When patients present with low back pain, it is not uncommon for pain to arise from areas other than the low back, such as the hip. There are many tissues in the low back and hip region that are susceptible to injury, and they share overlapping pain pathways, often making it challenging to isolate the truly injured area. Hip pain can present in many different ways, adding another layer of complexity to the diagnosis and treatment of low back pain.

Considering the anatomy of the low back (lumbar spine) and hip, it’s easy to see why differentiating between the two conditions is often difficult. The nerves that innervate the hip come from the low back. Therefore, complaints may include pain in the inside, outside, front, or back of the thigh, the knee, the buttocks, the sacroiliac joint, or the low back itself. And yet, the hip may truly be the pain generator in any of these areas. This overlapping pain referral pattern complicates the process of determining the exact source of the pain.

To make diagnosis even more complex, the hip pain patient may present one day with what appears to be sciatic nerve pain (that is, pain shooting down the back of the leg to the knee if mild, or to the foot if more severe). However, on the next visit, the patient might only report groin pain. When pain radiates down a leg, the almost automatic assumption by both the patient and their healthcare provider is, “…it’s a pinched nerve.” But once again, it could be the hip, and not a pinched nerve, that is creating the leg pain pattern.

In some cases, the patient may have both a low back problem and a hip problem at the same time. It is actually quite rare to x-ray the low back of a hip pain patient without uncovering some low back conditions such as degenerative disc disease, osteoarthritis (spurs off the vertebrae), or a combination of both. So, how do we differentiate between hip vs. low back pain, especially when both can often coincide?

During a detailed history, healthcare providers often ask, “What activities make your pain worse?” If the patient replies that weight-bearing activities like standing, walking, or getting up from sitting provoke the pain—and they point to the front or side of the hip—then a hip-related diagnosis is more likely. However, it’s still possible that the pain is arising from the low back or both areas simultaneously.

If the patient says, “Crossing my right leg over the other hurts in my groin,” that’s more suggestive of a hip problem, as hip rotation is often lost before the forward flexion motion. When asked to point to the area of greatest discomfort, a patient with hip pain will usually point to the front of the hip or groin. Less commonly, they might point to the inner thigh or knee.

Another key observation is that non-weight bearing positions like sitting or lying down almost always provide immediate pain relief. For patients with hip arthritis, motion loss is often reported, which can include a shorter walking stride. Pain usually worsens the longer the patient is on their feet. Initiating motion may cause pain, sometimes even when the patient is in bed, rolling over. In contrast, patients with purely low back pain may not report the same relief when lying down.

During the chiropractic examination, patients are often asked to lie on their back with their knee and hip both bent at 90°. Moving the bent knee outwards or inwards will almost always reproduce pain in the hip or groin area. Applying traction to the affected leg can often provide relief, as patients report that it “feels good.”

While reflexes and sensation in the knee and ankle remain normal, muscle strength may be weak due to pain. It’s important to note that bending the low back into different positions will not reproduce pain if the pain is only coming from the hip.

Although it can be challenging to differentiate between hip and low back pain, chiropractors are well-trained to evaluate and treat both areas. After a thorough examination, a chiropractor can determine whether the pain originates from the low back, the hip, or both. They will often treat both areas when necessary to address the underlying causes of pain and dysfunction.

For example, a chiropractor may use spinal adjustments to address any misalignments in the lower spine that could be contributing to low back pain. They may also perform joint mobilizations or soft tissue techniques to address issues in the hip that could be contributing to discomfort. Additionally, chiropractors can provide exercises to improve flexibility and strengthen the muscles around the hip and low back, further supporting recovery.

Low back pain can often be accompanied by hip pain, and the two can sometimes be difficult to distinguish from each other. The overlapping pain pathways between the lumbar spine and the hip make it challenging to pinpoint the exact source of discomfort. However, understanding the different pain patterns and knowing how to differentiate between the two can help guide treatment decisions.

Chiropractors are well-equipped to assess and treat both hip and low back pain. With the right diagnosis and treatment plan, patients can find relief from both conditions and improve their overall function. Whether the pain is coming from the low back, the hip, or both, chiropractic care can offer effective, non-invasive solutions to help restore movement, reduce pain, and improve quality of life.

As always, if you’re experiencing low back or hip pain, don’t hesitate to reach out to a chiropractor who can help you find the right treatment for your condition.