescribe them the appropriate exercises to help reduce the likelihood of this pain from returning.
As many Osteopaths, Physiotherapists and Chiropractors know, the biggest risk factor for developing back pain is a previous history of back pain. Many of us will apply our manual therapy techniques to address the acute back complaint and get our client back to daily activities successfully within a short period of time. Something that we also commonly see is the same client returning to the clinic some months or years later reporting to have either a similar complaint or in some situations and/or a progressively worsening history of back pain. Now why is this the case and what aren’t we doing as Osteopaths, Physiotherapists and Chiropractors to help prevent this recurrence?
Many therapists will go into very detailed case histories to help determine the key aggravating and maintaining factors and look to reduce the exposure to these. Something that I have taken a more keen interest in over the years has been to look at how the individual moves and determine if there are habitual movement patterns that may well be contributing to cumulative trauma of the lower back. Often we are trained to hone in on the area of pain and try and determine what the exact “tissue causing symptom” is and only address this. Whilst this strategy often can be useful in the short term, often failing to address the bigger picture of how the client moves and teaching them to move better is often given very little time. There is a lot of talk these days in the health and fitness industry about how the body doesn’t work in isolation and that we must treat and train the whole body or movement and I will take a look at how we can do this below.
Poor movement patterns is often a common observation in those clients who have an ongoing history of back pain. Often when we assess the clients movements in walking, squatting, lunging, single leg, step up and other fundamental and functional movements. Typically we observe a lack of mobility in areas around the lower back i.e. thoracic spine, hips/pelvis, foot and ankle, a lack of stability or motor control issues through the core, hips, pelvis and knee. An example of some clients this week who i have seen in the clinic presenting with various lower back complaints all demonstrated various movement pattern dysfunctions. When asked to squat, they showed a lack of mobility and control through the hips, foot/ankle and thoracic spine/shoulders, ultimately leading to excessive loading through the lumbar spine. When asked to demonstrate a hip hinging pattern, they also showed an ability to perform these movements well. Their ability to disassociate movement between the lumbar spine and hips/pelvis was evident. Now whether this engrained movement pattern was the cause of the original injury or not, it certainly isn’t helping them at the moment in regards to reducing the likelihood of further recurrence of back pain. When addressing clients with back pain, it is important to not only address mobility and stability issues, but also that of motor control and movement patterns.
There are many great practitioners across the globe who adopt this approach when it comes to improving clients movement patterns. Physiotherapist Gray Cook who designed the Functional Movement Screen incorporates the Deadlifting pattern and exercise regularly into his program for clients wanting to improve movement and overall conditioning. Hip hinging is something that we all must learn in order to perform the squat and deadlift movements correctly. Physiotherapist Shirley Sarhmann also goes detail about teaching clients to develop good movement between the lower back and hips and more can be read in her book Movement Impairment Syndromes.
To read more about Training the Deadlift by Gray Cook, please click on the articles below.
Teaching The Hip Hinge
The hip hinge is an important movement pattern to teach and learn for those with back pain as it helps teach the client how they can improve their movement to help prevent excessive loading of the spine. Typically a forward flexion bend without a posterior weight shift and hip flexion will result in increased lumbar flexion. This movement repeated thousands of times over the years can lead to cumulative trauma of the posterior structures of the spine and ultimately disc injuries, ligamentous sprains and muscle strains. Teaching the client to hip hinge means the client will gain more flexion through the hips and therefore reduce flexion loading through the spine.
In the video link below, Gray Cook teaches the hip hinge using a bar and some resistance. Whilst this can be a starting point for some clients, often I like to start with teaching the client using only a dowel stick. The dowel stick should be having 3 points of contact (head, thoracics and sacrum), hands placed in the cervical and lumbar lordosis.
If the client is having difficulties with learning this movement pattern, you can regress this strategy to a 4 point kneeling position and having the client find neutral spine position. Place a water bottle or across their lumbar spine and have them gently rock back onto their heels without losing the water bottle. Ask them to rock back until the range where they start losing the neutral spine position. Another way to progress this exercise from the 4 point kneeling position that was demonstrated to me by FMS Instructor Behnad Honarbakhsh was to place a swiss ball behind them and against a wall and have them push into some resistance as they move back.
Ideally we will train the client to move from 4 point kneeling through to bilateral stance hip hinging and deadlifting patterns to that with resistance. The single leg deadlift pattern and progressed to resistance is also another great exercise to incorporate as it splits the body into left and right and requires them to maintain good motor control and stability through range of movement. I have incorporated another video by Gray Cook demonstrating one way of achieving this.
Deadlifting Exercise Demonstration
Big thanks to Todd Carlon for coaching me over the last few months at Elite Sports Performance. Todd Carlon is a Level 2 ASCA coach and currently works at Elite Sports Performance in Melbourne. Elite Sports Performance is owned by Collingwood S&C Coach Martyn Girvan. Martyn is also involved with education at the Australian Strength & Conditioning Association. To read more about the Deadlift and the Biomechanics of the Deadlift, please check out Martyn’s article which has been published by Elitefts. Martyn talks about the biomechanics of the deadlift and the differences between the Sumo Squat Stance and Conventional Deadlift Stance.
Demonstration of the Deadlift – Lateral and Anterior View
In these videos I demonstrate the Sumo Squat Stance Deadlift with alternate grip. Whilst these videos are not technically 100% correct in their execution, I demonstrate in the lateral view the need to hip hinge, keeping the spine upright with bar position under the shoulders and shoulders back. The front video view also demonstrates the positioning of the bar and grip to be equal between left and right sides and the knees symmetrical.
Osteopath Heath Williams is owner and director of Principle Four Osteopathy. Principle Four Osteopathy is located in the heart of the Melbourne City CBD 3000 at 29 Somerset Place, Melbourne City CBD 3000. To find out more about the clinic and to book an appointment with Osteopath Heath Williams, please call 03 9670 9290 or book online at www.principlefourosteopathy.com.