Oh, My Aching Back — Or Is It My Hip?

Back problems can masquerade as hip problems. “There is a lot of overlap,” says hip specialist Trevor Murray, MD. Most pain from hip and back problems is due to ordinary wear and tear on the body.

When the hip is the usual suspect

Surprisingly, hip problems usually produce groin pain on the affected side. That’s because the actual joint of the hip is near the spine.

“Groin pain is a hip issue until proven otherwise,” says back pain specialist Russell DeMicco, DO. “Pain above the belt line is not a hip issue.”

The most common cause of hip pain is osteoarthritis of the hip joint. You may have hip arthritis if:

• Pain is in your groin.
• Discomfort comes and goes, becoming more frequent over time.
• Pain worsens with standing, walking and activity, and is relieved by rest.
• You feel stiff.
• You walk with a limp.

Avascular necrosis, or AVN, is a serious condition marked by death of hip bone at the joint. The pain is usually worse and far more constant than in osteoarthritis. “People come to me saying, ‘My hip is killing me,’” says Dr. Murray.

When the spine is the likely culprit

Most lower spine problems are caused by a herniated disk that presses on nerves in the spinal column. This produces the pain known as sciatica, which can be felt in the hip. You may have a herniated disk if pain:

• Is limited to your back, buttocks or hip.
• Shoots down your leg.
• Worsens with sitting or bending.
• Improves when standing or walking.

If you have night sweats, a history of cancer, or pain that is not relieved by lying down (“night pain”), see your doctor — the problem may be more serious.

Some people develop what Dr. DeMicco calls a “double whammy” — problems in both the hip and lower back. “It’s not surprising, since both osteoarthritis and spinal changes are more common with each passing decade,” he explains.

To relieve hip pain, try these first:

• See your primary care doctor. They will likely prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to see if hip pain improves.
• Lose weight. Shedding extra pounds is critical in relieving hip pain. “Losing weight often reduces symptoms to the point where surgery is not necessary,” says Dr. Murray. “It also increases your chances of a successful outcome if surgery is one day warranted.”

For back pain problems, try these first:

• See your care primary doctor, and stay active. They will likely prescribe NSAIDs for two weeks. Meanwhile, stay active. “Activity can and should be continued. Prolonged bed rest (more than 24 to 48 hours) is bad advice,” says Dr. DeMicco.
• Schedule physical therapy if needed after two weeks. If you’re still in pain after two weeks, a physical therapist can show you exercises that can strengthen the muscles supporting your spine as well as back-friendly maneuvers.
• Lose weight, and quit tobacco. Maintaining your ideal weight will take the pressure off your spine. It’s important to avoid tobacco products too. “Nicotine impedes microcirculation, so your spine will degenerate at a faster rate,” says Dr. DeMicco.

If the source of your pain is difficult to pinpoint, seek help from a hip or spine specialist. The specialist may order an injection of lidocaine, or they may perform diagnostic/therapeutic hip injection under fluoroscopy or ultrasound.

If the problem is the hip, this will numb the hip joint and relieve symptoms immediately. “If the pain does not improve, we know we’re barking up the wrong tree,” says Dr. Murray. The same technique can rule out or confirm back pain.