Lower back and hip
Hip osteoarthritis and lower spine wear often cause overlapping pain
Hip and lower back pain often show up together because both areas wear down with age, and their symptoms can overlap. Doctors call having both problems at once hip-spine syndrome [1][2].
Key points
- Hip-spine syndrome means degenerative conditions in the hip and the spine are present at the same time [1].
- Hip arthritis pain is most often felt in the groin, while spine problems more often cause pain in the low back, buttock or leg [3][4].
- Doctors sort out the main source of pain with a hip and spine exam, imaging, and sometimes injections [3][4][1].
- Back pain with fever, chills or unexpected weight loss is a reason to call your doctor [4].
Hip-spine syndrome describes hip and spine wear that happen together
Hip-spine syndrome is the presence of wear-related conditions in both the hip and the spine [1]. It was first described in 1983 [5]. Researchers link its growing frequency to longer life expectancy [2].
Both problems are common with age. Among adults over 60, an estimated 19 to 47 percent have narrowing of the spinal canal, and hip osteoarthritis affects an estimated 7.95 percent of adults in North America [2]. Older adults often show signs of both on imaging, and the overlap in symptoms can make the picture hard to read [2].
Wear in the spine starts early. Changes can begin in your 30s or even younger, yet they do not keep most people from living mostly pain-free lives [4]. Muscle soreness is another common cause of low back pain. It often follows an activity your body is not used to, and it usually goes away within a few days [4].
Hip osteoarthritis is the gradual wearing away of the cartilage that cushions the ball-and-socket hip joint. Bone spurs can form as the joint changes [3]. Wear in the spine can involve the cushioning disks between the vertebrae and the small facet joints at the back of the spine [4].
Hip osteoarthritis and spine problems tend to hurt in different places
Where the pain sits gives the first clue, though the symptoms of the two problems overlap [3][4][2].
| Feature | Hip osteoarthritis | Low back causes |
|---|---|---|
| Where it hurts | Groin most often, or thigh, spreading to the buttock or knee [3] | Low back, sometimes into the buttock or outer hip without going down the leg [4] |
| Leg symptoms | Pain can spread toward the knee [3] | Buttock and leg pain, numbness, tingling or weakness down to the foot (sciatica) [4] |
| Timing | Worse in the morning or after sitting, and later at rest or at night [3] | Often comes and goes, with good days and bad days [4] |
| Movement | Stiffness, a limp, grinding, or a joint that locks or sticks [3] | Most people feel better reclining or lying down [4] |
| Usual cause | Cartilage in the hip joint wears away [3] | Muscle strain, a torn or herniated disk, worn facet joints, or a narrowed spinal canal [4] |
A herniated disk happens when the soft center of a disk pushes out and presses on a spinal nerve. That pressure can send pain through the buttock and down the leg [4]. Pain from hip osteoarthritis can also spread to the buttock [3].
When to get care
Back pain with fever or unexpected weight loss is a reason to call your doctor
Most back pain goes away on its own within a few weeks [4]. Some signs point to something more serious and should not wait [4].
- Back pain with fever, chills or unexpected weight loss is a reason to call your doctor [4].
- Back pain that does not get better within a few weeks, at any age, is a reason to call your doctor [4].
- Pain that is always present, whatever your activity or position, is a reason to talk to your primary care doctor [4].
- A history of cancer or vascular or arterial disease is also a reason to talk to your primary care doctor about back pain [4].
- Sciatica can include numbness, tingling or weakness that extends down to the foot [4].
Why these signs matter
Back pain has other causes besides wear and tear, and some of them can be serious [4].
If you think you may have a medical emergency in the United States, call 911 or go to the nearest emergency room.
Clinicians separate hip pain from spine pain with an exam and imaging
When both areas are worn, the first goal is to find the main pain generator, using a careful hip and spine exam plus diagnostic and therapeutic injections [1].
- Your doctor asks about your symptoms and medical history [3][4].
- The hip exam checks active and assisted range of motion, any grating feeling in the joint, how you walk, and signs of injury to muscles, tendons and ligaments around the hip [3].
- The back exam looks at and presses on your back, has you bend forward, backward and sideways, and checks reflexes at the knees and ankles along with strength and sensation in the legs [4].
- X-rays may show a narrowed joint space, changes in the bone, and bone spurs in an arthritic hip [3].
- An MRI or CT scan is occasionally needed to see the bone and soft tissues better [3].
- Injections may be used to help decide which area is causing the pain [1].
Treating both problems is complex. It can involve spine surgeons, hip surgeons, physicians who specialize in pain and rehabilitation, and physical therapists [1].
Nonsurgical care comes first for hip osteoarthritis
Early treatment of hip osteoarthritis is nonsurgical. There is no cure, but options can help relieve pain and improve mobility [3]. Starting treatment sooner makes it more likely you can lessen the effect on your life [3].
- Cutting back on activities that aggravate the hip, such as climbing stairs [3].
- Switching from high-impact activities like jogging or tennis to lower-impact ones like swimming or cycling [3].
- Losing weight, which can reduce stress on the hip joint and mean less pain [3].
- Exercises that build range of motion, flexibility and strength in the hip and leg, which a doctor or physical therapist can tailor to you [3].
- Assistive aids such as a long-handled reacher, which help you avoid painful movements [3].
- Medication added when pain disrupts your daily routine, including over-the-counter pain relievers and anti-inflammatory drugs, which can have side effects and interact with other medicines [3].
Surgeons still debate whether to treat the hip or the spine first
Surgery is considered when arthritis pain causes disability and nonsurgical care does not help [3]. Total hip replacement is the standard treatment for painful end-stage hip osteoarthritis [2]. Severe narrowing of the spinal canal is typically treated with decompression surgery, and spinal fusion is sometimes added [2].
A review of studies found a higher rate of hip dislocation after hip replacement in people who had spinal fusion first than in those who had the hip replaced first [2]. Spinal fusion affects how the spine and pelvis work together, so caution is advised when replacing a hip in someone with a fused spine [2].
Even so, the evidence on surgical treatment remains sparse, and experts still debate which problem to address first [6]. The choice depends on clinical, imaging and surgical factors [1].
Sources
- Hip Spine Syndrome: Management of Patients With Concurrent Hip and Spine Degenerative Pathologies The Journal of the American Academy of Orthopaedic Surgeons
- Previous lumbar spine fusion increases the risk of dislocation following total hip arthroplasty in patients with hip-spine syndrome: a systematic review and meta-analysis BMC musculoskeletal disorders
- Hip Osteoarthritis orthoinfo.org
- Low Back Pain orthoinfo.org
- A Comprehensive Bibliometric Analysis and Visualization of Publication Trends in Hip-Spine Syndrome World neurosurgery
- Surgical Management of Hip-Spine Syndrome: A Systematic Review of the Literature World neurosurgery
Not medical advice. This page is general education written from the sources above. It cannot diagnose a condition or replace a licensed clinician who knows your history. If you may be having an emergency, call your local emergency number or go to the nearest emergency department.