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:

• Online booking

• Telephone: 01279 602675

Not everyone with knee osteoarthritis needs surgery — and for many patients, a structured exercise programme can significantly reduce pain, improve function and delay or even avoid the need for knee replacement altogether. Mr Dennis Kosuge, Consultant Orthopaedic Surgeon at The Rivers Hospital, Sawbridgeworth, always discusses non-operative options with patients before recommending surgery.

Here are five evidence-based exercises recommended for patients with knee osteoarthritis. As always, if you are unsure whether these are appropriate for your specific condition, consult your GP or specialist first.

1. Straight leg raises

Lie on your back with one knee bent and the other straight. Tighten the quadriceps muscle of the straight leg and slowly raise it to the height of the bent knee. Hold for two to three seconds, then lower slowly. Repeat 10 to 15 times per leg.

This exercise strengthens the quadriceps without placing load through the knee joint itself — making it ideal even when the knee is painful.

2. Wall squats (mini squats)

Stand with your back against a wall, feet hip-width apart and slightly in front of you. Slide slowly down the wall until your knees are at roughly 30 to 45 degrees of bend — do not go below 90 degrees. Hold for five seconds, then slide back up. Repeat 10 times.

This strengthens the quadriceps and glutes in a controlled, low-impact way. If this causes pain, reduce the range and stop if discomfort is significant.

3. Calf raises

Stand holding a chair for balance. Slowly rise onto your toes, hold for two seconds, then lower. Repeat 15 to 20 times. This improves lower limb circulation, strengthens the calf and indirectly reduces load on the knee by improving overall leg muscle function.

4. Seated knee extension

Sit in a chair with your feet flat on the floor. Slowly straighten one knee until the leg is as straight as possible, hold for three seconds, then lower slowly. Repeat 10 to 15 times per leg. This directly targets the quadriceps and helps maintain range of motion.

5. Step-ups

Using a low step (start with a 10 cm step), step up with your affected leg leading, bring the other foot up, then step back down. Perform 10 repetitions per leg. As your strength improves, you can increase the height of the step gradually.

Step-ups replicate a functional movement and build the strength needed for daily activities like stairs.

Other non-surgical measures worth considering

Exercise is the single most evidence-based conservative treatment for knee osteoarthritis, but Mr Kosuge discusses all other non-operative treatment options with patients:

• Weight management — even modest weight loss significantly reduces load through the knee joint

• Walking aids — a walking stick used in the opposite hand reduces joint loading

• Physiotherapy — a qualified physiotherapist can tailor a programme to your specific needs. Mr Kosuge will be happy to make a referral to the physiotherapy team at Rivers Hospital for you.

• Joint injections — steroid or Arthrosamid injections for patients who need additional pain relief

When is surgery the right next step?

If you have been doing these exercises consistently for three to six months and your quality of life remains significantly affected by knee pain, it is worth seeking a specialist assessment. Mr Kosuge provides honest, evidence-based advice regarding the option of a knee replacement.

Ready to take the next step?

Mr Kosuge offers private consultations at The Rivers Hospital, Sawbridgeworth and The Princess Alexandra Hospital NHS Trust, Harlow.

To book an appointment with Mr Kosuge:

• Online booking

• Telephone: 01279 602675