Hip IssuesThe hip/s move with the lower back during activities like walking, sitting, bending, etc. Tight muscles, normal wear-and-tear, and osteoarthritis can reduce hip movement, forcing the lower back to make awkward and poor posture causing adjustments. Individuals usually relieve the painful position by increasing the curve of their lower back. If an individual has severe arthritis of the hip, they put a lot of stress and pressure on the low back that often results in low back pain. Advanced hip osteoarthritis is the breakdown of joint cartilage and the most common type of arthritis. Individuals with this type experience low back pain 50% of the time, and even higher depending on the individual’s condition. 80% to 90% of individuals with hip or knee arthritis, unfortunately, develop low back arthritis. There is not yet a clear reason as to why this occurs. It is theorized that some osteoarthritis risk factors like obesity and high-impact/force activities can be modified with lifestyle adjustments. Other risk factors that include injury, trauma, age, and congenital conditions like hip dysplasia, cannot be avoided. Hip osteoarthritis isn’t the only hip issue that can also cause lower back pain. Other hip issues.
Sacroiliac joint dysfunctionThe sacroiliac joint connects the sacrum to the pelvis. It is a shock absorber between the upper body, the pelvis and can stiffen with time. Sacroiliac joint pain affects around 15% to 25% of individuals with low back pain. It worsens when climbing stairs, getting up from a seated position or running. Symptoms include:
- Low back pain
- Pain in buttock/s
- Groin pain
Piriformis syndromeAbout 200,000 individuals each year are affected with piriformis syndrome and is often misdiagnosed as symptoms resemble sciatica. What happens is the piriformis muscle, which connects the sacrum to the top of the femur, tightens/irritates the sciatic nerve. Symptoms are often mistaken for sciatica with pain in the buttocks, numbness, and tingling that travels down the back of the leg and into the feet.
DiagnosisA doctor or chiropractor will use a combination of diagnostic tools. This typically includes a physical exam, X-rays with other specific tests to help identify the source of pain. What typically happens is a patient will undergo a hip and lumbar spine X-ray, but the thoracic spine, pelvis, and hip areas are missed. Getting the middle segment is critical to see how the spine and hips are working together. It is critical to understand the hip-spine connection. All spine patients should have X-rays of the hips to make sure any problems don’t go undetected. The overlap of symptoms with these two areas could be overlooked. If necessary a diagnostic injection into the hip joint can help precisely locate the pain source. This can be done at the clinic or doctor’s office using ultrasound or X-ray to guide the needle. If no pain relief results from the injection, hip replacement is still not considered because the pain could be coming from the spine. A critical part of the diagnosis is not just imaging. One of the most important parts is getting a thorough history of symptoms. X-rays and MRI show what the problem could be, however, the symptoms could coming from another area.
Treatment OptionsBefore total hip replacement is considered there are nonsurgical approaches to be considered. All diagnoses should start with conservative treatment. Physical therapy, chiropractic, gait training, and core strengthening can optimize the spine to better manage hip issues and arthritis. Conservative therapies could also include:
- Weight loss
- Activity modification like walking instead of running
- Anti-inflammatory medication
- Cortisone injections