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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 87 Stiff Hips and Low-Back Pain Addressing Femoroacetabular Extension Restrictions ŒŒ BY ERIK DALTON, PHD What's the fi rst thing that comes to mind when a client presents with low-back pain—muscle spasm, nerve impingement, osteoarthritis, or maybe a disk problem? In my experience, therapists rarely link the femoroacetabular joint to back disorders, even though several studies have found a strong correlation between fi xated hips and lumbar spine pathology. 1 When assessing hip mobility issues, there are three things to consider. First, are the bones moving properly within the joint space, or is there an osteoarthritic bone- on-bone end-feel at end range of motion? Second, are the musculofascial tissues fl exible enough to allow the rectus femoris and iliopsoas to stretch the necessary length for full hip extension? Third, does the end- feel of the stretch indicate a fi brotic hip capsule (Image 1)? In this column, I'll focus on the hip extension restrictions that can wreak havoc on the low back and sacroiliac joints. WHAT IS HIP EXTENSION? To begin, let's clarify what is meant by hip extension. When the foot is behind the body with the knee straight, the hip is in extension, and as we walk, the hip must move 10–15 degrees beyond neutral extension to allow propulsion from the leg and foot. During normal gait, musculofascial tissues that cross the front of the hip must be of adequate length to permit fl uid hip extension. Lack of extensibility of the rectus femoris, iliopsoas, or the anterior hip capsule will result in noticeable gait alterations, reactive muscle spasm, or—if the brain perceives tissue damage—pain. technique | MYOSKELETAL ALIGNMENT TECHNIQUES During gait, a fi brotic hip capsule can limit hip extension and cause L5 –S1 facet jamming. Anterior hip capsule Ideal Range of Motion: 10 to 15 degrees Testing for hip mobility restrictions. ‚ ƒ TRICK MOVEMENTS When functional gait patterns are obstructed by muscle imbalances or pain, the brain looks for a way around the block. For example, if the hip won't fully extend, the brain may choose to hyperextend the lumbar spine to compensate for the fi xated hip. Vladimir Janda labeled such compensations "trick" movements, where the brain simply detours around a perceived trouble spot. Unfortunately, trick movements caused by inadequate hip extension often lead to strain and pain that manifest in the lumbar spine, the sacroiliac joints, or both. So, how do we determine if a client has a hip extension restriction? Here's a quick and helpful hip mobility test. Ask your client to half-kneel with their right knee on the ground and left leg in front so there's a 90-degree angle at the hip and knee. Place a bar (or broom stick) along the client's spine. It should touch between their shoulder blades and the top of their gluteals. Now, ask them to slowly push their pelvis forward so they fl atten their low back, allowing it to come in contact with the stick (Image 2). If the client feels a stretch in the front of their right hip, they have a fl exibility or mobility issue in or around that hip. Switch positions and repeat the test on the left hip. ASSESS AND ADDRESS To assess the left anterior hip capsule from the prone position, begin by fl exing the client's knee to 90 degrees and grasping the leg (Image 3). Place your left palm just below the ischial tuberosity on the proximal femur. As you step to your left foot, your right arm will slowly bring the