If your hip has been hurting, has anyone actually checked your back? Or has everyone gone straight to your hip, simply because that’s where the pain is?
A patient we’ll call Renee came to us after more than a year of hip pain. She’d already seen multiple orthopedic surgeons, and every one of them looked at her hip, because that’s where it hurt, so that’s what got treated. A steroid injection into the hip joint didn’t help. A round of PRP injected directly into the hip didn’t help either. By the time she walked into mPower, she was over a year into this with no real relief.
She hadn’t come in complaining about her back. If you’d asked her, she would have told you it was fine. But during her history, she mentioned something almost in passing, that she had to be careful with her back during workouts. That one sentence was the clue everyone else had missed.
Instead of going straight to her hip like everyone before us, we ruled out the spine first. One single session mobilizing her lower back into extension, nothing done to the hip at all, and her hip pain dropped by roughly 80 percent that same visit. Within two weeks, she was almost completely pain free. Not because we treated her hip differently. Because her hip was never actually the source.
Where you feel pain is not always where the problem begins. That’s the idea behind how we treat every patient who walks through our doors: can back pain cause hip pain? For a lot of people, the honest answer is yes, far more often than most treatment plans account for.
Why Hip Pain Is Not Always a Hip Problem
The nervous system is not perfectly precise about where it reports pain. The lumbar spine, the hip joint, and the surrounding soft tissue share overlapping nerve pathways, which means irritation or mechanical stress in one area can genuinely be felt in another. This is the basis of referred pain, a well-documented phenomenon rather than an unusual exception.
It’s worth separating two ideas that often get blended together: symptom location and pain source. Symptom location is where you feel it. Pain source is what’s actually generating the signal. For a lot of people with hip pain, those two things are assumed to be the same, and most of the time they are. But not always, and when they’re not, treatment aimed only at the hip tends to fall short no matter how well it’s delivered.
Symptom location and pain source are not always the same thing. Hip pain coming from the back is more common than most people realize, which is exactly why the spine deserves a look even when it isn’t the obvious complaint.
Can Back Pain Cause Hip Pain? What the Research Shows
A 2022 study by Rastogi and colleagues examined patients presenting with extremity pain, meaning pain in a joint like the hip, knee, or shoulder, and used Mechanical Diagnosis and Therapy testing to identify whether the true source was actually the spine. Across all the joints studied, more than 40 percent of extremity pain cases showed indicators of a spinal source rather than the joint itself. When the researchers broke the data down by joint, the hip had the highest rate of any joint studied, at 71 percent (Rastogi et al., 2022).
That number is striking, and it’s worth being careful about how it’s used. It doesn’t mean 7 out of 10 people with hip pain definitely have a spine problem instead. It means research suggests the spine should always be considered as part of a complete evaluation, especially when hip-focused treatment hasn’t produced lasting relief. The same research also found that patients who were correctly matched to their true source, whether that turned out to be the hip or the spine, had meaningfully better outcomes than those who weren’t.
Why Hip Imaging Does Not Always Tell the Full Story
When hip pain shows up, the natural next step is usually an X-ray or an MRI. If that scan shows arthritis, a labral tear, or signs of impingement, it’s tempting to stop looking any further. There’s your answer, right? Not necessarily.
Structural findings and symptoms don’t reliably line up. Plenty of people have real, visible findings on imaging and feel no pain at all. Others are in genuine pain with a scan that looks essentially normal. For several of the structures commonly evaluated on a hip scan, including impingement, there isn’t a well-established combination of history and exam findings that reliably confirms it’s actually the cause. Many of the orthopedic special tests used to pinpoint a specific hip structure also have limited accuracy, even when performed correctly.
None of this means imaging isn’t valuable. It plays an important role, especially in ruling out more serious pathology. It simply means a scan showing something is one piece of the puzzle, not the entire diagnosis. If everyone stops at the image, the spine, which the research above suggests is a common actual source, often never gets examined at all.
The Difference Between Hip Pain and Back-Related Hip Pain
While no single sign is diagnostic on its own, a few patterns tend to point more toward one source than the other:
More Suggestive of Hip Joint Pain | More Suggestive of Spine-Related Pain |
Pain in the front of the hip or groin | Pain in the buttock or back of the thigh |
Pain with hip rotation | Symptoms change with sitting or bending |
Weight-bearing increases symptoms | Symptoms may change with spinal movement |
Localized symptoms that stay in one spot | Pain that travels down the leg |
These signs are not diagnostic by themselves, and plenty of people fall somewhere in between. They exist to help guide a complete assessment, not to replace one.
5 Signs Your Hip Pain May Actually Be Coming From Your Back
1. Where You Feel the Pain
Pain concentrated in the front of the hip or groin more often involves the hip joint itself. Pain that sits in the buttock or back of the thigh is more likely to involve lumbar structures. It’s a good reminder that why does my hip hurt is often a more complicated question than it first appears, since two very different sources can produce pain in roughly the same general area.
2. What Positions Trigger Your Symptoms
Pain that consistently changes with sitting, bending, or certain prolonged postures points toward the spine. Pain that’s driven more by weight-bearing or rotating the leg itself points more toward the hip joint. Paying attention to what position, not just what activity, brings symptoms on is one of the more useful clues available.
3. Whether Pain Travels
Pain that stays in one localized spot behaves differently than pain that runs down the leg. Traveling pain, especially anything that extends past the knee, is more suggestive of a spinal or nerve-related source than a purely local hip problem.
4. Your History With Back Issues
You do not need current back pain for your spine to be contributing to hip symptoms. Renee is the clearest example of this. She didn’t have back pain when she came to us. She had a history of needing to be careful with her back during workouts, and that history turned out to be the most important detail in her entire case.
5. How Your Symptoms Respond to Movement
This is the core of how mPower approaches every evaluation. Rather than relying on a single stretch or a single picture from a scan, we watch how your symptoms actually behave with repeated movement over time, not just once. That real-time response, whether symptoms centralize, ease, worsen, or stay the same, is what tells us where your true source actually is. None of these five signs are reliable in isolation. Together, they build a much clearer picture.
Why Many People Stay Stuck With Hip Pain for Months or Years
It’s entirely possible to follow a well-designed, appropriate hip treatment plan and still miss the true reason you hurt. This usually isn’t a case of bad care. It’s a case of treating the location instead of the source, and a back causing hip pain is one of the more common patterns that gets overlooked this way. Chasing symptoms with the next injection, the next imaging study, or the next hip-specific exercise can bring temporary relief without ever addressing the mechanical pattern underneath it, especially when that pattern originates somewhere imaging never looked.
You can have a normal hip treatment plan and still miss the true reason you hurt. That gap is exactly what a comprehensive, whole-body evaluation is designed to close.
How Physical Therapy Determines Whether Your Hip or Back Is the Source
At mPower, this process starts with a detailed history, including the kind of small, easy to overlook detail that turned out to matter so much for Renee. From there, a thorough movement examination looks at both the spine and the hip, testing specific positions and directions to see how your symptoms actually respond in real time.
This is the foundation of Mechanical Diagnosis and Therapy, also known as the McKenzie Method, the framework we use for physical therapy for hip pain and back pain alike. Instead of guessing from a single test or relying only on a picture from a scan, we use your symptom response to repeated movement to build an individualized treatment strategy around your specific pattern, whether that pattern points to the hip, the spine, or a combination of both.
Frequently Asked Questions
Can a pinched nerve in the back cause hip pain?
Yes. Nerve roots in the lumbar spine can refer pain into the hip, buttock, and thigh, sometimes without any noticeable back pain at all, which is why spine related hip pain is often missed.
How do I know if my hip pain is coming from my back?
Common clues include pain in the buttock or thigh rather than the groin, symptoms that change with sitting or bending, pain that travels down the leg, and any history of back issues, even an old or minor one. A movement-based evaluation is the most reliable way to confirm it.
Can you have hip pain without a hip problem?
Yes. Research suggests a substantial share of hip pain cases are actually being driven by the spine rather than the hip joint itself, which is exactly why the difference between hip pain and back pain isn’t always obvious from symptoms alone.
Why didn’t my hip injection help?
If the hip joint wasn’t the true source of your symptoms in the first place, treatment directed at the hip, including injections, often won’t produce lasting relief, even when the joint itself has real structural findings on imaging.
Does a normal MRI mean nothing is wrong?
Not necessarily. A hip pain but normal MRI presentation is common, and it often means the source of the pain lies somewhere imaging didn’t capture, such as the spine, rather than meaning the pain isn’t real.
Should I see a physical therapist for hip pain?
A physical therapist trained in mechanical assessment can evaluate both the hip and the spine together, which is often the missing piece for hip pain that hasn’t responded to hip-focused treatment alone.
The Next Step Might Not Be Another Hip Treatment
If you’ve been treating hip pain without lasting improvement, the next step may not be another treatment directed only at the painful area. A comprehensive movement-based assessment can help determine whether the source is actually your hip, your spine, or a combination of both.
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References;
Rastogi R, Rosedale R, Kidd J, Lynch G, Supp G, Robbins SM. Exploring indicators of extremity pain of spinal source as identified by Mechanical Diagnosis and Therapy (MDT): a secondary analysis of a prospective cohort study. Journal of Manual & Manipulative Therapy. 2022;30(3):172-179. doi:10.1080/10669817.2022.2030625
