The two questions I ask every Denver athlete with low back pain.
Before I evaluate anyone's back, I ask two questions. Can you fully extend your hip with your pelvis in a neutral position? And do you have full rotation range of motion at your hips? Nine times out of ten, the answer to at least one of those is no, and that tells me almost everything I need to know before we even start treatment.
Low back pain shows up constantly in the athletes I see here in Denver and Boulder, and the pattern is remarkably consistent. It is rarely a back problem. It is a hip problem that the low back has been quietly compensating for, sometimes for years.
The setup: a joint built for motion asked to sit still
Your hip is a ball and socket joint. It is built to move through a huge range in every direction. A healthy hip should give you somewhere around 120 degrees of flexion and 40 to 50 degrees of internal rotation. Those numbers are not arbitrary. They map almost exactly to the demands of the things people in this city actually do. Getting low in a squat at CrossFit. Rotating through the trunk on a trail run descent. Transitioning edge to edge on skis. Sitting into a deep hinge to deadlift.
When the hip cannot supply that range, the body still has to complete the task. It borrows the motion from somewhere else. The lumbar spine is the closest, most convenient joint to borrow from, and it pays for it.
The lumbar spine was never built to be a primary mover. It is built to transfer load and stay relatively still while the hips and thoracic spine do the moving. Ask it to repeatedly flex, rotate, and extend to make up for a stiff hip, and the tissue around it gets irritated. That irritation is the ache people describe as worse the day after a hard effort, worse by the end of a workday, and stubbornly unresponsive to rest.
What I actually find when I test it
Two athletes I evaluated recently had almost identical stories. Both trained regularly, both had been dealing with low back pain for months, and both had been told the fix was more core stability work. Both had done exactly that, diligently, with no real change.
Here is what the screen showed in both cases.
Hip flexion was restricted, and the pelvis was compensating early. When I have someone pull a knee toward their chest, I want to see the pelvis stay level until well past 90 degrees of hip flexion. In both of these athletes, the pelvis started posteriorly tilting almost immediately. That is the hip telling you it has run out of range and the lumbar spine is stepping in to finish the job. Every time they squatted below parallel or hinged to pick something up off the floor, they were asking the low back to do work that belonged to the hip.
Internal rotation was well below normal. Tested face down with the knee bent to 90 degrees, a healthy hip rotates 40 to 50 degrees internally. Both of these athletes measured closer to 15 to 20 degrees. That is a huge deficit, and it matters every time the body needs to rotate over a planted foot, which is constantly in running, skiing, and most field and court sports.
Stack those two limitations on top of each other and put them under repeated load, and low back pain is not a surprising outcome. It is close to inevitable.
Why the core work they were already doing didn't fix it
Trunk stability matters, and I am not suggesting anyone skip it. But a strong trunk sitting on top of a stiff hip is still going to defer to the stiff hip. If the range required for the activity is not available at the hip joint, that range has to come from somewhere, and the lumbar spine remains the path of least resistance regardless of how strong the surrounding musculature is.
This is the gap I see most often in athletes who have already tried to self-treat. They have built genuine trunk strength and stability, and the pain has not moved, because the actual restriction was never addressed.
What we do about it
The fix starts with restoring the motion that is missing, not just stabilizing around the deficit.
90/90 hip switches. This is the single best drill for building usable internal and external rotation in a position that transfers directly to sport.
Couch stretch, tail tucked. Opens the front of the hip into extension. The posterior pelvic tilt is not optional here. Without it, the stretch is just loading the lumbar spine into extension instead of the hip.
Hip flexion mobility with inferior glide. The band pulling the hip down, toward your feet is doing all the work here. Relax your hip and allow the band to create space between the femur and pelvis.
If low back pain has been a fixture in your training despite months of core work, the restriction is very likely sitting one joint below where you feel it. Get the hip screened before you assume the back itself is the problem.
