The Importance Of Alignment

How To Test If Your Hip And Back Pain Is Actually Being Caused By Misalignment (In Four Steps)

Whether you’re suffering from back pain, hip joint pain, knees cracking, chronic shoulder pain, or other pain in your skeleton and joints… The underlying theme of causation is almost always misalignment.

There are many different approaches your doctors and specialists may be taking to try to help you resolve these issues and “make the pain go away”…only to have it come back again and again!

The problem is, if they are not addressing the alignment of your muscles and skeletal structure, then they are missing the boat in a big way!

There are four ways in which misalignments may actually be the hidden culprit behind your persistent, chronic back, shoulder, and joint pains…

But unless you test your movement, you will never know!


And the pain will keep coming back, no matter how many adjustments you get, how many medications you take, and how many “experts” you see. This gets expensive, and the worst part is, you will keep suffering – needlessly.

This article will show you how to tell if your ongoing chronic back and hip joint pains may actually be caused by misalignments (which, fortunately, have a cure which does not require more medication or expensive treatments).

Once you find out if your pain may be caused by misalignment, you can also find out how to fix the misalignment through some simple exercises and just by changing the way you move in everyday life!

Step One: Let’s try these four tests to see if this is your problem.

First you will either need a mirror in front of you or someone to watch and help inform you of your alignment. This will provide you the direct visual and feedback that you need. It’s important that you assess the position you are actually in and not the position you feel like you are in.

Alignment Test #1


First, let’s test your hip flexion and hamstrings range of motion. These muscles are often the cause of a hunched back or what’s called a posterior pelvic tilt. It’s what most people think of as aging posture.

Lie on your back and put your leg up as far as it will go toward your nose (with the knee straight / unbent and not using your hands to pull on your leg) as shown. If your leg does not go up to a 90-degree angle (or more) you do not have the hip motion range of motion you need to avoid spinal pain and injury.

Ideal functional range of motion is 90 degrees and the greater you are away from 90 degrees the greater the deficiency you have. Angles of less than 70 degrees range of motion are extremely likely to cause spine and or pelvic pain and injury. Further, ranges of motion below 60 degrees are extremely common to cause spinal misalignments which remove the arch from your lower back and places excess pressure on the discs between the vertebrae in your spine. This is a very common cause of disc protrusion for many people.


It’s amazing how one simple test can tell us so much to help you eliminate pain.  


Alignment Test #2


Second, let’s test your hip extension range of motion. There are two primary muscles which restrict the range of motion here. 1) The psoas and 2) rectus femoris. These muscles attach in the front of your hip and when they are restricted are highly correlated with low back pain especially while standing for extended periods of time.

To perform the test lie on your back on a table or at the end of your bed with your lower leg hanging completely off of the table / bed (as shown) then bear hug your other leg toward your chest (as shown).

The first alignment check is to assess if your relaxed thigh is elevated off of the table or if it is lying flat on the table. If it elevated off of the table you have a severely tight psoas which is causing you spinal misalignment and likely causing you lower back pain.

The second alignment check of Test #2 is to assess if your relaxed thigh is straightening beyond 110 degrees. (example lady in picture shown is straightening her knee when relaxed to about 130 degrees). If the knee is straightened beyond 110 degrees when relaxed in this position this means the rectus femoris is tight which is causing you spinal and pelvic misalignment when walking or running and likely is causing you hip pain.

Again, it’s amazing what we find out with a simple test like this.

Alignment Test #3


Next, let’s test internal and external rotation in your hips. This has a huge impact on how your pelvis and hips are aligned which effects every other joint in your body. When the hips don’t have adequate internal and external rotation or when they are assymetrical (one side of the body has a big variance versus the other side) it can throw the entire midsection of you body out of whack.

Bring your right knee up above your hip, bent as shown with the leg extended out and knee at a 90 degree angle above your hip. Then, bring your raised foot in so that it moves toward your left thigh. That is your external rotation.

Then, bring your raised foot out in the opposite direction, away from your left leg and body. This is your internal rotation.

 You should have about 40 degrees of external rotation (foot in toward the other leg) and about 30 degrees of internal rotation (foot going away from the other leg) in the angle your shin is making when you do this exercise (as seen in alignment Test #3 image).


It is very common that when someone has lower back pain, that they have a limited range of one of these rotation abilities. This is especially important for golfers as you require adequate rotation and follow with your swing – when it’s not adequate your spine takes excessive stress and motion to make up for the deficiency in your hips.

Alignment Test #4


Lastly, let’s test if you are using your glutes properly.

To perform this test you need a step or platform to step onto which is about 12 inches tall.

Start the test by stepping up onto a platform that’s about 12 inches high with your left leg followed by bringing your right onto the platform. To step down keep your left foot on the step and step down with your right. Complete 10 reps on each side while watching in the mirror or having someone watch you.  

CAUTION: If you feel unstable or loss of balance performing a step up skip this test (this means you have weak glutes, core, and are a high risk for falling).

  • Notice that the clinic picture shows the patient’s foot, knee, and hip all in one straight line. Is your working leg (the one you’re using to lift you up onto the platform) staying straight from the hip through to the knee and through to the foot during loading?
  • Is your pelvis staying level (as shown in image) while you transfer from the ground onto the platform? Note – This is best assessed from looking at the back side of your body.


If your answer is no to either of these questions this means your glute medius is weak and additionally could have weak hip muscles and poor motor control for this movement. The step up is a movement you are likely to use daily and very similar to the same movement as walking. When there is weakness in this area it allows the center of your body (hip and pelvis) to shift to the side causing a stress in your joints. This is called sheer stress. This stress is the cause of degenerative joint disease and osteoarthritis.

Ok! So, how did you do?


Are you holding and moving your body in the right way, and do you have full joint mobility and alignment?

Most people have been moving incorrectly for decades. It feels natural but it is causing pain and injury!

 If not, the truth is you will not be able to fully “fix” your chronic back or joint pains until these things are addressed.

The tricky part with these seemingly small things that happen every day, is that you may not feel any pain while you are doing them…but they will cause misalignment, which will come back to haunt you in the form of “mystery pain” in your back, hips and joints, and also can cause Degenerative Joint Disease and or Osteoarthritis.

The good news is, there’s a VERY easy and simple way to fix all of these things which may be causing the misalignment that is at the bottom of your back and hip pain without expensive surgeries.



Robbie Stahl is a Harvard Educator, the inventor of the Biomechanical Optimization System and the creator of The Fitness Doctor Method.

For over 20 years Robbie Stahl has been helping people over the age of 50 overcome signs of aging, weaknesses, pain, injury, and various physical deficiencies that make it difficult for clients to become fit.

He has developed a first in the world system to analyze clients from head to toe to determine where their unique deficiencies are. With an elite team of doctors Robbie has established a World Class system for clients to overcome the things which are holding them back from quality of life while providing them an individualized prescription for optimizing their function so that they can live life to the fullest.

By the age of 22 he had already been recognized as the best trainer in Arizona for client results serving over a thousand clients with profoundly improved fitness levels. He is a member of the American College of Sports Medicine, has been a featured educator at Harvard Faculty Club, and is known for being an innovator in anti-aging fitness training.



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