Can Low Back Pain Cause Hip Pain
Yes! As a sports medicine and rehab-based chiropractor, the concepts that tie the low back and the hip together are essential to understanding IRPC’s level of care. In this article, we will talk about regional interdependence, pain referral, and mobility Vs. stability.
Let’s create a scenario. Say you are dealing with low back pain with occasional hip pain that comes suddenly when you move or shift in a certain way. There are a few things that can be happening here. One is that you have a low back issue that is creating local and occasionally referred pain into the hip. What happens here is the same nerves that supply nociception (pain) sensation in the low back also supply the hip region at the joint level. Therefore, if the nerve is stimulated to produce pain in the low back, the brain can interpret pain at other locations along that nerves track. The same is seen with gallbladder issues creating pain in the right shoulder.
Another option is that the nerve is being physically encroached upon at the low back, creating radiating pain down the nerves track, and in this case, stopping at the hip. Potential reasons for physical encroachment here can include arthritic changes in the low back, disc bulges, and muscular hypertonicity creating pressure around the nerve after it exits the spine.
Now, what’s important to understand with low back pain associated with hip pain is that despite the pain generator, the true CAUSE of the pain still needs to be determined. Even if we have an MRI showing a pushing on the nerve as it exits the lateral canal of the spine, we still need to ask why that disc bulged in the first place. If an X-ray shows arthritic changes creating the encroachment on the nerve, why did the bone in this region of the back get exposed to such excessive forces that it had to adapt and lay done excess bone? Despite the issue, we need to ask why this happened so we can stop it from progressing or happening again in the future.
Regional Interdependence
This is a key concept for how we address the “root cause”. Regional interdependence is the idea that each joint along a chain of joints impacts each other as they were designed to share load through movement. In our scenario, we have low back pain and occasional hip pain. Why? Well, there is L5-S1 disc bulge creating local pain at the low back and referred pain to the hip. But is this the real why? No, it is because, after doing a full and thorough exam, there is missing range of motion in the hip on one side, limited relative motion in the pelvis, and excessive anterior or forward tilting of the pelvis. This creates the conditions for the bulge to occur, among many, many others.
So, the hips don’t rotate well, the pelvis is stuck forward, and the patient does not brace well in 360 degrees around the low back. The lack of hip rotation and flexion put pressure on the pelvis to start tilting early, creating a change in the orientation of the sacrum and L5. This combined with poor breathing and stabilization mechanics around the low back allows excessive motion at this region. Therefore, when squatting, the shear and compressive forces around the low back was great enough to create a bulge in the disc. You can see now, treating the location of pain typically misses 90% of the problem. Regional interdependence reminds us to look at ALL the regions responsible for creating and allowing proper motion through the joint with pain.
Mobility and Stability
From our example, we needed hip mobility, pelvic mobility, and lumbar stability. Unfortunately, without our athlete and exerciser, we lacked in all categories (not uncommon!). For this reason, exams at IRPC are comprehensive and go well beyond the site of pain. We want to know if there is stability and motor control where stability is needed and mobility where mobility is needed. Check out the brief video below showcasing some of the testing we do at IRPC in our comprehensive approach…
Conclusion
Overall, pain can be complex. It is important to understand what is generating the pain and understand the tissues healing time, but we must look globally to understand how we got here in the first place. This is where the concept of regional interdependence keeps us on track with truly comprehensive exam and treatment plans. We look for stability and mobility requirements up and down the chain and see if the patient can meet the demands. Do they have enough hip mobility to squat deep and meet the CrossFit judges standards? Do they know how to brace properly to stay strong and fight sheer forces in the low back? Are they able to extend the hip without the pelvis and low back compensating? There is a lot to know about a patient beyond where the pain is. So yes, low back pain can cause hip pain, but there is always more to the story!
-Dr. Nick, D.C.
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