Is it my back or my hips?

General

It is sometimes very difficult, even for doctors and clinicians, to differentiate between lower back/ spine problems, and hip joint problems, as a cause for a patient’s discomfort. Patient’s themselves, often come to their doctors not knowing whether to complain of back or hip pain, and what is an even greater conundrum, is the “double crush “phenomenon. The “double crush “refers to the presence of two separate, but co-existing problems, one usually in the lower spine/ back, and another within the pelvis and hip joints.

The reason for this “diagnostic dilemma” is due to the fact that the nerves which supply the hip and legs arise from within the spinal canal in the lumbar spine, before meeting and travelling down behind the hip joint on their way to supply the legs and feet.

 

As a result, problems like arthritis (spondylosis) of the lumbar spine, or disc problems like herniation, may compress the exiting nerve root, causing pain along the distribution of that nerve. This is often called “Pinched nerve” or SCIATICA.

Quick reference guide to back pain and hip pain:

Back pain and Sciatica Hip pain
Type Electric shock type Stabbing and sharp
Site Lower back, sometimes radiating down buttock and back of thigh sometimes even into the calf and foot Usually the groin, less often the buttock or outer side of the hip
Disability Problem with weakness of the foot or toes, sometimes also causing urinary and/ or faecal incontinence Difficulty rising from chair/ toilet seat, entering and exiting a vehicle, clipping/ painting toe nails and putting on socks or shoes/ sandals
Aggravated by Soft bed/ mattress, Walking on flat surface or down stairs/ hill or Lifting one’s leg while keeping the knee straight- straight leg test Low chairs, walking- especially upstairs/ hill, sometimes by crossing one’s legs
Relieved by Walking while leaning forward (like using a shopping trolley “or upstairs/ uphill Sitting down or lying down sometimes by using a walking stick

 

When visiting your doctor, he or she will ask questions to differentiate the cause of your pain- similar to the table above. The diagnosis is usually made on the patient’s history of their symptoms, soon after, the doctor usually confirms their suspicion with findings from their examination. A very big clue to hip pain, is pain reproduced by rotating the hip joint at examination- if the same pain in the original complaint is produced, the problem lies in the hip. If however, the same pain is reproduced by stretching the sciatic nerve with the straight leg test:

Then it is more than likely, that the patient is suffering from a spinal condition, rather than a hip problem.

After appropriate history and clinical examination, a doctor should be able to either image the appropriate area, or alternatively, direct the patient to the relevant specialist, who should be able to assist the patient on his or her road to recovery.