The Secret Cause To Lower Back Pain

Hey there, El Paso! This is Dr. David Middaugh, physical therapist, and owner of El Paso Manual Physical Therapy. Welcome to the Stay Healthy El Paso Podcast. Today our topic is going to be the secret cause of lower back pain.

Now for people that suffer from low back pain, especially if they have gone to see a doctor for it, and they have had any sort of diagnostic imaging like x-rays or MRI. They have probably been told that they have a disc injury, a pinched nerve. For set arthritis is a common one, and stenosis. There are all kinds of common problems that doctors will spot on an MRI or an X-ray as well. Degenerative disc disease is another one that comes to mind.

But something that is rarely ever, to tell you the truth, I've never seen a physician or anybody that saw somebody for back pain, bring this up besides physical therapists, because this is the way that we think, something that I've never seen anyone talk about and this is the secret here is hip problems.

Hip problems in people can come off as painless a lot of times, and usually the way that it feels is tightness in some of the muscles around the hip. Occasionally you do see somebody that has some severe hip arthritis and they have obvious limitations. They can't walk right, they limp, they have trouble getting up and down from a chair, going up and down steps or curbs.

I'm not talking about those kinds of people that have an obvious hip problem. What I'm talking about is somebody who has an obvious back problem. That's where they hurt. That's what bothers them day to day, are off and on. But they don't really think about their hips. And the reason why this is a secret, because one of the first things that we do here in the clinic, whenever we get somebody with a back problem, is of course, we ask them about their back problem to tell us what's going on. Let's get to the bottom of it.

But once we start checking people by hand, I always check their hip. I have to see how much that hip goes up, down, sideways, and rotates, because the ball and socket joint of the hip has tons of motion. Of course, you have to have a pair of hip joints. And if one of your hips is not moving correctly, and it's forcing the other hip to move extra, it will likely cause your back to move differently. If this has been going on for a long time, then usually it contributes to some major back problem.

I can't tell you exactly which back problem is going to contribute to, but it just does cause problems in the back. Oftentimes, what we are doing here in the clinic in addition to treating some disc injury or arthritis in the in the lower back, where we're dealing with some hip problem as well, some muscle imbalance and arthritis problem in the hip, a lack of mobility in the hip. Lack of knowing how to use the muscles properly. That's actually a common thing. People don't even realize that they are not using their muscles, right. And it's so cool to see some pretty quick changes in most people.

Once we start working on their hip, once they get full mobility in their hip, they feel like they get a chance to do some exercises and get more stability through their hips. The back pain tends to reduce significantly. We will do this in combination with the back treatments, the direct back “hands on” treatment and exercises that we do for backs.

But it's the combination of these two that really get people to the point where they are feeling tremendously better. But I just wanted to do this podcast talking about this, because if you are out there and you're listening to this, and you've had x-rays, MRIs, you've been trying to get to the bottom of what your back problem is, and you're frustrated because nobody really knows what's going on. And in fact, sometimes you get people to bring in their imaging, their x-rays and MRIs, CT scans. And they say that they look pretty normal. That they have mild arthritis, mild things going on in their in their back. But the doctor told them that that's normal and that there is nothing that can be done.

It's so cool to get that client in here and be able to check out their hips and tell them, your right hip does not bend anything like your left hip. In fact, you've lost 20 degrees of motion here, 30 degrees of motion there, and your muscles on this hip versus that hip don't feel the same, they're stiff, they're tight, and the strength isn't the same at all. So we end up treating the hip and the back gets better.

I just want to make sure that you know that that's a possibility. And in some cases, we see a knee problem that can contribute to a hip problem too. We have to look at the entire chain of joints. If you think of a chain. The chain of joints would be the foot, the ankle, the knee, the hip, and then the low back and all the joints in the low back. Any problem in any of those joints, they all affect each other. But the hip joint is the most mobile joint of all of those.

It's critical to make sure that we look closely at that joint. Look at every possible motion that that it can do. All the muscles that control that hip joint as well are important to check out. There are tons, when talking about the glute muscles, people just think of the gluteus maximus usually, but there's gluteus maximus, gluteus minimus, gluteus medius. There's a tensor fascia that contributes to the glute function as well. There are deeper glute muscles like the piriformis, the superior inferior muscles, the operator muscles internus and externus, the quadratus femoris there are all kinds of muscles. The hamstrings even run through there too and can affect the glutes and to a lesser degree there are nerves as well, that are in the area.

If those nerves are affected, they can change the strength of the muscles throughout the hip. So we sometimes end up looking at the nerves and it's more of a nerve problem that's affecting the hip. But that's what we do here. That's what we specialize in is getting to the root of the problem, peeling back all the layers, looking at every possible contribution. Holistically, to a back problem.

What we tend to see is people that have gone through other treatments, and then they come in here to our clinic, they usually have the response of Wow, nobody's ever looked at my hip like that, or my back like that, or whatever body part we're looking at. Nobody's ever thought to check this, or thought to check that, or nobody's explained how all this works together.

That's just normal for us here. We look at every single aspect that could be contributing to a single problem and the way that we see it here at El Paso Manual Physical Therapy, is that it's what's necessary, and we are going to take the time to do that. Because if we don't, then we're shortchanging you we are not fully looking at the problem.

What I've seen happen in other places that I've been at, as far as working as a physical therapist is, there just isn't enough time. The skill level, the technique level of the healthcare professionals is specialized differently than what we are here. They may be really good at something else, but they're not good at looking at the root of the problem.

I'll give you a clear example. For instance, most PT clinics around the country without knowing it, without saying it, they are really specialists and helping people after a surgery. So after a back surgery or hip surgery, like a replacement or discectomy and they are really good at getting people to move again and walk again and get back up on their feet.

But helping somebody out who has not had a surgery is a whole different ballgame. That requires a different kind of specialty. And that's what we do here. We rarely ever see surgical cases. About 99.9% of our clients here are our clients that are trying to avoid surgery and injections and medications. When they come here, they haven't been to another clinic like ours, and they are always surprised at how in depth we have to go. Because after dealing with the surgery, a surgical case, it's usually pretty straightforward.

We as a physical therapist, from my perspective, any way I can, I usually have the surgical report in front of me so I know exactly what was done. The surgeon’s notes, and the patient will tell me, and you can obviously see an incision on the patient wherever they were operated. As a physical therapist, we have like x-ray vision, so we know what's under the skin at that point. What muscles are there. What joints are there. What nerves are there. And it's pretty obvious to know what needs to happen next. But in somebody who's never had a surgery before, somebody who's trying to prevent the surgery,

There's no incision, there's no surgical notes. There's no obvious sign of what's going on. You're having to work off of what the patient's telling you. Asking the right questions is critical, making sure that we pull the right information out. We have to figure out what they have done in the past, what's helped, what has hurt, how their day goes, how it feels at night, how it feels during the day, there are so many components to putting it all together to make sure that we can get this person to the point where they can confidently go back to the activities they were doing before they started having problems, and truly escape surgery. As well as know what to do, to know how to prevent the problem from coming back so that they're not having to take pain medications or go get an injection at some point later on.

So there you have it. That's the secret to lower back pain - the hip. Checking out the hip and all the details around the hip and finding the root of the problem.

Hey, guys, thanks for listening. I hope that this podcast was beneficial for you. If you have any questions, if you're dealing with a back problem, and you have questions about it, or you think you might have a hip problem, feel free to give us a call at 915-503-1314 and we can talk more. I look forward to talking to you in the next podcast episode. Have a great day.

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