The Connection Between Lower Back Pain and Hip Health

The Connection Between Lower Back Pain and Hip Health

Introduction to Low Back Pain

Referred pain occurs when pain spreads beyond the source of the pain. It is a common phenomenon we recognize as physical therapists, but many patients are unaware that referred pain exists. Typically, pain will refer to a neighboring body region, though pain can refer from one part of the body to essentially anywhere else in the body. Did you know that hip pain can refer to the back and that back pain can refer to the hip? That may seem confusing how this works, but our brain processes nociceptive input, the signals that may be interpreted as pain if enough of them are received in the brain, uniquely. In medicine, we call this process smudging where the signals overlap in the brain making the exact source of the pain unclear without further investigation. In this blog, we are going to discuss the connection between lower back pain and hip health.

Anatomy and Function

Due to the close relationship between the hip and back, referred pain between the two regions is common. The sensory inputs from our nervous system are received in the brain directly next to each other, which is what contributes to the smudging process described above. This can make everyday movements of these joints painful. Our hips and lower back work together to support our entire body weight when we are upright. 

Common Hip Issues Leading to Lower Back Pain

1. 1. Pelvic floor dysfunction
   2. Osteoarthritis 
   3. Muscle strains (i.e. piriformis, glutes)

Lower Back Problems Affecting Hip Health

1. 1. 1. Muscle strains (i.e. quadratus lumborum, psoas, erector spinae)
      2. Nerve compression
      3. Pelvic floor dysfunction 
      4. Disc pathology
      5. Sacroiliac joint pathology 

Management

Diagnosis

How do we know the difference? Low back pain that spreads to the hip often has a radiating quality to it that may be electric if nerves are involved. 

A definitive diagnosis may take a few sessions with your physical therapist to establish. It will require a thorough evaluation of both the spine and hip regions including an assessment of each spinal segment, hip mobility, functional motor screening, and assessing any other complaints you may have.

Imaging often has limited utility in diagnosing hip vs. low back pain and should not be relied on to make the diagnosis. Current research suggests that spinal degeneration is present in nearly everyone after the age of 30. Think of this as wrinkles on the inside of our bodies. We don’t know they are there until we take the picture, but everyone has them! The same is true about hip arthritis. Most people are asymptomatic, meaning they have no pain and are fully functional despite their imaging showing arthritis. Imaging may be beneficial to guide treatment in patients not responding to their current therapy routine; however, imaging is not and should never be the end all be all in managing hip, lower back, or any pain.

Posture

Posture can also contribute to low back and hip pain. Our bodies like to move and are built to move, so too much time in any one position can wreak havoc on the body. The best posture is the one that is most comfortable for you! However, certain postures may contribute to further pain. Standing with your butt sticking out increase the lordosis, or spinal curvature, of your low back putting increased pressure on your joints. To fix this, gently engage your core muscles in standing and feel like you are tucking your tailbone underneath you. This will help offload your lumbar spine joints. Standing with all your weight on one leg while kicking out your hip can contribute to hip pain due to the increased compressive forces on the outside of the hip. To decrease pain, try to stand with equal weight on each foot. If you are having pain in standing, sitting, or lying down, set up a time to meet with one of us to help solve the root of your posture pain! 

Exercises 

Exercise prescription is incredibly dependent on your current symptoms and the deficits you present with. Some things you can incorporate into your daily routine that may help alleviate some of your hip pain include the following: hip mobility drills (i.e. standing open gates, frog stretch), hip strengthening (i.e. lateral lunges, squats, bridges, step-ups, single or double leg deadlifts), and balance training (i.e. single leg stance, use of foam or bosu ball). Some things you can incorporate into your daily routine that may help alleviate some of your lower back pain include the following: core stability (planks, bird dogs, dying bugs), lumbar mobility (i.e. child’s pose, cat/cow, forward folds, standing backward leans), and general cardiovascular exercise. 

Physical Therapy – book an appointment 

Want to learn more about where your hip or back pain is coming from? Schedule an appointment today with one of our therapists to customize your plan to get you back to life faster with more freedom! 

The next time you experience hip or back pain, consider the role that other body regions may be playing in your pain experience. Perhaps you’ve received treatment on your hip or back before and it just hasn’t gotten better. Maybe that pain isn’t really from the hip or the back and further investigation by a musculoskeletal expert trained to distinguish referral patterns is necessary. The connection between lower back pain and hip health exist. Let’s help you keep your freedom!