Like you, Mr. Smith has a desk job and every now and again he gets pain in his low back. He showed up the other day and asked for help because the pain was not going away like it usually does.

When I asked where it hurt, he said it was around his beltline and occasionally the front of his thighs feel achy. His hips also feel “kind of stoved up” or stiff.

He said that he hasn’t changed his activities or had any sort of injury or illness before it started getting worse.

• He said he does a lot of work at his computer, making phone calls, and mostly sitting throughout the day. He does occasionally get up to use the copier or to talk to his co-workers.
• He does have hobbies, mostly computer gaming, which means that he does a lot of sitting then, too.
• He walks maybe once a week for exercise and does a little lawn work. He doesn’t do stretching and remember ever being particularly flexible.

• When I examined him, I noticed that when he stood up, had a good deal of sway back (lordosis) When he lay down on the examination table, he was so stiff in his hips that the back of his thighs couldn’t touch the surface. Not surprisingly, he was a little uncomfortable.
• Even so, I saw that his muscle strength was fine, as were his feeling and reflexes. That told me that his nerves were fine: there was no pinched nerve (herniated disc) in his back.
• When I pushed on the lower part of his back, it was sore, as was the muscle that crosses the front of his hip over his groin.

Treatment

• My diagnosis is mechanical low back pain, which means that because his hip flexors are too tight, they’re pulling his pelvis forward, which is putting strain on his back. Like the old song, “the thigh bone is connected to hip bone, which is connected to the back bone…”
• Treatment is simple and inexpensive--a number of stretches--but means that Mr. Smith needs to get out of his chair a lot more often.
• Simple stretches to correct his posture
• Include stretch for iliopsoas (see picture)
• Towel stretch for anterior thorax
• Stretches for hip adductors and piriformis
• Stretches for spine flexion, extension, rotation and lateral bending.

So how did Mr Smith get on with this treatment?

• When I saw him 4 weeks later, he said that he was doing much better after stretching regularly
• He still has problems with his back if he sits too much, but when that happens he does the stretches and his pain goes away.

Body Mechanics

• The iliopsoas (see picture) is a strong muscle that flexes (bends) the thigh toward the trunk.  It originates both on the anterior portion of the lumbar spine and the anterion (inside) portion of the ilium (pelvic bone) and attaches to the upper inner thigh.
• The iliopsoas can get tight due to positions where hips are bent for a long time (such as sitting). 
• When the hip flexor muscles get tight, the pelvis is rotated downward, increasing a sway back (lordotic) posture and increasing the strain on your back. 
• The mechanics of the pelvis and thigh are restricted, so your lower back spine is forced to make up for movement.