Your Groin Hurts and So Does Your Back. They Are Related.

Two different doctors. Two different diagnoses. Two separate treatment plans, neither of which is working.

That is the situation a lot of people are in by the time they get to me. A retired teacher came in this summer with a folder for her hip and a separate folder for her back, and she apologized for taking up my time with two things. It was one thing. Nobody had put the folders on the same desk.

The orthopedist is looking at a hip x-ray. The spine specialist is looking at an MRI of the lumbar spine. Both of them found something, because everybody over sixty has something, and now you are stretching your hamstrings for one problem and icing your back for the other.

Your body does not have a hip department and a back department.

The hip is the floor the spine stands on

Think about what happens when a hip stops moving well.

You need about ten to fifteen degrees of hip extension to walk normally. That is the leg going behind you at the end of a step, the part that lets you push off. When arthritis or a stiff capsule takes that away, the leg cannot get behind you anymore.

But you still want to take a full step. So you get the motion somewhere else.

The pelvis tips forward and the low back arches to let the leg trail. Every single step. Around five thousand of them on an ordinary day, more if you are walking the dog on the TART. Each one asks a couple of lumbar joints to make up range that a ball-and-socket joint used to provide.

Same thing on rotation. A hip that cannot rotate internally hands that job upstairs. Every time you turn to grab something out of the back seat, every golf swing, every time you pivot to load the dishwasher.

The spine is not built to be a hip. It is built to be stable while the hips do the moving. Ask it to do the other job for two years and it will start complaining.

Which is the whole point of this post. Your back is very often the victim here, not the culprit. It is the link that gave in, not the link that failed first.

What the numbers look like

There is a good study on this out of the Rothman Institute in Philadelphia, published in Clinical Orthopaedics and Related Research in 2010. The researchers followed 344 patients who were scheduled for a hip replacement and asked them about their low back before surgery, then followed them afterward.

Before surgery, 170 of those patients, just under half, reported pain in the lower lumbar region.

That number alone should reframe things. Half the people walking into a hip replacement already have a back problem, and most of them think it is a separate issue.

Here is the part that makes the case. After the hip was replaced, the back pain resolved in 113 of those 170 patients. About two thirds of them. Nobody operated on their spine. Nobody gave them an injection. The hip started moving again and the back quit hurting.

It did not clear for everyone. It persisted in 57 patients, roughly a third, and some of those people genuinely had a spine problem alongside the hip problem. Two things can be true at once.

How to tell which one is talking

Not perfectly, but there are patterns worth knowing.

Hip-driven pain tends to sit in the groin and the front of the thigh, sometimes down to the knee and almost never past it. It shows up when you put weight on the leg. Getting in and out of the car is miserable. Putting on a sock or tying a shoe on that side is the moment people usually notice.

Spine-driven pain tends to sit in the back itself or the buttock and runs down the back of the leg, often past the knee, sometimes into the foot. Bending forward, sitting for a long stretch, and coughing tend to be the aggravators.

The overlap zone is the buttock and the outside of the hip, which is where most of the confusion happens. That area gets blamed on the spine constantly and turns out to be a gluteal tendon problem or a stiff hip about as often as not.

A simple thing you can try: sit down. If your groin and thigh pain largely goes away when you take weight off the leg but the back ache stays, that is a hint. If sitting is the worst thing you do all day, look at the spine.

What to do about it

• Get both looked at in the same visit by the same person. This is the whole point. Someone needs to watch you walk, check hip extension and rotation, and check what the lumbar spine is doing while you do it. That is a movement exam, and it takes about twenty minutes.
• Test your hip extension yourself at the edge of a bed. Lie back with one knee hugged to your chest and let the other leg hang. If the thigh cannot reach the mattress, your back is making up that range every time you take a step.
• Think twice before you only stretch your back. If a stiff hip is the reason your lumbar spine is working overtime, mobilizing the spine buys you a few hours and then the hip sends the load right back. Stretching is not wrong. It is just downstream.
• Strengthen the glutes. Weak hip muscles and an overworked low back travel together, and glute work is one of the few things that helps both.

Some symptoms need a physician before anything else. Numbness or weakness in both legs, a change in bowel or bladder control, unexplained weight loss with back pain, or a fever with back pain. Those get seen right away and they are not physical therapy problems.

The bottom line

Pain is the symptom. The cause is almost always somewhere else in the chain.

In that Philadelphia study, two thirds of the people with back pain got better from an operation on their hip. Not because the surgeon touched their spine, but because the hip started doing its own job again and the spine got to stop covering for it.

If you have been treating your groin and your back as two unrelated projects, it may be worth asking one question before your next appointment. Which of these two started first? People almost always know, and they almost never get asked.

You do not have to do anything with the answer today. But somebody should be looking at the whole leg and the pelvis together, and finding out which one is actually driving.

If your hip and your back have both been bothering you and nobody has connected them, that is exactly what our first visit is for. It is a free 20-minute movement assessment, in clinic, looking at the whole chain from the ground up. No charge, no insurance, no pressure to book anything after, and you are welcome to take what you learn and go do it on your own. Call the West Front St office at (231) 944-6541.

And if a hip replacement is on your horizon, grab a free copy of my recovery book at thesuperiortherapy.com.