Telling The Difference Between Hip and Back Pain

Lower back pain and hip pain are often mistaken for one another. The "hip" region often includes everything from the lower back around the side to the groin. Many times, this pain can be vague or even migrate around these areas, which makes localizing the problem a little more difficult. In this article, Dr. Boe will address several key aspects that he evaluates to form a diagnosis when a patient comes into the office with "hip" pain.

For example, is the pain worse in the groin, side of the hip or buttock? Is it worse with walking, bending over or turning? How would one describe the pain - achy, burning, sharp or does it feel like something in the hip is catching? These symptom features will help us determine what is the main source of a patient's pain. Generally, although there are exceptions, we can separate these symptoms into three main problems: hip arthritis, Iliotibial (IT) band bursitis and lower musculoskeletal back pain.

Hip arthritis often presents with a sharp or catching groin pain that is often worse with stairs or turning. IT band bursitis is often achy with significant tenderness over the bony prominence on the side of the hip, which is worse when laying on the side or using stairs. Lower musculoskeletal back pain can vary in nature and occasionally radiate if nerve compression is involved, but it is often localized to the lower back and buttock areas. This lower back pain will tend to get worse with heavy lifting and bending over. Pain that radiates from the back down the legs should be evaluated for more significant problems with the spine and nerves.

All of these diagnoses can be treated with conservative measures upon evaluation by an orthopaedic surgeon.

Conservative Treatment Options

Medications

  • Anti-inflammatories: Ibuprofen or naproxen
  • Topicals: Diclofenac gel, Lidocaine cream

  • Acetaminophen

Therapy

  • Stretching: IT band bursitis and lower back pain
  • Strengthening: Lower back pain and hip arthritis
  • Aquatic therapy: Hip arthritis and lower back pain

Alternative

  • Heat: For relaxing tissues
  • Ice: For reducing inflammation
  • Steroid Injections
Of the three diagnoses mentioned above, hip arthritis is the only degenerative disease, which means it will continue to progress over time. While many patients do get relief with the conservative treatments, they often find the pain does return at some point and may continue to get worse with time. Once the symptoms are severe enough, it may be time to consider a total hip replacement.


There has been enormous progress made in total hip replacement technology, which was once called "the operation of the century" by the Lancet medical journal (Ian D Learmonth, 2007). The use of state-of-the art implant designs and materials allow for a vast majority of hip replacements to last greater than 20-25 years (Nipun Sodhi, 2019).

Techniques have also progressed with the increased use of direct-anterior total hip replacement. This direct-anterior approach for hip replacement avoids cutting through the major muscles and tendons of the hip, which results in less pain and increased mobility right after surgery. Patients are leaving the hospital quicker, or having surgery at an outpatient surgery center, which allows them to get back to the activities they enjoy most.

If you are suffering from any of these symptoms, the total joint specialists at Resurgens Orthopaedics are here to discuss treatment options with you.

References

Ian D Learmonth, C. Y. (2007). The operation of the century: total hip replacement. The Lancet, 370(9597), P1508-1519.

Nipun Sodhi, M. M. (2019). Survival of total hip replacements. The Lancet, 393(10172), P613.