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Is It My Hip or My Back?
If you are not sure whether your pain is coming from your hip or your back, the location is the biggest clue. As a rule of thumb, true hip problems are usually felt in the groin, while back problems are more often felt in the buttock and down the leg. The two overlap more than you might think, though, which is why they are so easily confused.
It is one of the most common questions we are asked at Newhill Osteopathy in Horley, and it matters, because a hip problem and a back problem are treated quite differently. Here is how to tell them apart.
The quick answer: where is your pain?
Point to where it hurts, and you are already halfway there:
- Groin, or the front of the hip or thigh – more likely the hip joint.
- Buttock, or pain travelling down the back of the leg – more likely the lower back.
- The bony point on the outer hip, sore to lie on – usually a tendon or bursa, not the joint itself.
None of these is a hard-and-fast rule, but taken together they usually point you in the right direction.
Where does hip pain usually sit?
Genuine hip joint pain is most often felt as a deep ache in the groin, and it sometimes spreads to the front of the thigh or even the knee. It tends to be worse when you put weight through the leg – walking, climbing stairs, or getting out of a car – and the hip often feels stiff, especially first thing in the morning. A classic giveaway is discomfort putting on socks or shoes, because that movement squeezes the joint. You can read more on our hip pain page.
Where does back-related pain usually sit?
Lower back problems are usually felt across the back itself and in the buttock, and they often change with your position – worse after sitting, bending or lifting, and sometimes eased by walking about. If a nerve is irritated, the pain can travel down the leg, and you may notice pins and needles, numbness or a heavy, weak feeling. A jolt down the leg when you cough or sneeze points firmly to the back rather than the hip. There is more on our lower back pain page.
What about sciatica?
Sciatica is a back problem, not a hip one, even though people often feel it around the hip and buttock. It happens when a nerve in the lower back is irritated and sends pain, tingling or weakness down the leg, sometimes as far as the foot. So if your “hip” pain runs down the back of your thigh and below the knee, the source is almost certainly your back. Our sciatica page explains it further, and we bust a few common myths in this article.
A few simple self-checks
These are pointers rather than a diagnosis, but they can help you get a sense of what is going on:
- Where can you press to find the sore spot? Groin suggests the hip; the buttock or spine suggests the back.
- Does putting on a sock or getting out of the car catch you? That leans towards the hip.
- Does sitting, bending or coughing make it worse? That leans towards the back.
- Does the pain travel below the knee? That points to a nerve coming from the back.
If your answers are mixed, do not worry – pain coming from both is common, and it is exactly the sort of thing an assessment is designed to sort out.
When should you see someone?
If your pain is not settling, is stopping you sleeping or working, or you simply are not sure what is causing it, it is worth getting it assessed. An osteopath can examine the hip and the back together and work out where the trouble really lies, rather than guessing from where it hurts.
Please seek urgent medical help if your pain comes with numbness around the back passage or genitals, difficulty passing or controlling urine, loss of bowel control, or numbness or weakness spreading into both legs. These need prompt medical attention rather than osteopathy.
At Newhill Osteopathy in Horley we assess hips and backs day in, day out, and untangling which is which is one of the most common things we do. If yours has been grumbling, we would be glad to take a look.
Related pages
You can also see everything we treat on our conditions page.
Frequently asked questions
Can a hip problem cause back pain, or a back problem cause hip pain?
Yes, both happen, which is part of why they are so easily confused. A stiff or painful hip can change the way you move and load your back, while a back problem can refer pain into the hip and buttock. This is why it helps to have both assessed together, rather than assuming the pain is coming from exactly where you feel it.
Why does the outer side of my hip hurt when I lie on it?
Pain on the bony point of the outer hip, sore to lie on at night, usually comes from the tendons and the small cushioning bursa there rather than the hip joint itself. It is very common, particularly from around midlife onwards, and it generally responds well to the right loading, treatment and a few changes to how you sleep and sit.
Can a bad back really cause pain all the way down my leg?
Yes. When a nerve in the lower back is irritated, it can send pain, tingling or weakness down the leg, sometimes as far as the foot – this is what people call sciatica. Pain that travels below the knee, especially with pins and needles, points to the back rather than the hip as the source.
Should I see a GP or an osteopath?
For most everyday hip or back pain, an osteopath can assess you and start treatment without a referral. See your GP first, or seek urgent care, if you have red-flag symptoms such as loss of bladder or bowel control, numbness around the saddle area, or weakness in both legs, or if you feel generally unwell alongside the pain.
Can the pain be coming from both my hip and my back?
It can, and it is more common than people expect, particularly as we get older and a little wear appears in both areas. Having pain in both places does not mean something is seriously wrong. A proper assessment can tease apart how much each is contributing and target treatment accordingly.