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Have you had low back, buttock, or hip pain that seems unrelenting? No matter what you do, it seems to show up. Maybe it’s getting to a point where the pain just seems to always be there. You’re nervous about exercising or doing things around the house because you don’t want to flare it up.
Here’s the thing – you’re totally not alone and it doesn't have to be this way.
If you’ve tried physical therapy before and it wasn’t helpful, we’re so sorry to hear that! Low back, buttock, hip, and SIJ pain can be tricky; it’s often not one simple cause.
Luckily, we are really good at getting to the bottom of it! We spend time with our patients 1:1 so we can get into the nitty-gritty. We also work with you and have a WHY behind everything we do – it’s not just do this exercise or do that. It’s about figuring out what is going on specifically with your history and presentation, determining how to get the pain to calm down, and then progressing your tailored-to-you exercises so that the pain stays away!
Let’s break it down and talk about a specific patient case to put things into context.
Here’s what you need to know about the patient:
31-year-old female
2 pregnancies, 2 childbirths: emergency cesarean, 1.5 years later successful V-bac with mild perineal tearing. Currently breastfeeding.
History: mild scoliosis
Pain: Mid and low back pain with intermittent left lateral foot numbness and tingling in her 4th and 5th toes. Back pain began with 1st pregnancy and worsened into her 2nd pregnancy and postpartum. She felt scared to use her core muscles after cesarean.
She rates it as always present and a 5/10 on the pain scale.
Symptoms feel overall diffuse and ache in both her glutes and legs. X-rays taken within the previous year show lumbar arthritis.
Bladder: Stress urinary incontinence, leaking urine with coughing, jumping, laughing, and sneezing.
Bowel: No straining, good frequency.
Sexual: No history of pain or issues.
Exercise: Currently not doing much because of pain. Used to do online workout videos and programs (HIIT or circuit style).
Mental Health: She feels like exercise is a big part of maintaining good mental health so she is missing that as it helps her manage her stress.
Things that made her pain worse | Things that help alleviate her pain |
Standing for >10 minutes | Lying on either side |
Standing is worse than sitting | Resting/lying down so she isn’t “holding herself up” |
Lifting her kids or items (ex: car seat, laundry basket, moving boxes) | Getting into a deep squat |
Walking >5-10 minutes, when she puts weight on her left leg leads to sharp shooting pain in her low back | |
Carrying child upstairs, lifting child onto/off toilet | |
Pain is worse at night, compared to the morning | |
Pain does not wake her up at night but if she wakes up, she will feel it | |
And most importantly, her goals were to get back to doing at-home workout videos 30 minutes per day, being active with her kids (playing with them, picking them up), and doing activities around the house (chores, daily tasks like brushing her teeth, etc.)
Treatment:
Ok, so now we know everything we need to know about this patient. Where did we start?
The first issue is that her pain was limiting her from doing even her daily activities such as brushing her teeth, standing for a few minutes, and carrying her children. But she is a BUSY mom. We can’t just tell her NOT to do those things. So we need to figure out how to calm down the pain.
Through a series of movement testing, we discovered she had what we call a directional preference in her current state. This means her back preferred “flexion” or bending forward compared to “extension” or bending backward.
The low back (lumbar spine) naturally has a little bit of extension in it (think of the curve in the lower part of your back). So it makes sense that standing didn’t make her back feel great.
Once we discovered her directional preference, we assigned some homework. Every time her back would flare up, she should do a series of flexion-based exercises. This looked like:
Bending forward 10x while seated
Lying on her back, pulling both knees to her chest and holding for 30 seconds
Lying on her back, pulling one knee to her chest, and holding for 30 seconds. Repeat on the other side.
I encouraged her to think like a PT – after doing 1 set of the above, did her back pain reduce? Change location? If yes, great. Repeat the series. Did it reduce again? If not, then continue on with your day.
The other piece of homework? Modify her daily movements so her back would not be in prolonged extension. This didn’t mean she should stop brushing her teeth or doing the dishes. This meant modifying HOW she did these activities so her back could have a break. For example, sitting while brushing her teeth. Propping a foot inside an open cabinet while doing dishes. “Dancing” with the vacuum instead of repetitively bending at the back.
This was ultra-successful in bringing down her pain daily! This is SO important because as we mentioned, she is a busy mom and busy woman! She didn’t have time to let her pain limit her.
Great, so we got her pain down on the day-to-day. But we’re not done yet! She is modifying for now but we needed to get her to accomplish all her goals.
And for that, we needed to understand the WHY behind her pain. Our KEY findings were:
Thoracolumbar paraspinals (the big muscles that run along the spine) were very tight
Stiffness in lumbar spine and sacrum
She could not properly activate her core and had a core weakness (poor transverse abdominus and multifidi activation – 2 very important deep core muscles)
Glute weakness
Movement impairments: she used her back a lot when bending, lifting, getting up from a chair, and reaching overhead. You name it.
Piecing these key findings together, we determined that the pain she was experiencing was overall due to a pretty simple explanation: her back was doing all the work!
Our backs are really strong. But backs are meant to do their job only, not the job of your hips, core, glutes, etc! And so we got to work. We incorporated the following treatments:
Manual adjustments to improve the mobility of her sacrum and pelvis
Manual soft tissue release of her low back muscles
Cupping of her low back muscles – while lying prone and with movement
Teaching proper activation of deep core muscles: transverse abdominus and multifidus
Teaching proper activation of the glutes
Incorporating the core and glute muscles into daily movements: getting up from a chair, bending to lift an item, stepping up onto a stair
A home exercise program that was digestible – something she could fit into her day while still reaping the benefits
Over the course of 3 months, we are so thrilled to say her pain has come down significantly. She no longer has pain with any daily activities, she is back to exercising including lifting weights in squats and deadlifts, able to run and play with her children, and getting stronger by the DAY!
We are continuing to work together so she can progress with her exercise while maintaining good spinal health and feel confident in her home program. It is such a thrill to see our patients improve like this and get their life back. It’s why we do what we do!
Remember, seeking early orthopedic assessment and treatment can make a significant difference in your recovery journey. Don't hesitate to schedule an appointment with a qualified orthopedic specialist if you're experiencing any pain, discomfort, or mobility issues.
If you're ready to take that first step, click the link to book an appointment with a qualified orthopedic + pelvic health specialist today. Your journey to recovery is just a few clicks away!