Is It My Back or My Hip? Understanding your source of pain

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Sometimes it’s hard for you to pinpoint the source of your pain when it comes to back and hip problems. This can lead to problems in diagnosis, and without the proper diagnosis, your treatment is often ineffective.

It’s likely my hip causing me pain

Most true hip problems are, surprisingly, felt in the groin. The common culprit is osteoarthritis in the hip joint. In addition to the groin pain, you’ll often experience:

  • Pain when walking, pivoting and other physical activities.
  • Relief when sitting, although you may have stiffness.
  • Limping

You’ll usually have a history of loss of motion at the hip, which can make it difficult for you to put on shoes and socks or to cut your toenails. You may also have difficulty getting in and out of cars, and going up and down steps.

Your groin pain may extend down the front of the thigh as far as the knee. Hip arthritis may rarely present as knee pain rather than groin pain. But, if your pain radiates past your knee, there’s numbness or tingling in the leg, or weakness such as dragging your foot, hip arthritis is not the cause.

It’s likely my back causing me pain

When the pain is in the middle of the lower back, or when your back tightens up so that you can hardly move, there is generally no problem with the diagnosis.  This is particularly true when the pain radiates into the leg, especially below the knee, and is associated with numbness, tingling or weakness. However, not all back symptoms are so straightforward.

I often see patients with pain in one or the other buttock, and they almost always tell me they have a hip problem, but most of the time pain in the buttock actually originates in the lower spine.

This is called referred pain, similar to when a heart attack patient complains of pain in the left arm. Your lower back can refer pain from an impinged nerve to both your buttocks and legs. And, where it refers the pain to depends on which joint in your spine is causing the issue.

A lot of lower back problems that show as hip pain are caused by a herniated disc that presses on nerves in the spinal column. This produces pain known as sciatica, which you’ll often feel in the hip.

You may have a herniated disc in your lower back if your pain:

  • Shoots down your leg below the knee, with numbness, tingling or weakness.
  • Becomes worse when you sit or bend.
  • Improves when you stand or walk.

Treatment

Both back and hip pain may respond to anti-inflammatory medication like ibuprofen or naproxen. Physical therapy often helps back pain, and a lightweight back support may also be useful.

If these initial measures fail to provide relief, targeted cortisone injections may be helpful. This is where a correct diagnosis is so important. You’ll often feel no relief if the wrong area is injected.

If you’re experiencing back and neck pain, you can find out what factors may play a role and get recommendations for follow-up steps by taking a free back pain assessment at askAAMC.org/SpineHealth.

 

Author

Faust_Steve_MDStephen Faust, MD, is an orthopedist with AAMG Orthopedic and Sports Medicine Specialists’ SpineTODAY program. You can reach his practice at 410-268-8862.

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