Of all the complaints we get in our office, “My hips hurt” is one of the most common. What can be frustrating or confusing is that when a patient says “my hips hurt,” they’re often actually referring to their low back or to a problem that’s originating in their low back. This can lead to communication errors and issues if we don’t properly identify and educate our patients about what they’re actually experiencing. In today’s edition of our Low Back Series, I’m going to do my best to explain where the confusion comes from and hopefully help you learn more about what’s going on in your body.
Basic Anatomy
To begin our conversation, we need to get on a level playing field with regard to anatomy. “The hip bone connects to the leg bone” just won’t cut it anymore. The structure of your body is very complex and that’s especially true with your low back, pelvis, and hips.
As you can see in the image. There are multiple major joints around your pelvis:
The Lumbar Spine and Sacrum
The “Sacrolilac” Joints aka SI Joints
The Hip Joints (femoroacetabular joint)
The Pubic Symphysis (more on that another day)
I believe the primary source of confusion is that when you put your hands on your hips, you’re actually resting your hands on the “Ilium” which is the widest part of your pelvis. This is confusing because we then refer to our pelvis, sacrum, etc as our hips. It’s nearly impossible to rest your hands on your actual hips because they’re an internal joint.
Symptoms
When a patient states that their hips hurt, they often point to an area that is on their “backside” and usually in the area of the SI Joints or their glutes/buttocks. Usually pain in this area is caused by a problem in the lumbar spine or SI joints and not the hips. True hip pain is more often found in the front of the hip or in the area of the groin. Lets take a look at some common symptoms of true hip pain vs pain that comes from your SI Joints/low back:
Symptoms of TRUE Hip Pain
Pain in the front of your hip, groin, or deep in the glute - where your back pocket would be
Pain that is exclusively one-sided - though there are plenty of exceptions to this rule
Feeling of ‘catching’ or popping in the hip or groin
Difficulty flexing or bending the hip
Symptoms of SI Joint/Low Back Pain
Bilateral pain
Pain that stretches across the entire low back or glutes - where your pants sit
Pain that goes up into your lumbar spine
Pain improves with activity/movement - most hip issues worsen with activity
But here’s the kicker…in many cases, hip and SI joint/low back problems can present with the SAME SYMPTOMS like muscle spasms, radiating pain, pain with prolonged standing or sitting, etc. There’s even some crossover between the two categories listed above. As you can see, it can be very difficult for a patient to self diagnose a hip/low back issue which is why a proper hands-on exam, appropriate x-rays, and even sometimes additional imaging are extremely valuable.
Why Is It Important? You might think all of this is no big deal and just an argument over terminology…well let me give you some examples of why that’s not the case:
I had a patient a few years ago that presented with intense low back pain. She had spasms in her low back, spasms in her hips, radiating pain in her legs, hurt to stand, hurt to sit…basically the whole nine yards. At first glance, it looked like a lumbar disc herniation or bulge, which isn’t uncommon in younger athletic-type patients. We began the process of treating her, but after a few visits, realized that she wasn’t improving. Initially we had taken x-rays of her low back and it looked very healthy for all intents and purposes. We ended up referring her out for an MRI of her hip and it revealed that she had a severe tear of her labrum (basically the connective capsule around the hip joint). Within a month she’d undergone corrective surgery for the tear and made a full recovery.
Another patient came into my office with what she described as severe hip pain. Through my examination, I came to realize that the patient was actually experiencing “sacroliiltis” or inflammation of the SI Joint. This was causing a lot of referred pain and even muscle spasm around the hip. The resulted in pain around the hip, but the problem was actually more central. Had we only treated this patients hip, we would’ve completely missed the main problem.
I highlight these cases to make the point that we can’t just go off of what the patient says or thinks their problem is. This isn’t because our patients are untrustworthy, but rather because pain is not always a trustworthy indicator and because patients and doctors often use completely different terminology when describing complaints.
The most important thing to remember is that if we correct your terminology or description of what you’re feeling, we aren’t doing so because we want to be right and prove our intelligence, we simply believe that an informed and educated patient is the best type of patient to have. It also helps keep everyone focused on a common goal and helps guide our entire our entire treatment process. We want you to understand exactly whats going on, why we’re treating you the way we are, and ultimately empower you to make informed decisions.
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