Hip and lower back pain can sometimes feel surprisingly similar. Pain from the hip can spread into the thigh or buttock, while problems in the lower back can cause pain around the hip and leg.
This can make it difficult to know where your symptoms are actually coming from.
So, if you are wondering hip pain or back pain how to tell, the location, type and pattern of your symptoms can provide some useful clues. However, these symptoms can overlap, and a healthcare professional may need to examine your hip and back to identify the likely cause.
Where does hip pain usually occur?
Pain caused by a problem within the hip joint is often felt in the groin. It can also be felt around the buttock, outside of the hip or down the front of the thigh towards the knee.
Hip osteoarthritis is one possible cause. Typical symptoms include pain and stiffness, difficulty moving the hip and discomfort during activities such as walking, standing, bending or getting in and out of a car. Putting on shoes and socks can also become more difficult as hip movement becomes restricted.
If you want to understand more about the condition, our guide to hip osteoarthritis symptoms, stages and treatment options explains how hip osteoarthritis can develop and the treatments that may be considered.
Signs that may point towards the hip
You may be more likely to have a hip-related problem if you notice:
- Pain mainly in the groin
- Pain around the front or side of the hip
- Stiffness after sitting or resting
- Pain when walking or standing
- Difficulty putting on socks or shoes
- Difficulty getting into or out of a car
- Reduced hip movement
- Pain when bending or squatting
- Pain that sometimes extends towards the thigh or knee
However, none of these symptoms on their own confirms that the hip is responsible.
What does back-related pain feel like?
Lower back pain has many possible causes, including muscle strains, slipped discs and irritation or compression of nerves.
Sometimes a problem in the lower back can cause pain elsewhere in the body. This is known as referred or radiating pain. As a result, you may feel discomfort around your buttock, hip or leg even though the underlying problem is in your back.
Sciatica is one example. It occurs when the sciatic nerve becomes irritated or compressed. Symptoms commonly affect the buttock and the back of one leg and may extend towards the foot and toes. You may also experience burning or sharp pain, tingling, numbness or weakness.
Signs that may point towards the back
Back-related symptoms may include:
- Pain centred around the lower back
- Pain travelling from the back or buttock down the leg
- Burning or shooting pain
- Pins and needles
- Numbness
- Weakness in the leg
- Symptoms that extend below the knee
- Pain that changes with certain back movements
- Symptoms that become worse when coughing or sneezing, particularly with sciatica
If you have only lower back pain, without symptoms affecting the leg, this is less typical of sciatica.
Referred pain: hip or back?
Referred pain from the hip or back can make diagnosis particularly difficult.
The nervous system does not always allow you to identify the exact structure causing pain simply by where you feel it. A problem in the hip can sometimes cause discomfort in the thigh or knee, while a problem in the lower back can cause pain around the buttock or hip.
For example, hip osteoarthritis commonly causes pain in the groin but can also cause pain in the buttock, side of the hip or down towards the knee.
This is why the location of pain should be considered alongside other symptoms, movement and physical examination rather than used as a diagnosis by itself.
Groin pain: could it be hip arthritis?
Groin pain is one of the more recognisable symptoms of hip osteoarthritis.
You may notice deep discomfort in the groin that becomes more noticeable when walking, standing, bending or moving the hip. Stiffness may also make everyday movements such as putting on shoes and socks more difficult.
However, groin pain has many possible causes and does not automatically mean you have hip arthritis. A healthcare professional can assess your symptoms and determine whether further investigation is appropriate.
Our guide to hip osteoarthritis covers common symptoms, the different stages of hip arthritis and treatment options in more detail.
Sciatica or hip arthritis?
It is easy to confuse sciatica or hip arthritis, particularly when pain affects the buttock or upper leg.
There are some differences that may provide clues.
Hip osteoarthritis is more commonly associated with groin pain, hip stiffness and difficulty moving the hip. Pain may be worse when walking or putting weight through the joint.
Sciatica, on the other hand, typically involves symptoms along the sciatic nerve. Pain often travels from the lower back or buttock down the back of the leg and may be accompanied by tingling, numbness or weakness.
The two conditions can also coexist, so having symptoms that sound like one condition does not necessarily rule out another.
Can hip pain be caused by your back?
Yes. Problems affecting the lower back can cause pain that is felt around the hip or buttock.
The lumbar spine can refer to pain into areas around the hip and thigh, which is one reason distinguishing between hip and back pain can sometimes be difficult.
Equally, a hip problem can cause pain away from the joint itself. This is particularly relevant with hip osteoarthritis, where pain can extend from the groin towards the thigh and knee.
How do doctors tell whether pain is coming from the hip or back?
Your symptoms are only part of the assessment.
A healthcare professional may ask:
- Where exactly do you feel the pain?
- When did it start?
- Did it follow an injury?
- What activities make it worse?
- Does the pain travel down your leg?
- Do you experience numbness or tingling?
- Is your hip stiff?
- Has your walking pattern changed?
- Are everyday activities becoming difficult?
They may then examine both your hip and back, assessing movement, strength and other physical signs.
Imaging is not always necessary. For suspected osteoarthritis, diagnosis can often be based on symptoms and physical examination. If imaging is considered appropriate, an X-ray can help assess the bones and joints.
If your healthcare professional recommends an X-ray, you can learn more about what is involved through our Private X-ray Service, which provides X-ray imaging for a range of bone and joint problems.
Whether an X-ray is appropriate for you should be determined as part of a clinical assessment.
When should you seek medical advice?
You should consider speaking to a healthcare professional if your hip or back pain is persistent, worsening or affecting your normal activities or sleep.
Seek urgent medical advice if you develop severe or rapidly worsening pain, feel generally unwell or have a hot, swollen hip.
Back pain accompanied by numbness around the genitals or anus, changes in bladder or bowel control, or severe or worsening weakness or numbness in both legs requires urgent medical attention.
So, is it your hip or your back?
There is no single symptom that can reliably tell you whether pain is coming from your hip or back.
As a general guide, groin pain, hip stiffness and difficulty moving the hip may suggest a hip-related problem, while pain travelling from the lower back or buttock down the leg, particularly with tingling, numbness or weakness, may suggest nerve-related back pain.
But symptoms can overlap, and referred pain can make the source difficult to identify without an examination.
If your pain is persistent or affecting your everyday life, getting an appropriate assessment can help establish what may be causing it and what treatment options are available.
For information about another common source of joint pain, read our guide to knee pain and when to consider seeing an orthopaedic specialist.