3 Reasons Your Back & Hips Hurt, According to a Doctor of Physical Therapy 

A stiff, sore lower back and tight hips are common complaints for many athletes. While quick-fix solutions like stretching and foam rolling can provide temporary relief, dealing with back and hip pain can become a long-term problem that many gym goers find themselves facing despite their best efforts. 

So, what are you supposed to do if you can’t kick that chronic back and hip pain? According to Dr. Zach Long, a Doctor of Physical Therapy and co-founder of Performance Plus Programming, you might be going about fixing your pain in the wrong way.

1. You’re Working on the Wrong Muscle Group 

Oddly enough, when many of us experience back and hip pain, we tend to neglect those areas. “So much emphasis gets placed on the hamstrings, glutes, and core,” Long says of how gym goers tend to address back pain. 

“I think one of the most overlooked areas that contributes to back pain in gym goers is back strength,” he continues. “Rarely do athletes do any accessory work to focus on strengthening the back.” 

To combat this, Long recommends adding exercises like “reverse hypers, 45-degree back extensions, and good mornings,” saying that these movements can “go a long way toward strengthening your spine so that it’s better prepared.” If you’re struggling with where to start, Long’s Bulletproof Back Builder provides an excellent resource “for athletes to build more lower back strength,” he says of the accessory program. 

Long says he sees a similar problem when it comes to athletes struggling with tight hips – it’s not actually their hips. “Everyone likes to blame the hip flexors, but I’m shocked at how often athletes claiming their hip flexors are tight are actually moving well,” he says. 

Instead of the common culprit, the hip flexors, Long says that he “often finds limitations in other areas, and the two biggest are hip internal rotation and the ankles.” 

“For hip rotation, many athletes might stretch their hips into external rotation with exercises like the pigeon stretch. But I tend to see more hip stuff in internal rotation than external, and a small amount of work there can be a game changer,” he says. 

Long also suggests that “ankle mobility limitations contribute to hip issues” more commonly than many athletes might think. “When an athlete squats, their hips flex, knees bend, and the ankle dorsiflexes as the knees move forward. When ankles are stiff, not allowing the knee to travel forward, athletes must lean forward more as they descend into their squat. This challenges their hip mobility more, and often contributes to hip issues such as hip impingement.” 

2. You’re Not Doing the Right Rehab Exercises 

There are a million different mobility drills and exercises out there for stiff, sore backs and hips, but as Long points out, many gym goers are focusing on the wrong muscle groups when it comes to the back and hips.

To target the problem at its source, Long “absolutely loves reverse hypers” as an exercise for combatting back pain. “They build serious back strength without huge recovery demand,” he says.

While many gyms don’t have the piece of equipment required to perform reverse hypers, Long suggests this video to “show a few great ways to perform reverse hypers using more common pieces of gym equipment.” 

For the hips, Long suggests trying this mobilization exercise with resistance bands to get things moving. This Hip Mobility Overhaul can also help to provide a guide “for athletes needing more hip joint mobility and control.” 

Last but not least, give the ankles some attention with these goblet squat ankle stretchers. They’re “a great way to work on ankle mobility specific to the squat,” he says. 

If your ankles feel like they need a little extra after these goblet squats, Long’s Ankle Mobility Overhaul is a great way to really unlock your mobility. 

3. You’re Not Giving Your Body Enough Rest 

This one seems too simple, but Long emphasizes that rest and taking proper care of your body can make a huge difference. “I think of all acute injuries as imbalances between what we’ve asked a tissue to do and what [the tissues] were prepared to handle,” he explains. 

Long continues, saying “we make tissues more prepared by following a well laid out program that steadily increases. The loads and volumes we place on our body’s ability to handle the demands we ask of it. Things like sleep and nutrition are what is important here.” 

Just like any form of recovery, whether that’s from illness or injury, “if we aren’t giving our body enough nutrients or rest, it can’t recover from what we ask it to do. Eventually, that will lead to tissues being challenged too much, and either not performing as we want or becoming injured,” Long says.

So that back injury that you keep trying to rehab with exercises, mobility drills, and light stretching? It may actually just need a little extra rest. 

While everybody’s back and hip pain is unique, Long says these tend to be the most common culprits for back and hip pain. To learn more about your individual needs, he suggests using the Ultimate Mobility Checklist to “help you identify where you should focus your mobility work to not waste time working on the wrong areas.” 

Want more from Dr. Zach Long? Follow him @thebarbellphysio or work with him here.