Is it my hip or my back? How to tell the difference
Pain around the hip is one of the trickiest areas to pin down. The hip joint, the lower back, the sacroiliac joint and the tendons on the outside of the hip can all produce pain in overlapping places, and people are often surprised by where theirs is coming from.
Where is the hip joint, really?
Deeper and further forward than most people think. The hip joint sits in the groin, not at the side where you'd put your hands on your hips. That bony area at the side is the top of the thigh bone, where the gluteal tendons attach, and the back of the 'hip' is the buttock and sacroiliac region.
What does pain from the hip joint feel like?
Typically pain in the groin or the front of the hip, sometimes spreading to the front of the thigh and knee. It's often worse putting on shoes and socks, getting in and out of a car, pivoting, and after sitting. The hip may feel stiff, and you may limp.
What does pain from the lower back feel like?
Pain from the back is more often felt in the buttock, the back of the pelvis or the back or side of the thigh, and may travel below the knee with pins and needles or numbness. It tends to change with back movements and positions, such as bending, sitting or standing for long periods, and with coughing or sneezing.
Which signs point to the hip?
A study of 97 patients with lower limb pain found three signs that best predicted a hip problem over a spine problem: a limp, groin pain, and limited inward rotation of the hip. People with a limp or groin pain were about seven times more likely to have a hip disorder, and those with limited hip rotation about 14 times more likely (Brown et al., Clinical Orthopaedics and Related Research, 2004).
Is there a simple test I can try?
Sit on a chair and, keeping your knee in place, swing your foot outwards, which rotates the hip inwards. Compare both sides. If one side is clearly stiffer and reproduces your groin pain, the hip joint is more likely to be involved. This is only a guide; a proper examination tests much more.
What about pain on the outside of the hip?
Pain over the bony point at the side, worse lying on it and on stairs, usually comes from the gluteal tendons, not the joint or the back.
See our post on hip pain when sleeping on your side.
What about pain in the buttock?
Buttock pain most often comes from the lower back or sacroiliac joint. It can also come from the hamstring tendon at the sit bone, the deep buttock muscles, or the hip joint itself.
See our posts on sacroiliac joint pain and hamstring tendinopathy.
Can it be both?
Yes, and often is, particularly from middle age onwards. A stiff, arthritic hip changes how you walk and loads the lower back more, and the two can hurt together. This is sometimes called hip-spine syndrome. Treating only one may leave you with half the problem.
Can a hip problem cause knee pain?
Yes. Hip joint problems commonly refer pain to the front of the thigh and knee. In children and teenagers, knee pain with a limp should always prompt a check of the hip.
Will a scan tell me which it is?
Not always. X-rays and MRI scans of both the hip and the spine frequently show age-related changes in people without symptoms, so a scan can 'find' something in either. Examination findings are needed to work out which is actually responsible. Sometimes a diagnostic injection into the hip joint is used by specialists to settle the question.
Why does it matter?
Because the treatment differs. Hip joint problems respond to hip strengthening, mobility work and load changes. Back-related pain responds to movement, back and trunk strengthening and nerve-settling strategies. Before surgery, such as a hip replacement or spinal operation, getting this right is essential.
How does an osteopath work it out?
We take a history of where the pain is and what brings it on, watch you walk, test hip range and strength, examine the lower back and sacroiliac joints, and check the nerves. Often the answer is clear from the examination. We refer for imaging or a specialist opinion when it isn't, or when the findings suggest significant arthritis or nerve compression.
When should it be checked urgently?
See a doctor promptly for hip or groin pain after a fall with difficulty bearing weight, pain with fever, groin pain with a limp in a child or teenager, or constant pain at night with weight loss. Go to an emergency department straight away if back pain comes with new difficulty controlling your bladder or bowels, numbness around the groin or inner thighs, or weakness or numbness in both legs. See your GP promptly for leg weakness that's getting worse, back pain with fever or feeling unwell, unexplained weight loss, or a history of cancer.
See our hip and pelvic pain guide and our low back pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
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Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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