• January 11, 2024
  • /
  • Hip
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  • Peter Pizzarello

Pain in and around the hip area is an extremely common reason to see an orthopedic surgeon. In my practice, I see many patients who seek help with pain at their hip. It seems logical that pain around the hip is coming from the hip,

But I say, NOT SO FAST…

This is a complex area that often presents a challenge for diagnosis and treatment. Yes, this is tricky indeed, and often what is felt to be a hip problem is actually a problem in the back, and vice versa.

Problems in the hip area can present in a variety of ways. For example, symptoms can start abruptly following an injury, but sometimes symptoms have been brewing for years. Complaints may be more complex than just pain. There can be numbness, tingling and weakness. Daily activities such as walking, getting in and out of a car, and even putting on shoes and socks can be effected, but not always. Some people have swelling, some do not. Some people need a cane, but most do not. Tylenol and ibuprofen can be very effective for some, and others find over the counter medications completely ineffective.

So how do I know if my problem is coming from my hip or from my back?

In general, problems arising from the hip joint such as arthritis and labral tears, cause pain in the groin area. Pain can also be felt on the outside aspect of the thigh or in the buttock, and it is not uncommon to experience pain traveling down the thigh to the knee. Often, patients experience difficulty or pain when putting on shoes and socks and it is not unusual to walk with a limp, especially when arthritis becomes more advanced. Pain in the back of the hip without any of these other symptoms is unlikely to be coming from the hip. Pain that extends below the knee is less likely coming from the hip, especially if numbness and tingling are involved in the same distribution. Pain on the outside aspect of the hip can be bursitis, especially if there is pain sleeping on that side, but isolated bursitis is less common than most think. Bursitis is often an indicator and result of a chronic back or hip problem.

For obvious reasons, back problems most often present with pain in the back, but not always. Back problems such as strains, disc problems and arthritis can create pain across the low back and across the top of the buttocks. It is not uncommon for pain to radiate down into the buttocks and the top of the hamstring area in the back of the thigh. Pain can be felt across both sides, just one side, or just in the middle. If nerves in the low back are pinched, irritated or living in small spaces, symptoms can radiate down one or both legs, often below the knee, sometimes reaching the toes. To make things confusing, this nerve pain can radiate into the groin and thigh - the exact same areas where people feel pain coming from the hip joint. And even more confusing, sometimes back problems present with no back pain at all! Just nerve pain radiating into the groin or down the leg.

So if you have pain in your hip area, come see us to get checked out. Often, we figure out your problem immediately, but not always. Be patient as it may take more steps than you anticipate to figure out why you are uncomfortable. If you think it’s your hip, it may be your back, or the other way around. You may need X-rays of your hip, your back, or even both. We may not have the answer for you right away, and may need to try things such as medications, therapy and even a cortisone injection to solve the riddle. MRI can be helpful, but is not always the answer. You may even need to see a different provider than your first so that you get the specialized treatment that you need.