Lower Back and Hip Pain

Muscular tightness in the lumbo-sacral region can cause dull ache and stiffness. Standing for long periods, excessive walking or sitting in the same position may worsen the pain. Often local treatment on its own provides only short-term relief. There may not be any significant findings by the doctor following x-rays or other tests. This may suggest that some other underlying factors are involved that causes the return of the pain.

These other and often neglected factors can be diagnosed after a thorough biomechanical examination including a gait evaluation. The biomechanical exam can reveal structural or muscular problems that overload or strain the structures involved in back pain. The gait analysis should be conducted walking down a corridor viewing the whole body from behind, in front and from the side. This is videoed and relayed to a computer were the body movements can then be slowed down for assessment. The results may indicate how the body is compensating for the structural or muscular problems detected during the biomechanical exam.

If you have been previously diagnosed as having arthritis in the spine, disc bulge, sciatica or fusion from surgery, improvements can still be achieved if structural problems in the lower limb are an aggravating influence. The best results however are achieved when there is no significant bone or soft tissue injury.

The common reasons for postural low back pain include: 1. One leg is structurally shorter than the other (from previous hip or knee surgery, fractures of the femur or tibia, motor vehicle or work related accidents, birth defects) 2. Excessive pronation of the foot causes the leg to rotate inwards so that the pelvis shifts forward and downward. This creates a functional short leg. (See picture 1.)Inadequate shock absorption from a rigid high arched foot type or from surgical fusion of the ankle or subtalar joint of the foot. The picture on the following page shows how an in-rolling foot can indirectly strain muscles of the hip and lower spine by causing a lowering of the hip and leg on that side. The picture on the following page shows how an in-rolling foot can indirectly strain muscles of the hip and lower spine by causing a lowering of the hip and leg on that side.

The effects of excessive pronation (in-rolling) of one foot :

A. Excessive pronation or in rolling of the foot

B. Lower leg rotates inwards

C. Lower leg drops downwards

D. Excessive tension on muscles that connect to the lumbar spine

E. Spine rotates toward the functional short leg

F. Lumbar spine also rotates & this compresses the disc on I side & opens it out on the other

Treatment

1. Reducing excess pronation &/or limb length differences with heel raises, shoe modifications, custom made orthoses or modified stock inserts. People with spinal fusions and fusion of other joints in the lower limb may need extra shock absorption from shoes and custom orthoses.

2. Recommendation of adequate shoes to meet the needs of your foot type and problem

3. Improve body posture: stand & walk up straight. For people with office jobs: avoid prolonged sitting in same position, change position

4. Spinal adjustment and soft tissue therapy by a qualified practitioner

5. Exercises

: Strengthening abdominal muscles – ‘safe’ sit-ups (lift head & shoulders

the ground whilst keeping eyes focused on the ceiling)

: Press-ups: like push ups, however the legs & pelvis stay flat on the ground

: Hamstring & lumbo- sacral stretches

Footmed recognises that patients with chronic low back pain do not limp because they hurt; rather, they hurt because they limp. Addressing the reason for limping may resolve problems of postural low back pain.

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