Hunched and Worried
Dear Dr. Abby,
I have had pain on the outside of my right hip for at least 10 years. It seems to have come and gone over the years, but not until recently has it really given me a lot of trouble.
About 10 months ago I started to work from home 4 days a week and on the 5th day, I spend about 4.5 hours in the car commuting. That is when the pain really began. I also noticed that I started getting a lot of lower back pain, especially as the day goes on. At night when I am washing my face leaning over the sink, my back aches and feels weak; it takes me a few seconds to stand back upright. The back and hip pain are all starting to feel connected and I am worried that one day I will get stuck hunched over or slowing down far earlier than I'd like.
I do have two young children, 3 and 5, who I tend to pick up a lot and always carry on my right hip. Ever since they were born I never really worked out my abs again either.
I think it's safe to say that the 'middle' section of my body is full of aches and pains.
What advice do you have for someone who works from home and is in a seated position most of the day? How do I build up strength, but also make sure that I am stretching enough so I can bend over without feeling as if I won't stand back up? And how do I fit this in while working full time and taking care of two active kids?
Thanks!
Hunched and Worried in Massachusetts
Dear Hunched and Worried,
I’m sorry this has been worrisome and around for so long already. The good news: We got this. You are strong and healthy and just need to learn some news ways to do things. It sounds as though your low back and pelvis aren’t fluent in forward bending right now, so they like to play defense whenever you get into a bent position. And as you said, your habit of carrying your kiddos on your right hip may be exacerbating the right side, but it’s likely related to the back thing.
Ready to roll your eyes a bit? My biggest piece of advice is to find a physical therapist who looks at your habits and works to give you more options of how to move and build resilience. Resist the urge to go down the rabbit hole of what is happening structurally. Research shows that that people with back pain who go to physical therapy before getting any imaging or other medical intervention do better in the long run. Discomfort and feeling stuck are not permanent and usually come from having limited options for how to do something, in your case that is returning to standing from a bent over position. Improve this ability and you improve the symptoms.
Standing upright successfully requires your back and abdominal muscles to dynamically stabilize your spine so your hamstrings and glutes can tip your trunk upward. Sometimes, for any number of reasons usually related to previous pain or incident, your back muscles will try to do this on their own or you will just grip your glutes, pelvic floor, and more instead. Everything ends up just holding on tight to keep you “safe”. So sweet, right? Thanks for trying, guys! Note that I did not say your glutes or hamstrings are weak or “off”, they just don’t know what you want from them right now. Teach them! Oh right, that’s what you asked me to help you with. Here ya go:
Start re-programming in a safe, protected way so there is no need for defense. Here is a link to an exercise called the 90-90 hip lift. I like to use something like this because you’re laying on your back so the support is high and the risk of discomfort is very low: Take me to the exercise - I'm gonna do it everyday!
When this gets easier, move on to some trunk and hamstring strengthening exercises in gradually more challenging positions until you can deadlift your cute kids without any unhelpful safety responses.
Without evaluating your movement patterns in person, it’s not possible to accurately prescribe a progression of exercises, but an example might look like this:
Hands and knees flexion practice: All Fours Modified Belly Lift
All fours belly lift: See above, but do this in a rounded plank position instead.
Bridges: Focus on rolling up starting at your tailbone and then rolling back down so you move segmentally.
Supported standing forward bend: Standing Wall Reaches
Standing forward bending practice: Stand with soft knees. Exhale and roll down each segment into a forward bend. Then roll back up starting from your pelvis. You should feel the backs of your thighs initiating this movement.
Eventually work on deadlifts (fancy word for lifting from the floor) from different heights.
These movements are examples of ways to learn how to flex and how to return to upright afterward.
Without greater variety in how you carry your kids, a message is sent to the right side of your trunk and ribs asking it to operate in a shorter position during the rest of your day. This asks a lot more from your right hip and back
Try the following standing strategy:
Step back and shift your weight onto your left heel and let your back and chest relax.
Pull your left hip pulled back behind your right hip
Drop your left shoulder down
Breathe into the space this creates in the right side of your trunk.
It’s not easy to fit more in your day while having two kids at home and working from home (Thanks, Covid-19), this does not need to be an all day thing. You can keep your re-programming routine to under 5-10 minutes. By finding a PT who can help to narrow down which practice helps the most, you don’t have to throw the kitchen sink at it (strength, re-programming, stretching, posture, AH!). You can get really specific and targeted in your approach. Find a physical therapist who loves to think about movement strategies and will problem-solve with you.
Good luck and let me know how it goes!
Appreciate you,
Dr. Abby
Disclaimer: Advice given in the Dear Dr. Abby column is intended for educational purposes only. Always seek care from your medical provider with any questions you have regarding your medical condition.
