My ‘hip’ hurts

I’m always asking patients what they mean when they describe their hip pain – at the same time thinking ‘but they’re not pointing at their hip!’.

First, have a read of this article about referred pain.

The front of the hip joint ‘ball and socket’ is in the groin. From a practitioner point of view, hip joint pain manifests over the groin, and – when severe – can refer down the front of the thigh to the knee. Hip joint pain does not cause pins and needles, or numbness. Hip joints never refer or radiate pain below the knee.

The above is true for osteo-arthritic ‘wear and tear’ changes in the hip joint – there may be other pain referral patterns for conditions such as FAI.

Painful Hip Joint
Showing the groin location of the ball and socket joint of the hip. At the top of the thigh bone, you can see the nobbly trochanter poking out to the left, and the ‘neck’ of the femur diving inwards and up towards the ball and socket joint.

The large protuberance on the side of the upper leg (the greater trochanter) is not the hip joint.

Practitioners do not refer to the above area as the hip, though it is part of the hip system (being an essential link between the lumbar spine, the pelvis and the hip’s controlling tissues of muscles, tendons, and ligaments).

 

 

 

 

 

 

Some patients point to the top of the sacrum when describing hip pain – this area is not the hip but rather the low lumbar spine, surrounded on either side by the clamping, supporting pelvis through both posterior pelvic joints (the sacroiliacs).

Woman Holding Low Back
This person’s ring and little fingers are resting over the sacroiliac joints, a long way away from the hip joints.

The hip joint never refers pain to the base of the spine. But it is the case that certain types of hip problem (for example, the increasingly diagnosed FAI) can disturb lumbo-pelvic functioning enough to cause local pain at the base of the spine.

Back to that greater trochanter area again – pain here is either a local pain or a referred pain from the low back. Local pain (overloading fatiguing muscles – especially gluteus medius, or a bursa that has become sore) is more likely to occur as a result of the lumbar spine not working correctly above than it is from problems with the hip joint below.

Summary

This is a complex topic, but here goes.

  • Pain in your groin and radiating down the front of the thigh and not below your knee is more likely to be your hip that your back.
  • Pain on the side of your upper leg (where the trochanter is and just above) is not the hip area and in most people is more likely to be from your low back, except in advanced hip osteoarthritis, trauma or FAI of the hip.
  • Pain at the base of the spine around your sacrum is only occasionally and indirectly caused by a problem in your hip.