Muscle imbalances such as right/left sided differences (asymmetries), or overuse of specific muscles, can cause muscle and joint pain. A common scenario that causes low back pain occurs because people spend a large percentage of their day sitting. Prolonged sitting can cause tightness and overactivity in the hip flexor group (iliopsoas, iliacus muscles). If the hip flexors (located on the front of the spine) become overly tight, this can cause the gluteal maximus (located in the buttocks) to become inhibited or less active.
This process is called reciprocal inhibition and is defined as the contraction or activity of one muscle group inhibiting the contraction or activity of the antagonist muscle group. When the hip flexors are tight, the gluteal maximus may not be working to its full potential, causing an imbalance that has a secondary effect during walking or gait. These people will be unable to produce full hip extension with the gluteus maximus during gait, and they begin to substitute the low back extensor muscles for the hip extensors (Gluteus maximus). Altered gait (walking pattern) will allow repetitive walking or running to recruit the low back extensor muscles, causing an increase in biomechanical stress in the lumbar spine producing chronic pain, osteoarthritic degeneration, and disc herniation.
A key challenge to anyone dealing with low back pain is how to permanently correct this dysfunctional movement pattern. Once the pattern is changed, the body will stop irritating itself and be able to heal. However, changing the way a person walks is a difficult task.
The correction involves
1) stretching and relaxing the hip flexors, and
2) activating and strengthening the hip extensors (particularly the gluteus maximus).
This will allow the lumbar spine to stop over working and may eventually heal.
Another common example that causes the gluteal group to become inactive is a sprained ankle. A sprained ankle can cause a very slight change (alteration) in gait (the way you walk). It may not even be obvious. This subtle change in the way you walk is a change in movement which can cause the central nervous system to reprogram the gluteal maximus and/or medius muscle to become inhibited. This decreased muscle tone in the gluteal group will cause the low back muscles to increase there muscle tone. Increased muscle tone and joint dysfunction leads to pain. The gluteal muscles will need specific exercises to
reawaken them to function properly. The following maneuver is a specific way to fire the gluteal group.
Tucker Test: Purpose is to help recruit a deeper and stronger contraction of the gluteal group.
To take the Tucker test: Place a quarter on the outside of the clothes between the buttocks at the level of the anus and have the client hold it in place with a strong gluteal contraction.
Assess: Can you contract the gluteals strong enough and continuously while performing the bridge exercise up and down so the quarter does not drop to the floor.
Relate: In order to hold the quarter in place you must concentrate on performing a strong gluteal contraction. This forces the continuous contraction of the gluteus and initiates a co-contraction of the abdominals.
Exercise Progression: Perform deep squats with the quarter held in the buttocks.
The benefit of having good hip flexor muscle length and good gluteal muscle function is in improved control of hip extension and this decreases mechanical musculo-skeletal pain in the low back.
