Now that I caught you with the title...we know nothing in Physical Therapy is 'all about' one thing. The beauty and difficulty of the human body is our unique differences. There is not one thing that is the same for all of us. However, when dealing with back pain, we know the importance of proper strength and mobility of the hips is essential.
Throughout my lumbar evaluation, I look at the function of the hips in several planes. From the functional movements of gait analysis and squatting to AROM and strength testing, I try to gain an understanding how people use their hips. If a patient is lacking range of motion, their mobility will likely arise from the lumbar spine. Contrarily if the hips are lacking strength, the low back will attempt to compensate for the weakness. For example, when someone performs a squat, if they are lacking hip strength, they will likely use their low back to ascend from the squatted position. This excessive lumbar hyperextension demonstrates an inability to stabilize the trunk.
The hips are inherently stable and facilitate the overall health of the lumbar spine. When rehabbing the lumbar spine, we must focus on hip mobility, strength, and retraining functional movements. In my therapy sessions, I start retraining the gluteals with basic table exercises such as bridges and clamshells. When pain decreases, I advance to quadruped exercises, standing hip extensions with TrA activation, and dynamic single leg balance activities. Regarding function, I start retraining the hip hinge technique as well as squat and lunge patterns. We must check the hips on every lumbar evaluation!
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