Is Your Hip Pain Actually From Your Back? How to Tell

This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2020. For the original video go to https://www.youtube.com/watch?v=ugUIwENVI8w&t=345s

Bob: Today we're going to talk about is your hip pain actually coming from your back and how to tell. We've got some simple questions and some simple tests that you can try.


Brad: Absolutely Bob, because as therapists we know the two can easily be misconstrued.


Bob: Misunderstood or mistaken. I don't know, we'll come up with a word.


Bob: So yes, hip pain or back pain, it can be very deceptive because sometimes they share the same locations even.


Brad: Yep, and similar symptoms. How many times have you had someone come in with a hip pain diagnosis from the doctor and you end up treating the low back and the problem's gone?


Bob: Absolutely, this happens all the time. So, the first thing we're going to do is ask three questions. By the way, this information is from the book Treat Your Own Hip, by Robin McKenzie. This man truly was the most famous physical therapist on Earth.


Brad: Yeah, he has a whole system that's worldwide. We love him.


Bob: So the three questions, number one: do you have pain in your central low back, that means your middle low back?


Brad: By the belt line.


Bob: And particularly back pain on the same side as the hip pain. So, you're having hip pain, and you're like, "Ah, I always have back pain too along with it." It's on the same side. Two: does coughing or sneezing increase your back pain?


Brad: Or your hip pain.


Bob: Or your hip pain, right.


Brad: Does it create your pain, the problem you're having.


Bob: Right, do you have numbness, tingling, pins and needles, or weakness in the knee or foot on the same side as the hip pain? If you answer yes to all three of these, it's more likely that you're having back pain than hip pain. Those are the signs of back pain not hip pain.


Brad: But not necessarily, we're just saying, it's more likely.


Bob: It's more likely, right. It's not positive but it's more likely. Okay, the second thing you want to look at is pain location. I have used tape and my tape is representing what's more typically hip pain. Hip pain tends to be more in the groin, and also on the side. This is more what we consider the hip. I know a lot of people consider the buttock the hip, but this is really more the hip.

Bob: All right, if you're having pain in the areas that Brad has marked off here in the low back, or going down the butt, or maybe even going down the leg all the way, then it's more likely back pain.

Brad: Right, right.


Bob: Again, not 100%, but your odds are more, if you're a betting man or a betting woman, that's how I would bet.


Brad: It's really important to understand that pain location oftentimes is not related to the source of the pain. It refers because of the way the nervous system is in the body. It refers to different locations. You know as therapists we work with it all the time, it just is common knowledge to us. But the layperson may not understand that.


Bob: Yeah, it's weird to think your shoulder might be sending pain down the arm or neck pain is sending pain down the arm.


Brad: Very similar.


Bob: All right, the third thing that I want you to try, is I'm going to have you sit in a chair. And you're going to sit straight up first and see what that does to your pain. You're going to sit on a stool or a chair, and you're going to sit straight up and see what your pain does. Then I want you to slouch, and while you’re slouching, I want you to grab the bottom of the chair and pull up. That's going to put compression on the spine. Pull up.

Brad: I think it's pull down?


Bob: Pull down with the back, pull up at the arms.


Brad: Compress that back a little bit.


Bob: Compress the back. I just did this with a patient yesterday because she had a hip replacement, but she seems to be having back pain with it. This caused increased pain. This made her pain worse. So it was more likely her back because your hip is not going to hurt when you do this.


Brad: There's no extra stress being put on the hip when that happens. It's clearly more on the back.


Bob: So, you can also test it by standing. So you stand and put your hands on your thighs. Then slide down the thighs like this. Again, this is not increasing the stress on the hip to any large extent, it's increasing the stress on the back. If this makes your pain worse, again we're thinking more back pain.

Bob: You can do extensions standing. You can extend with your arms up or extend with your hands on your hips. If this makes your pain worse, again more likely to be the back.

Brad: Right.


Bob: Have I been clear Brad?


Brad: Yep, clear as mud.


Bob: I had a medical teacher who used to say, "Oh am I as clear as mud?" He'd always say it like that. "Am I clear as mud?" What, it was funny? So that's it, that's the end of the thing there. If you are having back pain, obviously, you want to treat that, because your hip pain is never going to go away if it's actually coming from your back and you're treating your hip.


Brad: So the next question our viewers are asking is, well what are we