Hip Pain vs. Back Pain: Where Is Your Pain Really Coming From?
Is It Your Hip — or Is It Your Lower Back?
Hip pain and lower-back pain can be surprisingly difficult to tell apart.
A problem in the hip can cause pain in the buttock, thigh, or even around the knee. At the same time, a problem in the lumbar spine can produce pain around the buttock, hip, or leg.
That overlap is why simply pointing to where you hurt does not always tell us where the problem actually begins.
At Molina Spine, one of the most important parts of evaluating pain is identifying the true pain generator before deciding on treatment.
The Spine Minute: Hip Pain vs. Back Pain
Watch the video above for a quick explanation from Domingo Molina IV, MD, FAAOS, about some of the clues we use to determine whether pain may be coming from the hip or the lumbar spine.
Where Does Hip Pain Usually Hurt?
One of the biggest misconceptions about hip problems is that hip pain must occur directly over the outside of the hip.
In reality, pain coming from the hip joint itself is commonly felt in the groin.
Hip arthritis and other conditions involving the hip joint may cause:
Groin pain
Pain in the front of the thigh
Pain around the buttock
Pain that travels toward the knee
Hip stiffness
Difficulty putting on shoes or socks
Difficulty getting in or out of a car
Pain when standing from a chair
Pain with prolonged walking
Decreased hip motion
Pain produced when the hip is rotated during an examination can also suggest that the hip joint itself may be contributing to the symptoms.
The American Academy of Orthopaedic Surgeons notes that hip osteoarthritis commonly produces groin pain and that moving an arthritic hip during an examination may reproduce that pain.
Where Does Pain From the Lower Back Usually Hurt?
Problems in the lumbar spine can also cause pain around the hip and buttock.
Depending on which structures are involved, symptoms may include:
Lower-back pain
Buttock pain
Pain traveling into the thigh or leg
Numbness or tingling
Burning or electrical pain
Leg weakness
Symptoms that worsen with prolonged standing or walking
Pain associated with certain movements of the lower back
When a spinal nerve is compressed or irritated, patients may experience radiculopathy, often referred to as sciatica when the nerves of the lower lumbar spine are involved.
However, not every spinal problem causes classic pain shooting all the way down the leg.
Sometimes the primary complaint is simply pain around the buttock, upper thigh, or what a patient describes as their "hip."
A Simple Clue: Groin Pain vs. Buttock Pain
Although there are plenty of exceptions, the location of the pain can provide an important clue.
Pain predominantly in the groin:
May make us more suspicious that the hip joint is involved.
Pain predominantly in the lower back or buttock:
May make us more suspicious of the lumbar spine or sacroiliac joint.
But this is not a perfect rule.
Hip arthritis can cause buttock or thigh pain, and conditions in the lower back can cause referred pain around the hip. Mayo Clinic similarly notes that pain inside the hip or groin often suggests a problem within the hip joint, while some hip-region pain can actually be referred from the lower back.
That is why the history and physical examination matter.
What About Pain on the Outside of the Hip?
Pain directly over the outside of the hip is another common complaint.
Interestingly, this pain does not necessarily come from inside the hip joint.
Pain along the outer hip may arise from structures surrounding the hip, including tendons, muscles, or bursae.
Patients may notice:
Tenderness when pressing over the outside of the hip
Pain when lying on that side
Pain climbing stairs
Pain with prolonged walking
Discomfort when getting up from a chair
This is another reason that the phrase "hip pain" does not automatically mean hip arthritis.
Could It Actually Be the SI Joint?
There is also a third structure sitting right between the lumbar spine and hip that can complicate the picture:
the sacroiliac joint, or SI joint.
The SI joint connects the pelvis to the bottom of the spine.
SI joint pain is frequently felt:
Just below the belt line
Along one side of the lower back
In the upper buttock
Around the back of the pelvis
Occasionally into the thigh or leg
Patients may experience increased pain while standing from a chair, climbing stairs, rolling over in bed, walking, or placing most of their weight on one leg.
This can look remarkably similar to either a lumbar-spine problem or a hip problem.
Hip vs. Back Pain: Some Common Clues
SymptomMore Suggestive of HipMore Suggestive of SpineGroin pain✓SometimesLimited hip rotation✓Difficulty putting on shoes/socks✓Pain getting in/out of a car✓SometimesLower-back pain✓Buttock painSometimes✓Shooting pain down the leg✓Numbness or tingling✓Leg weakness✓Pain reproduced by moving the hip✓Pain affected by lumbar position✓
These findings are clues—not absolute rules.
Some patients have abnormalities in both their hip and their lumbar spine at the same time.
The MRI Doesn't Always Give You the Answer
This is an especially important point.
As we age, it is extremely common for imaging to show degenerative changes.
A patient may have:
Arthritis on a hip X-ray
Degenerative discs on a lumbar MRI
Spinal stenosis
Bone spurs
Facet arthritis
Sometimes more than one of these findings appears at the same time.
The challenge is determining which abnormality is actually responsible for the patient's symptoms.
An abnormal MRI does not automatically mean the spine is causing the pain.
Likewise, arthritis visible on a hip X-ray does not necessarily mean that every symptom is coming from the hip.
Treating an image instead of treating the patient can lead you in the wrong direction.
How Do We Determine Where the Pain Is Coming From?
Diagnosis usually begins with three things:
1. Your History
Where does the pain start?
Where does it travel?
What activities make it worse?
Do you have numbness, tingling, or weakness?
Is putting on your shoes difficult?
Can you walk through a grocery store without stopping?
Does sitting help?
Does rotating the hip reproduce the pain?
Those details can be extremely valuable.
2. Physical Examination
A careful examination can evaluate:
Hip range of motion
Strength
Sensation
Reflexes
Walking pattern
Lumbar movement
Nerve-tension signs
SI joint provocative maneuvers
The goal is to reproduce the patient's typical pain and determine which structure is most likely responsible.
3. Imaging and Sometimes Diagnostic Injections
Depending on the examination, we may review or obtain:
Hip X-rays
Lumbar X-rays
Lumbar MRI
Other advanced imaging
Occasionally, a targeted injection can also help distinguish between possible pain generators.
For example, if numbing medication is placed inside the hip joint and the patient's typical pain temporarily disappears, that can provide valuable diagnostic information.
Similarly, selective spinal or SI joint injections can sometimes help determine whether those structures are contributing to the symptoms.
Diagnostic injections are one of the tools physicians can use when symptoms and imaging overlap. AAOS describes targeted spinal and SI joint injections as having both diagnostic and therapeutic roles.
Can You Have Both Hip and Back Problems?
Absolutely.
This is actually one of the situations that can make diagnosis particularly challenging.
A patient may have significant hip arthritis and lumbar spinal stenosis.
Both findings may be real.
Both may even be causing symptoms.
The question then becomes:
Which problem is responsible for which symptom—and which should be treated first?
That decision should be based on the patient's history, examination, imaging, and sometimes targeted diagnostic injections rather than imaging alone.
Don't Assume "Hip Pain" Means the Hip
One of the most important lessons in musculoskeletal medicine is simple:
Where you feel pain is not always where the pain originates.
Groin pain may point toward the hip.
Buttock and radiating leg pain may point toward the spine.
Pain around the back of the pelvis may be coming from the SI joint.
And sometimes more than one problem exists at the same time.
The goal is not simply to find something abnormal on an X-ray or MRI.
The goal is to identify the actual pain generator.
At Molina Spine, we focus on determining the source of your symptoms first and then choosing the most appropriate—and whenever possible, least invasive—treatment for that particular problem.
Not Sure Whether Your Pain Is Coming From Your Hip or Your Back?
If persistent hip, groin, buttock, lower-back, or leg pain is affecting your ability to walk, work, exercise, sleep, or enjoy your normal activities, an evaluation can help determine where the problem is actually coming from.
Domingo Molina IV, MD, FAAOS
Board-Certified, Fellowship-Trained Orthopaedic Spine Surgeon
Molina Spine
140 W. Main St., Suite 100
Springfield, Ohio 45502
Phone: (937) 398-1066
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This information is provided for general educational purposes and is not intended to replace an individual medical evaluation. Symptoms involving new or progressive weakness, loss of bowel or bladder control, numbness in the groin or saddle region, or other rapidly worsening neurologic symptoms require urgent medical evaluation.