Lower back pain and hip problems are so frequently connected that treating one without addressing the other is one of the most common reasons that lower back pain persists despite treatment. The hip and lower back are mechanically and neurologically intertwined to a degree that makes them functionally inseparable in most real-world movement.
This guide explains exactly why the hip and lower back are so connected, how to identify which is the primary driver of pain in your situation, and the specific exercises that address both simultaneously. These are not generic hip exercises or generic lower back exercises: they are chosen specifically because they target the hip-lower back interface and produce benefits for both regions.
The Hip-Lower Back Connection: Why They Affect Each Other
The psoas pathway: The psoas major muscle is the only muscle that connects the lumbar spine directly to the femur. It originates from the bodies and transverse processes of the lumbar vertebrae (L1 to L5) and inserts onto the lesser trochanter of the femur. This means that a tight or overactive psoas creates a direct pulling force on the lumbar vertebrae with every step, and that psoas weakness leaves the lumbar spine without its primary anterior dynamic stabiliser during hip loading. No other muscle in the body creates this direct mechanical link between the lumbar spine and the hip.
The pelvic bridge: The pelvis connects the spine above to the femurs below. Any movement of the pelvis affects both the lumbar spine and the hips simultaneously. Anterior pelvic tilt (pelvis tipping forward) increases the lumbar curve and places the hip flexors in a shortened position. Posterior pelvic tilt flattens the lumbar curve and restricts hip extension. The position the pelvis habitually adopts determines the resting load on both the lumbar discs and the hip joint.
The gluteal connection: The gluteus maximus is the primary hip extensor. When it is weak or inhibited, the lumbar erector spinae muscles compensate to assist with hip extension during activities like rising from a chair, climbing stairs, and bending forward. This compensatory lumbar extensor overactivity is one of the most common causes of muscular lower back pain in otherwise healthy people. Developing gluteal strength directly reduces the demand placed on the lumbar extensors.
The gluteus medius and lateral shear: During single-leg activities, the gluteus medius prevents the pelvis from dropping on the unsupported side. When it is insufficient, the pelvis drops laterally and the lumbar spine must accommodate this lateral shift by producing a lateral flexion shear force at the lumbar segments. Repeated over thousands of steps during running or daily walking, this lateral shear loading is a significant contributor to lower back pain in runners and active people.
Hip mobility and lumbar compensation: When hip extension range is limited (from hip flexor tightness or posterior hip capsule restriction), the lumbar spine compensates by hyperextending during activities that require full hip extension. The lumbar spine is not designed to repeatedly absorb the forces of a compensating hip, and this hyperextension pattern is a common cause of facet joint irritation and lumbar pain in athletes.
Identifying the Primary Problem: Hip or Lower Back?
This distinction guides the exercise selection and the urgency of medical assessment.
Signs the hip is driving the lower back pain:
- Lower back pain consistently improves when hip mobility and flexibility is addressed
- Pain in the lower back is accompanied by tightness or discomfort in the front of the hip or groin
- Lower back pain appears or worsens after prolonged sitting (hip flexor shortening is driving lumbar tilt)
- Single-leg activities (running, stair climbing) consistently trigger lower back symptoms
- Strengthening the glutes and hip stabilizers produces noticeable improvement in lower back symptoms
Signs the lower back is the primary problem:
- Pain radiates into the leg, particularly below the knee (suggests nerve root involvement)
- Pain is worsened by forward bending rather than being relatively position-independent
- Lower back pain preceded any hip tightness or weakness
- Pain does not change with hip-focused exercises after 4 to 6 weeks
When to seek medical assessment:
Seek assessment if lower back pain is accompanied by leg pain below the knee, numbness, tingling, weakness in the leg, or any bladder or bowel changes. These symptoms may indicate nerve root compression that requires specific medical management rather than exercise alone.
The Best Hip Lower Back Exercises
Category 1: Exercises That Address Lumbar-Pelvic Control
Pelvic Tilt
The foundation of lumbar-pelvic awareness and the starting point for anyone with lower back pain related to pelvic position.
How to do it:
- Lie on the back with knees bent and feet flat on the floor
- Gently flatten the lower back against the floor by tilting the pelvis backward (posterior tilt)
- Hold for 5 seconds
- Return to neutral and then allow a slight arch (anterior tilt)
- Hold for 5 seconds
- Repeat the cycle 10 times
Why it matters: This exercise develops awareness of pelvic position, which is the first step in addressing the pelvic tilt patterns that drive lumbar loading. It also activates the transverse abdominis and multifidus at a gentle level appropriate for acute lower back presentations.
Supine Hip Flexion Hold (90/90 Position)
Develops deep core and hip flexor endurance in the hip flexion position most relevant to lumbar stability.
How to do it:
- Lie on the back with both hips and knees at 90 degrees, feet in the air
- Hold this position while maintaining the lower back flat against the floor
- The challenge is preventing the lower back from arching
- Hold for 30 to 45 seconds
- Complete 3 sets
Dead Bug
One of the most effective lumbar-pelvic stabilization exercises available. As covered in the isometric core exercises article on this site, the dead bug simultaneously develops anti-extension core stability and hip flexor and extensor coordination.
How to do it:
- Lie on the back with arms toward the ceiling and knees at 90 degrees above the hips
- Slowly lower the right arm overhead and the left leg toward the floor simultaneously
- Keep the lower back absolutely flat against the floor throughout
- Return and repeat on the other side
- Complete 3 sets of 8 per side
Bird Dog
Develops the anti-rotation core stability and opposite arm-leg coordination that directly replicates the demands of walking and running on the lumbar stabilising system.
How to do it:
- Start on hands and knees in a tabletop position
- Extend the right arm forward and the left leg backward simultaneously
- Hold for 3 to 5 seconds with a flat, neutral spine
- Return and repeat on the other side
- Complete 3 sets of 10 per side
Category 2: Exercises That Develop Hip Extension (Reducing Lumbar Compensation)
These exercises specifically target the gluteus maximus to reduce the compensatory lumbar extensor overactivity that occurs when the glutes are weak.
Glute Bridge
The most important exercise in this category. By developing gluteus maximus strength in the hip extension position, the glute bridge directly reduces the lumbar extensor compensation that drives muscular lower back pain.
How to do it:
- Lie on the back with knees bent and feet flat on the floor hip-width apart
- Drive the hips upward until the body forms a straight line from knees to shoulders
- Squeeze the glutes firmly at the top for 2 seconds
- Lower slowly
- Complete 3 sets of 15 reps
Key cue for lower back protection: The lower back should not arch at the top of the glute bridge. If it does, the lumbar extensors are compensating rather than the glutes producing the movement. Tuck the pelvis slightly and focus on squeezing the glutes rather than pushing the hips as high as possible.
Hip Thrust
A loaded progression of the glute bridge that develops greater gluteal strength and provides stronger stimulus for reducing lumbar compensation.
How to do it:
- Sit with the upper back against a bench, knees bent, feet flat
- Drive the hips upward until the body forms a straight line
- Squeeze the glutes at the top
- Lower slowly
- Complete 3 sets of 12 reps
Single-Leg Glute Bridge
Develops unilateral gluteal strength and addresses the side-to-side gluteal asymmetries that create the asymmetric pelvic loading patterns contributing to one-sided lower back pain.
How to do it:
- Set up in the standard glute bridge position
- Extend one leg and perform the bridge on the other leg only
- Hold at the top for 2 seconds
- Complete 3 sets of 10 per side
Romanian Deadlift
Develops the complete posterior chain (glutes and hamstrings) through the hip hinge pattern. The hip hinge is the functional movement most compromised when the hip-lower back relationship is disrupted.
How to do it:
- Stand with feet hip-width apart holding dumbbells or a barbell
- Push the hips backward while maintaining a neutral spine
- Lower until a strong hamstring stretch is felt
- Drive the hips forward to return
- Complete 3 sets of 8 reps
Category 3: Exercises That Address Hip Abductor Strength (Reducing Lateral Shear)
These exercises develop the gluteus medius strength that prevents the lateral pelvic dropping that creates lateral shear loading on the lumbar spine.
Clamshell With Band
Develops gluteus medius activation as the entry-level hip abductor exercise.
How to do it:
- Lie on the side with a loop band above the knees, hips bent to 45 degrees and knees to 90 degrees
- Rotate the top knee upward against the band resistance
- Hold for 2 seconds at the top
- Lower slowly
- Complete 3 sets of 15 per side
Side-Lying Hip Abduction
Develops gluteus medius strength in the abducted position with the hip in a more extended position than the clamshell.
How to do it:
- Lie on the side with the body straight
- Lift the top leg to approximately 30 to 45 degrees
- Hold for 2 seconds at the top
- Lower slowly
- Complete 3 sets of 15 per side
Lateral Band Walk
Develops gluteus medius endurance in a weight-bearing position that is more functionally relevant to running and daily activities than the side-lying variations.
How to do it:
- Place a loop band above the knees and assume a quarter squat
- Step laterally for 15 steps, maintaining the squat and level pelvis
- Return for 15 steps
- Complete 3 sets per direction
Single-Leg Romanian Deadlift
Simultaneously develops posterior chain strength, hip abductor stabilization, and single-leg pelvic control in the exercise with the highest specificity to the hip-lower back interface.
How to do it:
- Stand on one leg with a slight knee bend
- Hinge forward from the hip while extending the free leg behind
- Focus on keeping the pelvis level (no hip drop or rotation)
- Drive the hip forward to return
- Complete 3 sets of 8 per leg
Category 4: Hip Mobility Exercises for Lumbar Relief
When hip mobility restriction is forcing the lumbar spine to compensate, improving hip mobility directly reduces the lumbar loading.
Kneeling Hip Flexor Stretch
Reduces the hip flexor tightness that drives anterior pelvic tilt and lumbar hyperextension.
How to do it:
- Kneel with one knee on the floor and the opposite foot forward in a lunge
- Tuck the pelvis slightly under (posterior tilt) before driving the hips forward
- Maintain the pelvic tuck throughout the stretch to maximise hip flexor stretch and minimise lumbar extension
- Hold for 60 to 90 seconds per side
- Perform twice daily
Key cue: The pelvic tuck before driving forward is what differentiates an effective hip flexor stretch from a lumbar extension exercise. Many people perform kneeling hip flexor stretches with an anterior pelvic tilt that extends the lumbar spine rather than stretching the hip flexors.
Supine Figure Four Stretch
Reduces posterior hip and external rotator tightness that restricts hip internal rotation and contributes to lumbar rotation compensation.
How to do it:
- Lie on the back with one ankle crossed over the opposite knee
- Draw the bottom knee toward the chest
- Hold for 60 to 90 seconds per side
- Perform once to twice daily
Child’s Pose
Provides gentle lumbar flexion decompression and posterior hip mobilisation simultaneously.
How to do it:
- Start on hands and knees
- Sit the hips back toward the heels while extending the arms forward
- Allow the lower back to round and relax
- Hold for 60 to 90 seconds
- Perform as needed for symptom relief
90/90 Hip Stretch
Develops hip rotation range in both directions, reducing the rotational compensation demands placed on the lumbar spine.
How to do it:
- Sit with both hips and knees at 90 degrees
- Hold the forward position for 45 to 60 seconds per side
- Transition between sides for 3 cycles per session
A Structured Hip Lower Back Programme
Phase 1: Symptom Management and Foundation (Weeks 1 to 3)
Goal: Reduce acute symptoms and establish the basic hip-lumbar control patterns.
Daily:
- Pelvic tilt: 3 x 10
- Kneeling hip flexor stretch: 90 seconds per side
- Supine figure four stretch: 60 seconds per side
- Child’s pose: 90 seconds
3 times per week:
- Dead bug: 3 x 8 per side
- Glute bridge: 3 x 15
- Clamshell with band: 3 x 15 per side
- Bird dog: 3 x 10 per side
Phase 2: Strengthening (Weeks 4 to 6)
Goal: Develop the hip and pelvic strength that reduces lumbar compensation.
3 times per week:
- Hip thrust: 3 x 12
- Single-leg glute bridge: 3 x 10 per side
- Lateral band walk: 3 x 15 steps per direction
- Dead bug: 3 x 10 per side
- Romanian deadlift: 3 x 8
Daily mobility (continue from phase 1):
- Kneeling hip flexor stretch: 90 seconds per side
- 90/90 hip stretch: 45 seconds per side
Phase 3: Integration (Weeks 7 to 9)
Goal: Develop the integrated hip-lumbar control that prevents recurrence.
3 times per week:
- Romanian deadlift (heavier): 4 x 6 to 8
- Single-leg Romanian deadlift: 3 x 8 per leg
- Hip thrust (loaded): 4 x 8 to 10
- Lateral band walk (heavy band): 3 x 15 per direction
- Bird dog with resistance band: 3 x 10 per side
Frequently Asked Questions
Should I rest or exercise when I have hip-related lower back pain?
Complete rest is rarely the optimal approach for hip-related lower back pain. The exercises in Phase 1 are appropriate to begin even during an acute episode because they develop hip and pelvic control at intensities that do not aggravate the painful structures. Walking is also beneficial: it activates the gluteus medius and promotes circulation to the lumbar structures without the compressive loading of more demanding activities. Avoid heavy loaded exercises and high-impact activity during acute flares.
Why does my lower back hurt more after sitting than after walking?
This pattern strongly suggests hip flexor tightness as a contributing factor. Prolonged sitting holds the hip flexors in a shortened position, which tightens them further and increases the anterior pelvic tilt they produce when you stand. The lumbar spine must accommodate this tilt, which loads the posterior lumbar structures and produces the characteristic pain and stiffness of standing up after prolonged sitting. The kneeling hip flexor stretch performed several times during the day, and taking movement breaks every 45 to 60 minutes, directly addresses this mechanism.
Can strengthening the core fix hip-related lower back pain?
Core strengthening helps but is not sufficient on its own when the hip is the primary driver of lumbar symptoms. A strong core that is connected to weak, tight, or poorly controlled hips will not resolve the lower back pain driven by those hip problems. The most effective approach combines the lumbar-pelvic control exercises in Category 1 with the hip strengthening in Categories 2 and 3, rather than exclusively focusing on either the core or the hips.
How long until I see improvement?
For hip-related lower back pain without significant nerve involvement, consistent daily stretching and three-times-weekly strengthening typically produces noticeable symptom improvement within 2 to 4 weeks. Full resolution of the underlying hip-strength deficits and the movement pattern changes that produce lasting relief typically takes 8 to 12 weeks. Athletes returning to full training after hip-related lower back pain should allow the full 12 weeks before resuming high-intensity loading.
Is it normal to feel the exercises in the lower back rather than the glutes?
During the glute bridge and hip thrust, feeling the lower back rather than the glutes indicates that the lumbar extensors are compensating for insufficient gluteal activation. This is the exact pattern that the exercises are designed to correct. To shift the load to the glutes: perform a pelvic tilt (flatten the back against the floor) before initiating the bridge, focus on squeezing the glutes rather than pushing the hips high, and try placing the feet slightly further from the body to change the mechanical advantage. If the lower back feeling persists, start with the clamshell and lateral band walk to activate the glutes before attempting the bridge.