What is really causing my hip pain?
This is an age old question….. Is it my hip or my back that is causing my pain? It is something that we see all the time in clinic. The reality is, it can sometimes be fairly difficult to differentiate between the two. However, it is really important to distinguish these in order to know that you are getting the appropriate plan of care. So, how do we figure this out? Well, there are some classic findings of each that can help us to better determine the source of pain.
How do we help to distinguish this at your visit?
History and Symptoms
Characteristics that can be associated with BACK pain
- Pain that shoots down your leg
- Numbness or tingling of the lower extremity
- Pain that improves with bending forward
- Pain aggravated by a twisting motion of the spine
- Generalized weakness of the legs
Characteristics that can be associated with HIP pain:
- Pain with movement of the hip
- Difficulty bending at the waist to tie shoe
- Inability to sit cross legged
- Pain in the groin, or a feeling like a “groin pull”
- Walking with a limp
- Discomfort with lying on side of hip at night
- One leg shorter than the other
- Pain when getting in and out of a car
A good thorough physical exam is usually the most important diagnostic tool we have. We can typically have a good indication of the correct pain source just by laying hands on the patient.
Physical exam findings consistent with:
- Pain with/decreased range of motion of hip
- Decreased strength in hip abduction, flexion, etc.
- Tenderness to palpation at the side or back of your hip
- Inability to do a single leg stance
- Pain with flexion or extension of back
- Pain that is made worse by a straight leg raise
- Tenderness to palpation of the muscles surrounding spine
- Obvious curvature of spine
In addition to a good physical exam, radiographic images are an extremely important tool to help aid in our diagnosis. In some cases, if the physical exam does not give us enough information we may deem it appropriate to obtain x-rays of both the spine and the hip.
If the culprit of the pain is osteoarthritis of the HIP the x-rays will show decreased space between the ball and the socket. It may also show the presence of bone spurs, or even a flattening of the head of the femur.
If osteoarthritis or degenerative disc disease of the BACK is responsible you may see loss of height of the intervertebral disks, bone spurs, or a curvature of the spine.
If we are still uncertain after these modalities, a diagnostic and therapeutic injection may be the next step. An injection of a local anesthetic (with or without cortisone) can tell us usually within minutes if that body part is truly the source of the pain. What the local anesthetic does is basically turn off the pain sensation in that area. Therefore, if your pain disappears completely in the few minutes following the injection…. Voila! The pain source has been discovered.