Causes of lower back and hip pain
Is the pain you’re feeling coming from your lower back, your hip, both, or maybe somewhere else entirely? It’s not always easy to tell. Lower back and hip pain often travel together, and it can be hard to figure out where the pain is coming from.
The lack of an obvious source for the pain makes sense because the hip bone is connected to the backbone (spine). But bones are just one of the structures in your back and hip that can cause pain. There are joints, tissue, muscles, nerves, ligaments, blood vessels and discs too.
As a result, the list of potential causes of lower back and hip pain is long, overlapping and varies by age, says Dr Rahul Shah, an orthopaedic spine and neck surgeon. Your risk for developing lower back or hip pain increases with advancing age, excess weight and smoking, and the pain may be triggered by overexertion, falls, hormonal changes that leave bones more likely to crack, and other causes, he says.
Here are a few possible causes of lower back and hip pain and the types of treatment available to alleviate the pain.
Osteoarthritis (OA), the wear-and-tear form of arthritis, can strike any joint in the body, but typically occurs in weight-bearing joints such as your hips or spine.
Your risk for OA increases with advancing age and/or excess weight and pressure on your joints, says Dr Nikhil Jain, MD, a neurosurgery fellow.
Arthritis-related pain may occur across the back, into the side of the buttocks area, and sometimes even begin to trickle down the leg, Dr Shah says. The pain may also hinder your ability to walk or participate in other activities. Arthritis of the hip commonly causes pain in the groin, too.
Diagnosis and treatment
Imaging tests along with a physical exam can help determine if OA or another type of arthritis is causing your hip or back pain. Your doctor will also consider your risk factors when making a diagnosis. If you are older and overweight, for example, it may tip the scale in favour of OA as opposed to another cause.
Blood tests are often needed to diagnose other forms of arthritis like ankylosing spondylitis (more on this later). Physical therapy and pain medications are first-line treatments for arthritis, but sometimes steroid injections or possibly joint replacement surgery may be warranted, Dr Jain says.
Stress makes everything worse, including arthritis, lower back and hip pain.
Your lower back comprises five vertebrae (L1-L5), which are small bones that support your upper body. Shock-absorbing discs are found between each one, and these discs can slip, tear, shift or degenerate.
Discs may herniate or rupture from poor posture, heavy lifting, twisting, bending, injury, falls, or advancing age, Dr Jain says.
In addition to low back pain in the area where the disc is bulging or out of line, herniated discs may press on your nerves, causing sciatica, which can be felt in your hips too. Sciatica is pain triggered by the sciatic nerve which runs from the lower back down the back of your legs all the way to your feet.
Diagnosis and treatment
Your doctor will examine you and ask detailed questions about your pain and when it first started, and order imaging tests to find out if your discs have shifted. Treatment usually involves pain medications and/or physical therapy. Sometimes bigger guns are needed, including steroid injections or surgery, Dr Jain says.
Disc problems are very common, however, and don’t always cause symptoms. So sometimes a scan can lead to unnecessary surgery even if disc problems aren’t the true source of pain.