A few weeks ago, my friend and fellow author Kevin Mullins, who wrote Day by Day: The Personal Trainer’s Blueprint to Achieving Ultimate Success, shared his take on the state of corrective exercise in the fitness industry. In short: stop overdoing it. People still need to train to get better. He then followed with thoughts on the shoulders, and today he returns to cover the lower back and hips. Grab a cup of coffee—this is good.
PART II: CORRECTING THE LOWER BACK AND HIPS
In the previous article we looked at how to address issues in the shoulders and thoracic spine. We found that optimal shoulder function comes from a healthy scapulohumeral rhythm, a mobile thoracic spine and humerus, and strong scapular and core muscles. We identified common problems and proposed targeted exercises that can correct issues when they arise and also strengthen the joint’s overall capacity.
That followed my opening piece in which I explained my view on the current state of the industry and how corrective work has been pushed too far. You can read that earlier piece.
This installment digs into the lower back and hip joint—an anatomically different region, but with similar physiologic demands. You’ll learn that lower back pain isn’t limited to the back itself, that hip dysfunction requires more than just flexibility and blood flow, and that integrated three‑dimensional movements are key to unlocking the hips and core. We’ll explore the region’s anatomy, physiology, and biomechanics that professionals should consider, and we’ll add five strong exercises to the mix. But first, a quick amendment to a point from my previous post.
AN AMENDMENT ON THE FMS
In my last article I discussed my concerns about the Functional Movement Screen (FMS). I didn’t communicate my position clearly enough in my attempt to cover a complex topic concisely. My claim that “the FMS puts the fear of God into trainers” wasn’t accurate.
Brett Jones of FMS and I had a productive conversation about the FMS, how trainers use it, and my specific concerns. Brett emphasized that when taught and used properly—especially after Level 2 certification—the FMS provides trainers useful tools to identify and address issues seen in the screens. He’s right.
From my experience and the literature, I’ve found great value in identifying flawed patterns and guiding corrective work. The tools exist for a trainer to succeed. So, to be clear: the FMS itself isn’t the problem. The certifications and resources from Gray Cook and Lee Burton are excellent educational resources for trainers. The responsibility lies with the trainer performing the assessment to understand what they’re screening, why they’re screening it, and what it means for the client’s program.
Bottom line: the FMS can feel intimidating to trainers who haven’t invested time to understand its purpose. That can be avoided by investing in education and digging into new information.
BASIC HIP AND LOWER BACK ANATOMY – SKELETAL
Looking at the skeletal framework of the spine and hip, there are four major considerations:
– The thoracic spine—capable of flexion, extension, and rotation. Ideally, the thoracic spine handles most rotation and extension of the spine.
– The lumbar spine—capable of flexion, extension, and rotation. Ideally, the lumbar spine serves as a stable base for movement that allows the pelvis to move beneath and the thoracic spine to move above.
– The pelvis—capable of anterior tilting (forward), posterior tilting (backward), and lateral tilting to either side.
– The femurs—capable of internal and external rotation, flexion and extension, as well as abduction and adduction. These movements are necessary for daily locomotion patterns and the movements we perform in training.
The ankle and foot also affect hip health, especially for runners. Issues there can propagate up the kinetic chain and lead to negative adaptations in the hip or lower back. We’ll address these corrective strategies in the final part of the series, Hip–Knee–Ankle–Foot, so stay tuned. For now, simply acknowledge their role in the process.
Shoulders can also impact hip function. A shoulder dysfunction, such as upper-cross syndrome, can affect the thoracic spine, which in turn disrupts the lumbar spine and pelvis. Improving shoulder health can ease postural stresses that affect the lower spine, allowing for a better-functioning pelvis and improved hip movement. The scapula will be a focus in our corrective work.
BASIC ANATOMY OF SPINE AND HIPS – MUSCULAR
There are deep muscles with very specific roles, such as the multifidus that runs along the spine. Our training doesn’t always target these directly, but it’s good to be aware of them.
For day-to-day training, most trainers don’t need to drill into every detail. The major players you should know include:
– The abdominal wall: transverse abdominis, rectus abdominis, internal and external obliques, and the psoas. These muscles flex, extend, and rotate the spine, and some act on the hip as flexors.
– The glutes: maximus, minimus, and medius. They act as hip extensors and external rotators.
– The thigh muscles: the four quadriceps, three hamstrings, the tensor fasciae latae, and the abductors and adductors. These drive the movement of the femur in the hip socket in a variety of patterns. The next section will isolate the specific motions and the muscles involved for reference.
– The posterior trunk muscles: the erector spinae, quadratus lumborum, latissimus dorsi, and lower trapezius. These help position the thoracic and lumbar spine and stabilize the spine during movement.
Basic Movement Physiology
Knowing the structures is only half the battle. Understanding how they create movement is essential. To keep this concise, here’s a practical overview of the main functions and the muscles behind them:
– Spinal flexion — rectus abdominis, psoas major
– Spinal extension — quadratus lumborum, erector spinae, latissimus dorsi
– Spinal rotation or lateral flexion — core muscles acting unilaterally, with the obliques and serratus anterior contributing
– Spinal stability — transverse abdominis, multifidi, and the coordinated action of the abdominal and back muscles
– Hip flexion — psoas major, iliacus, rectus femoris, sartorius, tensor fasciae latae, adductor longus and brevis, gracilis, pectineus; some fibers of gluteus minimus and medius assist
– Hip extension — gluteus maximus, biceps femoris, semitendinosus, semimembranosus; some gluteus medius fibers
– Hip abduction — gluteus maximus, minimus, medius, tensor fasciae latae; piriformis assists at 90 degrees
– Hip adduction — adductor longus, brevis, magnus, pectineus, gracilis
– Hip internal rotation — tensor fasciae latae, adductors, portions of gluteal muscles
– Hip external rotation — piriformis, gemelli, obturators, glutes, psoas, sartorius, quadratus femoris
This list can read like a textbook appendix, but note the overlaps. The glutes, adductors, and TFL have multiple roles, which helps explain the major players.
FASCIAL INTEGRATION
We must also consider the fascia surrounding the core, hip, and thigh. Whether you use myofascial release or integrated, nonlinear movements, fascia deserves attention. Fascia responds quickly to stress and can reorganize the body efficiently. Sitting all day tends to tighten and dry it out; an active routine with varied movements helps keep fascia healthy. Nonlinear movements are particularly effective for fascia.
THE MAJOR ISSUES
Problems in the spine and hips are usually interconnected. A client may have one or several issues, and you’ll likely encounter most of them at some point. Here are the common ones, each important to read as its own issue while also understanding a client may present with many at once. The corrective strategies we’ll discuss later are versatile enough to help most people.
1) DESK POSTURE
Desk posture keeps showing up. Upper-cross syndrome can impair core function and, in turn, hip function. Slouched shoulders, a kyphotic thoracic spine, and weak abdominal muscles often mean the hips won’t move well. Lower-cross syndrome—weak glutes and abs with tight hip flexors and lower back—can accompany this. When a client presents these together, it can be hard to prescribe challenging work, so early corrective steps are essential. We’ll include exercises below that help UCS and LCS together.
2) EXCESS ANTERIOR TILT
A pelvis held in forward tilt for too long can cause issues at rest and during exercise. Prolonged anterior tilt can tighten the back muscles while weakening the abdominal wall, making hip function harder and risking spinal injury. It can also cause the rib cage to flare, creating a midsection that looks atypical but would normalize with neutral pelvis alignment.
3) EXCESS POSTERIOR TILT
The opposite is posterior tilt, often linked with lower-cross issues due to weak abdominal walls and overactive hip flexors. This position flattens the natural curve of the lumbar spine and makes hip extension difficult. Corrective work targets glutes, hamstrings, the abdominal wall, and lat muscles, and also improves external rotation and abduction. The pelvis should be able to tilt posteriorly in some movements to support stability.
4) STICKY FEMURS
This informal term describes hips that won’t rotate smoothly in the socket, often from limited movement variation and training that doesn’t cover all three planes. Some people have weak end-range rotators, while others have mobility but lack strength at end ranges. Detrained individuals and those who don’t train external and internal hip rotation frequently fall into this category.
5) POOR COORDINATION
Sometimes the fix is simply getting people moving more and in a variety of ways. A program featuring unilateral, contralateral, ipsilateral, and bilateral movements in all three planes is ideal to improve coordination and hip function.
6) WEAK CORE
A weak core disrupts movement and can affect any segment of the body. The core’s main job is to transfer forces between the limbs and the environment. A strong core helps maintain stability as the limbs generate and absorb force. Core programming should emphasize creating and maintaining tension, and training should cover all three planes with varied loads.
THE CORRECTIVE EXERCISES
The corrective moves work for multiple issues and are great as warmups, isolated correctives, or fillers between main lifts. The sumo deadlift is a primary movement to include early in a program when you’re ready to load it.
1) GLUTE BRIDGE PULLOVERS
This variation strengthens the glutes and lats while addressing coordination and spinal control. It supports the glutes, lats, and abdominals and helps with several issues listed above, except for “sticky femurs.”
2) FOOT ELEVATED GLUTE BRIDGES
Elevating the feet increases range and strengthens the hip muscles, both flexors and extensors. It also helps manage the lumbar spine, improves pelvic tilt, and supports posture and core strength.
3) COSSACK SQUATS
A demanding lateral squat requiring substantial external hip rotation. It works the abductors and the hip flexion/extension pattern in the frontal plane. Use supports to work into depth and progress gradually.
4) COPENHAGEN SIDE PLANKS
A strong adductor and rotary-core exercise performed from a side plank. Maintain the bottom-leg squeeze and a stable side plank posture throughout.
5) LOADED MARCHING CARRIES
Loaded carries are highly effective for hip function, combining hip flexion with loaded posture. Focus on keeping knees vertical, varying tempo, and maintaining a tight upper back and scapular control. This one targets multiple issues.
6) SUMO STANCE DEADLIFTS
Sumo deadlifts train hip hinges across the thighs, hips, core, and upper back. The external rotation and abduction of the hips improve strength and mobility, making them especially useful for people who sit most of the day.
7) LOADED BEAST TO WORLD’S GREATEST HIP OPENER
A mobility-focused movement that blends traditional mobility work with loading to increase hip control and coordination, connecting upper and lower body movement.
BONUS:
8) HINGE POSITION FACE PULL
A hinge-focused face pull that builds shoulder health while enhancing core tension and lat stability. Use this variation to teach proper hip and back coordination beyond a simple pull.
WRAPPING IT UP
Improving a client’s hip function requires addressing both mobility and stability, along with ensuring enough training stimulus to drive change. Understanding anatomy and physiology helps you design progressive programs that correct issues and deliver results. The final part of the series will explore the relationship between the hip, knee, and ankle.
On a lighter note: the gemelli muscle’s name often brings to mind Gimli from The Lord of the Rings, which is a fun mental image when thinking about anatomy.
