If you have pain your lower back or side of your hip, it can be helpful to figure out where the pain is coming from without imaging. When I meet a patient who says their main problem is pain in this area, I automatically go into detective mode because the pain could be coming from the hip, the lower back, or the hip AND the lower back.
*Disclaimer: This blog is not a substitute for a thorough examination from your medical provider. Before trying any of the tests in this blog or performing any exercise, make sure you are safe and appropriate to exercise by consulting with your medical provider.
With lower back pain you’re probably going to feel some center lower back pain and maybe some pain into your butt (a.k.a. your glutes). This is very common and most types of back pain will not refer pain lower than the glutes. Sciatica is very different and check out this video to learn more.
The hip can also refer pain into your glutes, so you’re starting to see where things get a little dicey. However, the hip can also refer pain to other areas like the front of the hip or down the side of the leg. Groin pain is the most common symptom related to hip joint pathology or involvement.
When it comes to the hip we want to figure out if the issue is inside the joint or outside of the joint. Inside the joint issues are things like osteoarthritis and labral injuries. Outside the joint problems are issues related to muscles like the glutes, piriformis, TFL that surround your hip.
It’s also totally possible to have both hip AND lower back pain at the same time. This is why you want to perform testing to help you know the best way to go about getting rid of your pain.
To help you start to solve the mystery, I have a helpful test that you can perform at home right now.
To do this test, you’re going to sit down and cross one ankle over the opposite knee. You might recognize this as a piriformis stretch and while it definitely will stretch your piriformis, it’s also going to tell us some other information.
Once you’re in this position you can do 3 things: *make sure to be slow and gentle with the force.
Make sure when you do the test to compare each side and see how it feels because this will also give you feedback about any asymmetries you may have.
If in this position you feel the stretch in your glute area and after a while of being in the position you get relief from your pain, then it’s likely you have a piriformis issue. A piriformis problem could be caused by doing too much for too long or by not having enough strength. Check out more about the amazing piriformis muscle!
But if in this position you feel it more in the front of your hip, you might be more likely to have a tight hip flexor or a hip joint issue. This also means your problem is definitely more likely related to the hip itself.
If when you do the testing position, your glute pain doesn’t change or you notice your back is achy with the motion, it’s likely the issue could be coming from your back.
This is just one of many tests we can do to start to get information from your body about what we need to do to start getting you back to feeling like you again. And it gives you great information to tell your physical therapist, doctor, or chiropractor, to help them make sure they are treating the right thing.
1. O'Sullivan P, Caneiro JP, O'Keeffe M, O'Sullivan K. Unraveling the Complexity of Low Back Pain. J Orthop Sports Phys Ther. 2016 Nov;46(11):932-937. doi: 10.2519/jospt.2016.0609. PMID: 27802794. 2. https://www.uptodate.com/contents/evaluation-of-low-back-pain-in-adult
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