Back and hip pain are among the most common complaints seen in orthopedic practice. Both types of pain often manifest with similar symptoms, making differentiation difficult. However, an accurate diagnosis is essential to initiate the correct therapy and prevent long-term problems. This article examines the various causes, symptoms, diagnostic techniques, and treatment options to provide clear guidance for both patients and medical professionals.

Anatomy of the back and hip

The back

The human back consists of several anatomical structures:

• Spine: Divided into cervical, thoracic, lumbar spine, sacrum and coccyx.
• Muscles: Deep and superficial muscles provide stability and movement.
• Nerves: The spinal nerves emerge from the vertebral column and supply the surrounding structures.

The hip

The hip area includes:

• Hip joint: A ball-and-socket joint consisting of the femoral head and the acetabulum.
• Muscles: The gluteal muscles and the adductors support mobility and stability.
• Nerve structures: The sciatic nerve runs close to the hip joint and can cause discomfort.

Because both regions are closely connected, pain can occur or radiate to both the back and the hip.

Common causes of back and hip pain

Causes of back pain

1. Herniated discs: Protruding intervertebral discs press on nerve roots.
2. Spinal stenosis: A narrowing of the spinal canal causes pain and numbness.
3. Muscle tension: Often caused by poor posture or overuse.
4. Osteoarthritis: Wear and tear of the small vertebral joints leads to stiffness and pain.

Causes of hip pain

1. Hip osteoarthritis: Wear and tear of the hip joint.
2. Hip impingement (FAI): Mechanical problems caused by malformation of the femoral head or acetabulum.
3. Trochanteric bursitis: Inflammation of the bursa in the hip area.
4. Tendonitis: Often triggered by overuse or unhealthy movement patterns.

Differences in pain presentation

Typical characteristics of back pain

• Location: Pain often occurs in the lower back (lumbar spine).
• Radiation: Possible radiation from the buttocks down into the legs (sciatica).
• Character: Dull or pulling pain that intensifies with certain movements.
• Accompanying symptoms: tingling or numbness in the legs.

Typical characteristics of hip pain

• Location: Front of the thigh or groin pain.
• Radiation: Sometimes to the buttocks or the knee.
• Symptoms: Pain when walking, sitting, or climbing stairs.
• Accompanying symptoms: Restricted hip mobility.

Diagnostic procedures for differentiating between back and hip pain

Medical history

A detailed discussion clarifies:

• Onset, duration and intensity of the pain.
• Trigger points and factors that alleviate or worsen the pain.
• Pre-existing conditions such as osteoarthritis or herniated discs.

Clinical examination

1. Palpation: Examining the spine and hip joints by touch.
2. Movement tests:

• Thomas test: To check hip flexion.
• Schober test: For assessing the mobility of the lumbar spine.

1. Strength and sensitivity tests: Indicative of nerve irritation.

Imaging

1. X-ray: For assessing bone damage or osteoarthritis.
2. MRI: For detailed examination of soft tissues, nerves and intervertebral discs.
3. Ultrasound: Particularly suitable for examining bursae and tendons.

Pain radiating as a diagnostic clue

Pain can radiate from either the hip or the back. Important points for differentiation:

Pain radiating from back problems

• Sciatic pain runs along the back of the thigh to the calf.
• Pain often worsens when sitting or moving forward.
• Neurological symptoms (e.g., tingling) are a common accompanying symptom.

Pain radiating in hip problems

• The pain usually radiates from the groin to the front of the thigh.
• Climbing stairs or rotating the hips worsens the symptoms.
• Often no neurological symptoms.

Treatment of back and hip pain

Conservative treatment approaches

• Physiotherapy:
• Strengthening the muscles to stabilize the back and hips.
• Mobilization of restricted joints.
• Pain management:
• NSAIDs (non-steroidal anti-inflammatory drugs) to relieve inflammation.
• Local injections for severe symptoms.
• Occupational therapy: Optimizing movement patterns in everyday life.

Surgical therapy

• Disc surgery: To relieve pressure in cases of herniated discs.
• Endoprostheses: In cases of severely advanced hip osteoarthritis, an artificial joint can improve the quality of life.

Conclusion

Differentiating between back and hip pain requires careful diagnosis, as the symptoms can be similar. A comprehensive medical history, clinical tests, and targeted imaging can help narrow down the cause of the discomfort. Early and appropriate treatment is crucial for pain relief and improving quality of life.