Clinical Pilates in Practice: Hip-Spine Syndrome
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This narrative review explains the mechanism by which abnormal hip pathologies contribute to low back pain in patients without hip osteoarthritis.
Key Points: Hip-spine Syndrome
Hip abnormalities limiting hip flexion and/or extension require compensation from the pelvis and lumbar spine for the lack of sagittal movement at the hip.
Between 13.1% and 37.5% of the total hip flexion is provided by the pelvis through sagittal movement at the lumbopelvic area.
Abnormalities at the hip joint contributing to low back pain include flexion deformities, osteoarthritis, developmental dysplasia, and limited hip range of movement.
The bony overgrowth of a cam impingement produces shear forces resulting in an ‘outside-in’ acetabular cartilage damage and labral tears, which amplifies the damage as the femoral head–neck junction rolls into the acetabulum.
Cam and pincer deformities cause premature femoroacetabular coupling in flexion and affect the lumbopelvic structures, namely the pubic symphysis, sacroiliac joint, and lumbar spine.
Cam and pincer impingements increase sacroiliac and lumbar spine stresses.
Limited spine mobility is present in symptomatic patients with femoroacetabular impingement, requiring more flexion at the hip to achieve sitting position, which may lead to impingement between the acetabulum and proximal femur.
Abnormal femoral torsion affects the capsulo-labral and musculotendinous structures of the hip and lumbar spine, and may contribute to increased lumbopelvic pain.
Abnormal gait displayed by patients with abnormal femoral torsion is a result of the rotational misalignment of the lower extremities.
Ischiofemoral space is decreased in the longer side of individuals with leg length inequality.
The limitation in hip extension in individuals with increased femoral torsion is caused by contact between the femoral neck and acetabulum or the trochanter and ischium.
Tension in the ischiofemoral ligament decreases by externally rotating the hip.
Pelvic incidence, which is the sum of pelvic tilt and sacral slope, is a constant value for any given patient:
→ When the pelvic tilt increases, the sacral slope decreases;
→ When the pelvic tilt decreases, the sacral slope increases.
Clinical Pilates in practice
Work on lumbopelvic mobility.
→ Seated Roll Backs.
→ Assisted Roll Ups.
→ Side Leg Kick.
Hip rotation mobility is integral, always working into comfortable ranges.
→ Use rotator discs.
→ Sleeper/Side Leg Press in hip internal rotation.
Pubic symphysis and sacroiliac joint integrity support equal pelvic mobility bilaterally.
→ Side to Side on the Mat.
→ Teaser on the Wunda Chair.
Work to centre the femoral head prior to movement: recall the function of the hamstrings and rotator cuff of the hip.