Is It Back Pain or Hip Pain? Getting to the Root of the Problem

If you have pain in your low back, hips, and other areas in your lower body, the source isn’t always easy to pinpoint. Your pain may originate in your lumbar spine (low back) or your hip—or both—and it’s important that your doctor identifies the source of the problem, so you receive the right treatment.

Because the hips and lower spine are located so closely together, it’s easy to mistake back pain for hip pain (and vice versa). Regardless of the origin, most low back pain and hip pain share a common cause: normal wear and tear on the body due to aging or triggered by overuse injuries (your doctor may refer to this wear and tear as degeneration or degenerative changes). Lumbar sprains and strains, osteoarthritis, and herniated discs are common degenerative culprits behind low back and hip pain.
X-ray image of anterior, posterior hip joint.Determining if pain is back or hip related can be difficult to distinguish because the lower back and hips are close to each other. Photo Source: 123RF.com.

Signs that Your Hip Is the Source of Your Pain

One of the biggest signs that your pain is caused by a problem in your hip is the presence of groin pain. Your hip joint is located behind the groin, that’s why groin pain usually means the hip is the root cause of pain. In some cases, this groin pain will radiate downward toward your knee.

Another obvious sign that your hip is the source of your pain is pain around or over the hip joint. However, hip problems can also refer pain to your low back, contributing to the confusion over where the true source of the pain is located.

Hip-related pain is most often caused by osteoarthritis in the hip. In addition to groin pain, people who have osteoarthritis in their hip joint often report pain in their buttock, front of thighs, and knees. They may also limp when they walk and report reduced range of motion in their hips, pain that worsens with activity and improves with rest, and discomfort that begins as occasional but becomes more regular.

While osteoarthritis is the most common cause, hip pain may also derive from piriformis syndrome, avascular necrosis in the hip, and/or sacroiliac joint dysfunction.

  • Piriformis syndrome causes dull, mild pain in the low back and buttocks and can cause pain radiating down the leg—or sciatica.
  • On the other hand, the hip pain associated with avascular necrosis is severe and constant.
  • Sacroiliac joint pain might be attributed to both the hip and the low back, as the sacroiliac joints connect the sacrum in spine to the hip bones.

Signs that Your Spine Is the Source of Your Pain

Whereas groin pain is a telltale sign that the pain is linked to the hip, pain above the waistline that travels down the body typically indicates a low back issue. A low back problem may also be responsible for other types of lower body pain, including thigh, buttock, and below-the-knee pain.

Among the most common degenerative conditions that affect the lumbar spine are herniated discs, spinal stenosis, and spondylolisthesis. These conditions cause pain by irritating your low back nerves, resulting in pain that shoots down your legs (ie, sciatica), weakness, numbness, and reducing your range of motion.

The pattern of pain coming from the lumbar spine can be variable, depending of the specific issue causing the pain. Commonly, pain from arthritis of the spine occurs during transitions such as getting out of bed in the morning or raising up from sitting. It can often then improve after getting moving. In contrast, pain from spinal stenosis or nerve pressure (ie, compression) is often worse with prolonged standing or walking and relieved with sitting.

How Doctors Get to Root of Your Pain

If you have pain in your lower body and aren’t sure whether your back or hip is to blame, a good first course of action is to visit your personal doctor. He or she will review your medical history and may perform a series of physical exam tests (ie, movements) to get to the root of your pain. Alternatively, your personal doctor may refer you to a doctor who specializes in the hip or spine to make an accurate diagnosis.

Your doctor will ask you to describe your pain, including its location, when it worsens/is relieved, and what the pain feels like (eg, sharp, dull, etcetera).

After listening to your description of your pain, your doctor may have you perform several maneuvers or movements as part of a physical exam. The goal of these maneuvers is to determine what movements recreate your pain. One such maneuver is called the Flexion Abduction External Rotation (FABER) test, which helps determine if the disorder is sourced in your hip and may illuminate sacroiliac joint problems. During this test, you lie down your back while flexing and rotating your hips. Your doctor may also palpate (press) the area of pain.

Next, your doctor may also order imaging scans, such an x-ray to view your bones or an MRI to view soft tissues (eg, nerves), which may help reveal the true nature of the spinal or hip problem. It is important for your doctor to then determine if your complaints and exam findings can be explained by what is seen on the images.

If still unable to definitively yield a diagnosis, your doctor may recommend using an injection containing a numbing agent to help confirm a diagnosis. Here’s how a diagnostic injection works:

  • If, for example, your doctor injects the medication into your hip joint, and your symptoms are relieved, that indicates that your pain originates in your hip. However, if the injection does not relieve pain, that means the source of pain is located elsewhere. Therefore, even if the injection does not make the pain go away permanently, your doctor may be most interested in your initial response to the injection.

Know the Source, Know the Solution: Treating Back Pain and Hip Pain

Once your pain is identified as truly originating in your hip or in your low back, your doctor will work with you to craft a treatment plan to address it. In many cases, this regimen will include medication to reduce inflammation and pain, and a specially designed physical therapy program to teach you movements, stretches, and physical activities to help alleviate symptoms and prevent them from returning. Depending on the nature of your pain, your doctor may also recommend lifestyle modifications (eg, losing weight or quitting smoking) to treat your pain. For both spine pain and hip pain, surgery is rarely necessary and viewed as a last-resort treatment option.

Updated on: 08/19/19
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Piriformis Syndrome

Piriformis syndrome involves the piriformis muscle a target for repetitive motion injury especially in people who are runners. Piriformis symptoms include buttock pain and if the sciatic nerve is compressed, sciatica.
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