Dr. Matthew Levy, orthopedic surgeon, writes a monthly column for the Cleveland Jewish News focusing on orthopedic issues, concerns and topics. This column was originally published in Cleveland Jewish News on April 8, 2021. 

Is your hip and leg pain caused by your hip joint?  Or is it your back?  It can be difficult, particularly for to the untrained eye, to tell the difference. It is easy to mistake back pain for hip pain, or vice versa.

The body’s very anatomy makes it difficult to identify between pain caused from hip abnormalities or common degenerative conditions of the lumbar spine.  The hips and lower spine are located closely together, with the hip joint just behind the groin area on each side of the body.

That is why it is important to receive an accurate diagnosis from your physician so you can follow the proper treatment plan.

Pain present in the groin area of the affected side is typically a sign it is caused by a problem in the hip. Pain can also radiate down the thigh toward the knee. Patients tend to find walking worsens the pain, resting relieves it and range of motion is limited.  Oftentimes, patients will complain of difficulty putting on their shoes and socks. Hip-related pain is most often the result of osteoarthritis of the hip joint.

On the other hand, certain back conditions can place pressure on the nerves of the lower spine, creating radiating pain known as sciatica.  This pain can be felt in the buttocks, hip region and the upper leg. It is understandable why so many confuse this as pain coming from the hip joint.  Signs that your pain is coming from a condition in the back include pain that is:  present in your back, buttocks or hip; and shoots down the leg, typically past the knee.

In some patients, diagnosing hip pain versus back pain is not so clear cut.  Often times, patients with osteoarthritis of the hip also have osteoarthritis or degeneration of the spine. Or, for example, abnormalities of the hip can change how we walk and move, creating pain in muscles of the back.  Similarly, those with back pain often reduce movement, causing the muscles surrounding the hip joint to become tense and painful. The key to finding a solution is identifying the root source.

The first step in my approach as a physician is listening to a patient’s description of their pain, including its location, relieving and exacerbating factors, associated symptoms, and comparing that to information gained from x-ray or MRI imaging. Physical examination of the hip and back and identifying the location and severity of pain provides additional data.

If, after this information is reviewed and conservative treatments, including anti-inflammatories and physical therapy has failed to localize the source of the pain, I will often inject lidocaine into the hip joint as a diagnostic tool. Often times, this injection can also be mixed with cortisone, such that the injection may be diagnostic as well as therapeutic. If pain is relieved from the injection, then we know the hip is the root cause. If it isn’t, we know to look to the back.  Working with your physician to identify the root cause – where did the problem start – is key to getting back to a healthy, active lifestyle.

Born and raised on Cleveland’s east side, Dr. .Levy worked for 14 years as team physician for local sports teams. After graduating from Case Western Reserve University Medical School in Cleveland, he completed his internship and residency at Mount Sinai Medical Center in Cleveland. Levy is also fellowship trained in sports medicine. He sees patients in Solon, Independence and downtown Cleveland.