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Hip Pain OR Lower Back Pain? Or is it, Hip Pain AND Lower Back Pain

Hip Pain OR Lower Back Pain? Or is it, Hip Pain AND Lower Back Pain

Dr. Michael Derry, DPT, PT, OCS Jacksonville, Florida
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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.

So at this point you’re probably wondering, “How do you know if it's the hip or the lower back that is causing your pain?” Let’s dive in to answer that question.

*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.

Hip and Lower Back Referral Patterns

It can be a little tricky to figure out if the hip or the lower back pain is causing your pain because sometimes they have the same pain referral patterns. The human body is complicated by treating lower back and hip pain doesn’t have to be. 

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.

Figure Out If It’s Your Hip vs Lower Back with This Test!

Check out this video to learn exactly how to do the test and how you might be able to use it for as a treatment, too!

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. 

  • Add pressure by pushing down at the knee
  • Add a gentle up and down oscillatory movement at the knee
  • Lean forward into the position

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.

Want to learn more?

If you want to know more about your lower back pain and hip pain and you want to learn what you can do to jump start your recovery. Check out my masterclass on hip and lower back pain.

Subscribe to my blog for articles loaded with tips and tricks for anyone dealing with lower back pain.


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.

Dr. Michael Derry is a Doctor of Physical Therapy and board certified in orthopedics. He is very passionate about treating lower back pain and helping people build their resiliency. He has spent time assisting at universities as well as managing large clinics before starting his own practice in Jacksonville, FL.

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