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Keep Your Back Healthy & Pain-Free

As someone who has personally dealt with back pain, I can appreciate how important it is that my hips stay strong to maintain a healthy back. By having good strength in the hips, some of the extra work and strain can be taken out of the back and can even help decrease the workload on the knees too! These muscles are some of the largest and/or thickest in the body, but we don’t always utilize them in the most efficient ways.

Let’s learn a little bit more about the gluteus maximus, the largest muscle in the back, or posterior section, of the hip. And, of course, we’ll give you a few ways to work this muscle to keep your back healthy.

The Anatomy & Function

The gluteus maximus (glute max) sits at the back of the hip and pelvis. It is the true powerhouse of our lower bodies. It originates from the gluteal surface of the ilium, lumbar fascia, sacrum, and sacrotuberous ligament. The glute max then inserts on the gluteal tuberosity of the femur and iliotibial tract. It gets its nerve supply from the inferior gluteal nerve (L5, S1, S2).gluteus maximus

The glute max helps with external rotation and extension (turning your foot outward and moving your leg behind you) of the leg. Because of its connections and location also helps in keeping your torso upward (like coming back up from bending forwards) and can help with abducting the leg (moving the leg to the side).

If you’ve ever dealt with hip, knee, or low back pain, or even feeling like your hamstrings are tight, you may actually need to do some work on the gluteus maximus. Let’s keep your back healthy!

This muscle is important for a wide variety of activities, including:

  • getting up & down from a chair,
  • going up & down stairs,
  • walking or running up/down hills, or navigating more challenging terrain,
  • power for squats, jumps, and leaps,
  • and more.
What to Do About It

There are a lot of different ways to work the glute max. We’ll talk about a few options, including some squat variations, hip thrusters, and donkey kicks. We’ll also show you how to stretch the glutes, since tightness here affects the back, just like weakness can cause problems.

The Basics

There are a couple of things that we need to consider any time that we are working on the glutes.

First of all, while working the glutes, it can be tempting to let our back do some of the work, which it isn’t necessarily meant to do. One way to combat that is to keep your core engaged. We like to think about gently pulling your bellybutton towards your spine, without flattening your back. It should feel like when you’re trying to fasten that top button of a pair or jeans. 😊

Secondly, our hamstrings also like to help the glute max in doing its job. As you’re working to strengthen the glutes, make sure that you’re feeling more of the effort in the buttocks or back of the hip, not in the hamstrings in the back of the thigh. You can imagine gently squeezing the glutes as you work. Another option is to bend the knee, giving less advantage to the hamstrings.

Squats
squat

There are MANY variations of squats. Here we have a standard squat pictured, using a weight in the hands as a counter-balance. By doing this, it allows you to get your hips further back by counter-acting your body weight. Notice that knees are staying aligned with the toes and feet are pointed straight ahead. Core is engaged and we are squeezing the glutes on the way up and down.

You can do these with a wider stance, single leg, standing on an unsteady surface (BOSU is our favorite), and more.

Hip Thrusters
hip thruster starthip thruster finish

 

  • Start by lying on your back, knees bent, and feet flat on the floor.
  • Keeping core engaged and glutes activated, push your hips up towards the ceiling.
    • The goal is to make it a smooth, fluid motion, not jerky.
  • Slowly lower yourself back down to your starting position.

We’ve added a little resistance by holding a weight over the pelvis. You can use a kettlebell like we did, a free weight, a barbell, or even use a resistance band. Another option to engage core even more – keep your upper back and shoulders on an exercise bench with feet on the floor. It will allow for a larger range of motion to work the glutes.

Donkey Kicks
standing donkey kick start

standing donkey kick finish

 

 

 

 

 

 

 

 

Standing Kicks:

This is good if you have more back pain, have difficulty maintaining the hands and knees position, or can only work in a limited range of motion at the hip. This is also a good starting spot if you are new to this sort of exercise.

  • Stand about 1-2 feet away from a table, counter, or other sturdy piece of furniture that is at least waist height.
  • Lean forward to get your upper body supported on the surface, whether it’s bend elbows as picture or on your hands with straight arms.
  • Engage your core.
  • Extend one leg behind you while maintaining a neutral spine. Feel as though your heel is driving your leg backwards or like you’re even extending through your heel.
  • Slowly lower back down to your starting position.

You can start with a straight leg, which will get both glute max and hamstrings to help with the motion. As it gets easier, work towards doing this with a bent knee, which starts to focus in on the glute max even more.

Make sure that you don’t let your back arch or pelvis twist as you do this!

donkey kick start

donkey kick

 

 

Quadruped Kicks:

  • Start on hands and knees. Your shoulders should be over your hands and your hips should be over your knees.
  • Engage your core, keeping your spine straight.
  • Extend one leg behind you while maintaining a neutral spine. Feel as though your heel is driving your leg backwards or like you’re even extending through your heel.
  • Slowly lower back down to your starting position.

You can start with a straight leg, which will get both glute max and hamstrings to help with the motion. As it gets easier, work towards doing this with a bent knee, which starts to focus in on the glute max even more.

Again, make sure that you don’t let your back arch or pelvis twist as you do this!

Glute Stretch
glute stretch

Tightness in the low back and glutes can also contribute to low back pain, so here’s a way to combat that. We like to use the stretch strap or a belt to help hold the legs in place, so it doesn’t feel like you’re straining your upper body in order to stretch the lower body!

 

 

 

 

  • Lie on your back on the floor.
  • Bring one knee up towards your chest and then the other. By moving both at the same time, you may place more stress on your back, especially if you’re already having low back pain.
  • Bring your knees towards your chest until you feel a gentle stretch in the low back or buttock.
  • Hold for a total of 1-2 minutes.
  • To come back out of this position, again move one leg at a time.

Give these exercises a try and let us know how they work for you. Here’s to a healthy back!

Want more exercise ideas? Check out our other blogs and our YouTube channel!

DISCLAIMER: The purpose of this site is to promote understanding of health, wellness, and prevention. The information on this site is not intended/implied to be a substitute for professional medical advice, diagnosis, or treatment. If you are experiencing pain, please see a medical professional.

Strong Hips are Crucial!

There are many important muscles and other structures to consider in the hips, and it’s important to have strong hips. One that is often neglected or underused is called the gluteus medius.

The Anatomy & Function

This muscle sits at the back of the hip and pelvis, underneath the gluteus maximus. It originates from the gluteal surface of the ilium and inserts onto the greater trochanter of the femur, and gets its nerve supply from the superior gluteal nerve (L4, L5, S1).Gluteus medius anatomy

The gluteus medius helps in abduction, or moving your leg to the side. It also has a small part in flexion and internal rotation (moving the leg in front of your and turning the leg in) with its anterior fibers, and extension and external rotation (moving the leg behind you and turning the leg out) with its posterior fibers.

When the gluteus medius is working appropriately, it helps to keep your pelvis level when standing on one leg. This also means that it helps with maintaining balance. Lastly, when this muscle is strong, it helps maintain an even workload through your back, hips, and knees. It’s an important player with take off and landing for jumps and leaps. So you can imagine why this is such an important muscle!

What to Do About It

There are MANY ways to work on strengthening and improving the performance of the gluteus medius. Ideally, we get to a point where it’s being worked in a variety of positions and through different movements.

Today, though, we are just talking about a simple place to start. We’ll be working through five different levels of an exercise called Clamshells. Our examples are without any additional resistance added, like a resistance band or ankle weights. To see these exercises in action with a full walk-through, check out our YouTube video here.

Otherwise, keep reading to learn the progression!

The Basics

The starting position is the same for all levels. Start in side-lying with hips stacked on top of one another, knees bent, and fee stacked. Your hips should be bent to about 45* and knees at about 90*.

Some important things to remember:

  • Keep your pelvis stable with abdominal muscles engaged.
  • Minimize the use of your hands for balance.
  • Slow and controlled motion is key.
Level 1Clamshell Level 1

 

  • Feet remain stacked and touching.
  • Top knee lifts towards the ceiling, moving into external rotation.
  • Hold for 5-10 seconds.
  • Slowly lower back down to starting position.
Level 2Clamshell Level 2

 

  •  Knees & thighs remain stacked and touching.
  •  Top foot lifts towards the ceiling, moving the hip into internal rotation.
  •  Hold for 5-10 seconds.
  •  Slowly lower back down to starting position.
Level 3Clamshell Level 3

 

  •  Hips remain stacked, without rolling or tipping.
  •  Entire leg stays in slightly bent position, and lifts towards the ceiling, only lifting as high as possible without the spine collapsing towards the floor.
  •  Hold for 5-10 seconds.
  •  Slowly lower back down to starting position.
Level 4Clamshell Level 4

 

  • Hips remained stacked, with bellybutton just slightly rolled towards the floor.
  • Bottom knee stays on the floor, and feet lift off of the floor.
  • From this new starting position, lift the top knee up off of the other leg, while maintaining contact at the feet.
  • The top leg then extends to a straight leg, while maintaining the rest of the position.
  • Hold for 5-10 seconds.
  • Slowly bend knee and reconnect at the feet, then lower back down to starting position.
Level 5Clamshell Level 5

 

  • Position yourself into a side plank, hips without any bend (straight line at hips), knees bent to 90*.
  • While maintaining the side plank position and keeping feet stacked, lift top knee towards ceiling.
  • Hold for 5-10 seconds.
  • Return to side plank position.

Try these exercises out to create strong hips for yourself. Let us know if you have any questions!

DISCLAIMER: The purpose of this site is to promote understanding of health, wellness, and prevention. The information on this site is not intended/implied to be a substitute for professional medical advice, diagnosis, or treatment. If you are experiencing pain, please see a medical professional.

 

Low Back Tightness – Stretches To Try

In some cases, tightness in a variety of muscles can contribute to low back, hip, or knee pain. We wanted to share a couple of basic ideas to try.

It’s best to contact your physical therapist if you’re suffering with pain in any of these areas. You will get evaluated and your PT will ensure that stretches like these are appropriate for you and your situation.

Stretch #1: Single Knee to Chest

Lie down on your back. Bring your knee towards your chest, supporting underneath the thigh/knee. If this places any strain on your back, keep your opposite leg bent with the foot on the floor. For a deeper stretch, keep your opposite leg straight as pictured.

This stretch should be felt in the buttock or back of the hip.

Stretch #2: Double Knee to Chest

Lie down on your back. If your back is currently feeling painful, bring one knee up at a time to take some stress off of the back. Bring both knees towards your chest, again supporting under the thighs.

This stretch should get further into the low back, as compared to Stretch #1.

Stretch #3: Piriformis Stretch

Lie down on your back. Start with both knees bent and feet on the floor. Cross one ankle over the opposite knee, and let you knee fall out to the side. To increase the stretch, pull your knee towards your chest as pictured.

Dosing

For all of these stretches, aim for a total time of 1-2 minutes of stretching. Break it up into workable chunks, but aim for at least 10 seconds. These stretches should not increase pain and should not make you more sore afterwards.

Disclaimer: The purpose of this site is to promote the understanding of health, wellness, and prevention. The information on this site is not intended/implied to be a substitue for professional medical advice, diagnosis, or treatment. If you are experiencing pain, please see a medical professional.

The New Stretch Session Fad

You’ve been seeing a rise in the new stretch session fad. New businesses are popping up across the country and existing businesses are adding it as a new service.

In doing research about these sessions, I found that companies offer appointments that range from 15 minutes all the way up to 90 minutes. They often run for the same price as a typical massage and sometimes more. One company offers a 50-minute self-stretch session for $185. These sessions have you working with a “stretch professional” who guides you through stretches that you can do on your own. A 90-minute session can run $375 to have someone stretch you!

The websites all state that they use a proprietary method, so it’s hard to say exactly what you’re getting. One thing I did consistently find, however, was that they have a list of stretches that the stretch professional takes each client through. The order of the stretches may be customized, but they frequently do the same stretches for everyone.

Now, of course, this is not to say that stretching sessions are uncalled for or can’t be done well. There are several things to consider when deciding if it might be the right choice for you. Keep reading to find out more!

More About Stretching

Now I have no problem with the concept of stretching. It’s an option that has its place and time. Some patients may receive a stretch as a part of their home exercise program. Others may have an assisted stretch that is used during a treatment session. This treatment option is only recommended or used after doing a thorough examination, and it certainly is not the only type of treatment provided.

Stretching comes in many types – active/dynamic stretching versus passive stretching, self-stretching versus assisted stretching. You don’t hold the position for very long for an active stretch. It’s more like moving in and out of the position with good control. A passive stretch is different – you hold a position for a period of time. Self-stretching is exactly what it sounds like. You’re in charge of your position, how long you hold, and how deep of a stretch you get. Assisted stretching (done by a trained professional) will have someone else making sure that it’s done in the ideal position for the given muscle. They may include other techniques to increase the benefit of the stretch. 

What the Research Says

There is some conflicting information when you look through the research about stretching. The topics include things like: is it helpful or harmful, how to do it properly, how to dose it, etc.

Some research suggests that for a short period after stretching, you actually show a decrease in maximum power, strength, and strength endurance. Other research finds that regular stretching (10-15 minutes, 3-4 days per week) facilitates an overall increase in power, strength, and endurance. It also suggests that it increases flexibility and mobility. An overall theme is that stretching does not significantly help to prevent injuries in the first place. And if you do stretch in conjunction with doing an activity or sport, research leans towards doing it afterwards. It’s also suggested that active/dynamic stretching is more helpful than a passive stretch.

Dosing a stretch is also all over the board. Just for passive stretching alone, I’ve noticed a change over time. When I first learned about it, the most popular suggestion was that you had to hold for at least 30 seconds up to 60 seconds, 3-5 repetitions. It has changed in the last couple of years, now recommending a stretch for 1-2 minutes in total, broken down into manageable chunks.

The most important thing is that you stretch within an effective zone. You won’t be placing enough influence on the tissue to actually create a change if you don’t go far enough. You place too much stress on the tissue and can cause harm if you push too hard. Even when you work with a trained professional on an assisted stretch, it’s important that you have open communication to make sure that you’re getting the right intensity.

Stability and Mobility

Our bodies are a balance between mobility and stability. Mobility, or flexibility, allows us to move more – like a shoulder being able to move in more directions than a knee. Stability, on the other hand, must exist to allow us to have mobility elsewhere.

Imagine a marionette doll – if we were built like them, with all of their flexibility, it would be very difficult to get through most of our day. We’d also have to use a lot more muscle power and effort to move, or to even just sit up or stand up. If we were built like a mannequin, on the other hand, we also would have difficulty getting much accomplished. We would be incredibly stable, but moving would be incredibly difficult.

Our bodies are meant to be a good blend of mobility and stability. Stretching works on the mobility piece, but not the stability side of things. We need to work on both sides of the coin to keep our bodies happy. Getting stretched at a stretch session or going through a stretching program may help things get looser, but if you’re not also working on strengthening other muscles to balance with your new mobility, you’re likely to have other problems.

In fact, in some cases, people may say that they feel “tight” or “stiff” and feel like they need to stretch, but what they actually need it to strength that muscle. I know it seems counter-intuitive, but our bodies aren’t great at telling the difference between the two.

The Take-Home Messages

Stretching can serve a purpose when applied to the right individual under the right circumstances. There is no magic set of stretches that each and every person needs. Stretching is not necessarily the answer, even when you feel “tight” or “stiff”. Stretching can even be counterproductive if you what you need is more stability and support.

If you think that you need a stretching program, make sure that you’re working with a trained professional who can do a thorough assessment to see what the right answer is for you. Make sure that they can explain why you need that specific treatment and that they can discuss various options for you.