Lower back pain can be caused by a variety of problems. Many patients live with low back pain that radiates to the buttock,
groin, thigh, and even knees. The challenge for patients, and often
their doctors, is determining the origin of the pain - the hip, the
spine, or both.
A new article published in the February Journal of the American Academy of Orthopedic Surgeons
(JAAOS) outlines the identical symptoms associated with hip and spine
pain and discusses the diagnostic steps and tests required to treat them
‘The overlapping symptoms and challenges in correctly diagnosing 'hip-spine syndrome' has been discussed in the new study.’
Typically, groin pain, and/or difficulty putting on shoes or getting
in and out of a car, are associated with a hip condition. Buttock or
back pain, with or without a tingling sensation, most likely originates
in the spine. However, patients with complex "hip-spine syndrome" have
lower back and hip pain with no clear source of the discomfort. Hip
arthritis, for example, can increase pressure on the lower back.
"In these instances, similar or overlapping symptoms may delay a
correct diagnosis and appropriate treatment," said article author Afshin
Razi, an orthopedic surgeon and clinical assistant professor at
NYU Langone Hospital for Joint Diseases.
The article recommends that patients provide a detailed health
history and undergo a comprehensive physical examination that includes
an assessment of gait (how the patient walks); hip and back range of
motion; posture; pelvic, lower limb, and spinal alignment; loss of
muscle (atrophy); previous surgical scars; and limb-length discrepancy.
"Plain and advanced imaging studies and diagnostic injections also
can be used to further delineate the primary problem and guide the
appropriate sequence of treatment," said Dr. Razi.
Diagnoses for hip and spine pain can include hip osteoarthritis, a
stress fracture, osteonecrosis of the hip (a blockage in blood flow to
the hip), a labral tear (damage to the cartilage that surrounds the
hip), disc herniation and possible pinched nerves, stenosis (narrowed
spinal canal causing nerve pain), sacroiliac joint dysfunction, and
other less common sources of pain.
"Focusing on both the spine and the hip as potential causes of pain
and disability may reduce the likelihood of misdiagnosis, and the
management of conditions affecting the spine and/or hip may help reduce
the likelihood of persistent symptoms," said Dr. Razi.