Hip osteoarthritis and back pain: why the hip is often the hidden cause
Could your back pain be driven by your hip?
The myBackPain assessment identifies the referred pain and mechanical patterns that point to hip pathology — the diagnosis that is easily missed when the focus stays on the spine. Results in minutes.
What is hip osteoarthritis — and why does it cause back pain?
Hip osteoarthritis is the progressive degeneration of the cartilage lining the hip joint. As the cartilage thins and the joint space narrows, the hip becomes stiffer and its range of movement reduces. What is less well understood is the consequence of that restriction on the lumbar spine.
The hip and lumbar spine are biomechanically interdependent. When hip movement is restricted, the lumbar spine compensates by moving more than it should to perform everyday tasks. Over months and years, this increased spinal demand creates muscle fatigue, facet joint stress, and mechanical back pain. This combination is known as hip–spine syndrome.
Many people with significant hip OA present primarily with lower back pain, groin pain, or both — and the hip is not examined. A patient whose back pain is driven by altered lumbopelvic mechanics from a stiff hip needs very different management from true spinal pathology. The two are frequently treated as the same thing.
Where does the pain go?
What does hip OA feel like?
- Groin pain — the most characteristic symptom of true hip joint pathology
- Anterior thigh pain referred from the hip, often to the knee
- Lower back pain from altered lumbopelvic mechanics
- Stiffness after rest, particularly on waking or after sitting
- Reduced walking tolerance — pain or stiffness that builds with distance
- Difficulty putting on shoes and socks — requires hip rotation that is restricted by OA
- A limp or altered gait, often noticed by others before the patient
- Pain getting in and out of a car, climbing stairs
Restricted and painful internal rotation of the hip is the most reliable clinical indicator of hip OA. If a practitioner examines your back but does not examine your hip, ask them to. A single passive range-of-motion test of the hip can change the entire diagnostic picture.
Groin or anterior thigh pain that is not improving • A progressive limp or difficulty weight-bearing • Back pain in an older adult whose hip has not been examined • Back pain diagnosed as sciatica but without the typical shooting/electric nerve quality below the knee.
What helps?
Exercise
Hip strengthening — particularly the gluteal muscles — and maintaining hip flexibility significantly slow OA progression and reduce pain. Swimming, cycling, and walking are all well tolerated. Strengthening the muscles that unload the hip joint is one of the most effective non-surgical interventions available.
Manual therapy
Targeted hip joint mobilisation, soft tissue work, and treatment of the altered lumbopelvic mechanics can significantly reduce both hip and associated back pain. Addressing the spine in isolation, without treating the hip, typically produces incomplete results.
Weight management
Each additional kilogram of body weight increases hip joint loading by 3–5 kilograms during walking. Even modest weight reduction produces meaningful reductions in joint load and symptom levels.
Walking aids
A walking stick used in the hand opposite the affected hip reduces hip joint loading by up to 50%. This is a clinically significant intervention — not simply a comfort measure.
Hip replacement
Total hip arthroplasty has excellent outcomes for end-stage hip OA. Outcomes for associated back pain are frequently good following hip replacement, as the lumbopelvic mechanics normalise once the hip restriction is resolved. People who have been told their back pain cannot be helped are sometimes significantly improved by hip surgery directed at the actual source of their problem.
The assessment identifies the referred pain patterns that point toward hip pathology — groin pain, anterior thigh pain, and the absence of true neurological leg symptoms. If the hip pattern fits your picture, the report will direct you toward the right assessment and management pathway.
Could your back pain actually be coming from your hip?
The myBackPain assessment identifies the pattern of hip-referred and mechanically-driven back pain that gets missed when only the spine is assessed. Safety screening included. Results in minutes.