Hip pain and lower back pain can be surprisingly easy to confuse — and it is not uncommon for patients to arrive at Mr Kosuge's clinic at The Rivers Hospital, Sawbridgeworth, believing they have a hip problem when the source is actually their lumbar spine, or vice versa. Understanding the difference is important, because the treatment for each is quite different.
Why do back and hip pain get confused?
The hip and lower back are anatomically close and share nerve pathways. Referred pain — pain that is felt in one location but originates elsewhere — is common in this region. The sciatic nerve runs from the lower back through the buttock and down the leg, meaning a spinal problem can produce symptoms that feel very much like a hip issue.
Similarly, hip osteoarthritis can refer pain to the groin, the inner thigh, the knee, or even occasionally the lower back — making the true source far from obvious without a careful clinical assessment.
Signs that your pain may be coming from the hip
Pain is felt in the groin — groin pain on walking or at rest is a classic hip symptom
Pain is reproduced when Mr Kosuge rotates or flexes your hip during examination
Pain begins gradually and worsens with activity, particularly walking and twisting
You notice stiffness putting on shoes, socks or getting in and out of a car
X-ray shows osteoarthritis of the hip joint
Signs that your pain may be coming from your back
Pain radiates below the knee — hip problems rarely cause pain below the knee
Pain is associated with pins and needles, numbness or weakness in the leg or foot
Symptoms vary significantly with posture — worse sitting, better walking, or vice versa
Pain began after a period of heavy lifting or a specific incident involving the back
Hip movements in examination do not reproduce the pain
It can be both
One of the most challenging scenarios in orthopaedic practice is when a patient has both hip osteoarthritis and lumbar spine disease simultaneously — sometimes called "hip-spine syndrome". In these cases, it can be genuinely difficult to determine which is the main driver of symptoms.
Mr Kosuge is experienced in assessing this complex presentation and may recommend a diagnostic hip injection — placing local anaesthetic into the joint — to help determine how much of the pain is attributable to the hip. If the injection provides significant temporary relief, the hip is likely the dominant source.
What should I do if I am unsure?
The most important step is to seek a specialist assessment. Mr Kosuge will take a thorough history, examine both your hip and your spine, and review any relevant imaging. If the source of your pain turns out to be the spine rather than the hip, he will advise you accordingly and, where appropriate, refer you to the right specialist.
Ready to take the next step?
Mr Kosuge offers private consultations at The Rivers Hospital, Sawbridgeworth and NHS consultations at The Princess Alexandra Hospital NHS Trust, Harlow.
To book an appointment with Mr Kosuge:
Telephone: 01279 602675