The lower back and the hip are close together. Often a patient will present to my office with “hip pain” that turns out to be coming from the back.
I also see frequent cases where a patient thinks he is having sciatica but who turns out to have a hip problem. How can you tell the difference? To answer that, lets look at sciatica. What is it? It is a symptom, not a disease. It’s a term that describes pain which starts in the buttock and travels down the leg. Classically, it travels all the way to the foot, but even pain which is just in the buttock is often called sciatica. In almost all cases, it is caused by a nerve in the back which is either pinched or irritated. This can be from a bone spur, ruptured disk, or other problem. When a nerve is pinched, the pain is felt down the length of the nerve. The sciatic nerve is made up of little nerves from the lumbar spine which join up together, then travel through the buttock and down the leg. When patients come to see me for “hip pain,” they often point to the buttock area, right where the sciatic nerve comes out. The true hip joint is a ball-and-socket type joint which is located where the pelvis (the socket) comes together with the femur (thigh bone), the top end of which is shaped like a ball. The location of the hip joint is actually in the groin area in front. Many people think of the hips as the area which is wrapped by a tape measure, but that is actually a knobby area of the thigh bone called the trochanter.
By far, the most common problem that develops with hips is arthritis; the wear-and-tear of lubricating cartilage that eventually causes raw bone to rub on bone. Pain which occurs in the trochanter area is usually a form of bursitis. Bursitis is the inflammation of some lubricating tissue that overlies the trochanter. So how do you tell if it’s a hip problem or a back problem? The location of the pain is important. Pain from hip problems will usually be located in the groin in front, and sometimes spread into the front or side of the thigh. Sciatica will usually be in the back, and radiate into the back of the thigh or leg. Hip pain also occurs immediately upon arising from bed or chair, while sciatica can often slowly build in intensity as a patient walks. If a limp is present, chances are that it is a hip problem (although it can occur less commonly in sciatica.) Any numbness or tingling would be from sciatica, not a hip problem. There are also tests on physical exam which can tell the difference between the two.