How to Tell the Difference Between Lower Back and Hip Pain

low back and hip pain
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Approximately 80-90% of Americans struggle with back or hip pain at some point in their life. Many people struggle specifically with hip pain at night and wonder, “Why do my hips hurt when I sleep?” In fact, this kind of pain is the second most common reason for missing work aside from the common cold. At SPORT Orthopedics + Physical Therapy, we want to make sure you don’t miss work just from being in pain. Call us today at (469) 200-2832 and we’ll get you back to your pain-free life.

What Causes Lower Back and Hip Pain?

Back and hip pain can range in intensity. Some people experience a dull, constant ache, while others have sharp, shooting pain. But what causes these aches and pains? It could be a hip pointer, a pulled muscle, sciatic nerve pain, cervical spinal stenosis, lumbar stenosis, lumbar spondylosis, or something much more sinister. That’s where the orthopedic experts at SPORT come in.

Lower Back Pain Causes

Most low back pain is due to a disruption in the way the spine, muscles, discs, and nerves fit together and move. Some mechanical causes of low back pain include:


  • Skeletal Irregularities: scoliosis (curved spine), lordosis (abnormal arch in the lower back), kyphosis (excessive outward spinal arch), etc.
  • Spina Bifida: the incomplete development of the spinal cord or its protective covering.


  • Sprains: overstretched or torn ligaments.
  • Strains: muscle or tendon tears.
  • Spasms: sudden muscle contraction.
  • Traumatic Injury: sports accidents, car accidents, or falls.

Degenerative Problems

  • Intervertebral Disc Degeneration: spinal discs wear down from aging, causing them to lose their natural cushion.
  • Spondylosis: general spinal degeneration from aging. This issue affects the joints, discs, and bones of the spine.
  • Arthritis and Other Inflammatory Diseases: osteoarthritis, rheumatoid arthritis, spondylitis, etc.

Nerve and Spinal Cord Problems:

  • Spinal Nerve Compression, Inflammation, or Injury: This is often called having a “pinched nerve.” Pinched or inflamed nerves can happen from any kind of injury, herniated discs, or even from repetitive motions.
  • Sciatica: Caused by something pressing on the sciatic nerve that travels through the buttocks and down the back of one leg. The pain is often described as “shock-like” or burning.
  • Spinal Stenosis: The narrowing of the spinal column which puts pressure on the spinal cord and nerves.
  • Spondylolisthesis: Caused by a lower spine vertebra slipping out of place which pinches nerves.
  • Herniated Discs: Caused by an intervertebral disc being compressed and bulging outward.
  • Infections: Osteomyelitis (a vertebrae infection), discitis (an intervertebral disc infection), or sacroiliitis (sacroiliac joint infection).
  • Cauda Equina Syndrome: Caused by a ruptured disc pushing into the spinal canal and pressing on lumbar and sacral nerve roots. If left untreated, this can result in permanent neurological damage.
  • Osteoporosis: A progressive decrease in bone density and strength which can lead to fractures.

Non-spine Pain Sources:

  • Kidney Stones: sharp lower back pain, usually on one side.
  • Endometriosis: the buildup of uterine tissue outside the uterus.
  • Fibromyalgia: a chronic pain syndrome causing muscle pain and fatigue.
  • Tumors: tumors can press on or destroy the spinal cord and nerves.
  • Pregnancy: lower back pain usually begins in later stages of pregnancy, and is resolved after birth.

Hip Pain Causes

The hip is the body’s largest ball-and-socket joint and is built for fluid, repeated movements. Despite its durability, the hip joint can still become worn down and damaged, which causes pain. Some patients even need a hip replacement before they can get back to living their lives. Here are some of the most common causes of hip pain:

  • Arthritis: Osteoarthritis and rheumatoid arthritis are some of the most common causes of hip pain. Arthritis leads to hip joint inflammation, which breaks down the cartilage that cushions your hip bones in the socket.
  • Hip Fractures: Typically caused by falls, car accidents, and sports injuries.
  • Bursitis: Caused by the inflammation of bursae sacs that are found between bone, muscle, and tendon tissues. Bursae inflammation is typically caused by repetitive motions which overwork the hip joint. To learn what does bursitis in the hip feel like, read our related blog.
  • Tendinitis: Caused by the inflammation or irritation of the tendons which attach bones to muscles. This kind of inflammation is typically caused by repetitive motions.
  • Muscle or Tendon Strain: Caused by overusing the muscles, tendons, and ligaments that support the hips.
  • Hip Labral Tear: Caused by a rip in the ring of cartilage (the labrum) on the outside rim of the hip joint socket. Athletes and those who repeatedly twist their bodies are at a higher risk of hip labral tears.
  • Cancer: Tumors that begin in the bone or spread to the bone can cause chronic hip pain.
  • Avascular Necrosis: Caused by blood flow to the hip bone slowing down which kills the tissue. This issue can affect other bones, but most commonly affects the hip usually after a fracture or dislocation.

Can Hip Pain Cause Back Pain?

The short answer is yes, hip pain can cause back pain and vice versa. Hip injuries sometimes come from the hip, but many times come from the back. This is the same with back pain. Sometimes the pain comes from the back, but it often comes from the hip. Your hip joints sit near your spine, and because of that, the pain often manifests itself in your lower back.

To narrow down the source of your pain, analyze it. If the pain starts in the hip and groin area and radiates down to your knee, it’s most likely a hip issue. However, if the pain starts in the buttocks region and radiates down your leg, it’s most likely a spine issue. Come visit one of our Dallas orthopedic surgeons to be extra sure.

What Causes Lower Back and Hip Pain When Sitting?

Lower back and hip pain when sitting could be as simple as poor posture or sitting positions, or as complicated as a herniated disc. If your back or hip pain started recently, consider sitting up straighter in your desk chair and not craning your neck forward. Additionally, avoid sitting cross-legged (because it puts more pressure on the hips) and make sure to sit on a flat surface to avoid tilting your body off to one side.

If improving your posture or sitting positions don’t fix your pain, come see one of our Dallas orthopedic specialists because you could be suffering from one of the hip or back conditions listed previously.

What Causes Low Back and Hip Pain When Walking?

Once again, poor posture could be the culprit in back and hip pain while walking. To potentially improve your pain, make sure to:

  • Avoid looking down too much when you walk, which reduces neck and back strain.
  • Avoid slouching when you walk.
  • Keep your hips level when walking, avoid unnatural hip swaying.
  • Pull in your stomach and engage your core to take the pressure off your lower back.
  • Make sure your feet hit the ground heel-first, then roll through the ball of your foot.
  • Own comfortable shoes, especially if you have flat feet which can cause back pain.

Another potential cause of hip and back pain when walking is being overweight. According to a review by the American Journal of Epidemiology, people who are overweight are at a higher risk of developing sciatica. This is because the lower back supports more weight as a person gets heavier, naturally causing pain. Stretches that target your back and hips can ease the pain, and frequent exercise keeps you fit while fighting muscle pains caused by a sedentary lifestyle.

If improving your posture, stretching, and exercising doesn’t improve your back or hip pain, stop by SPORT Orthopedics + Physical Therapy and we’ll take care of you.

What Could Cause Lower Back and Hip Pain on One Side?

One-sided back or hip pain is a common issue. Sometimes one-sided pain can indicate a non-skeletal, non-spinal, or non-muscular issue. 

The most common causes of lower back pain on one side are tissue injuries from trauma, muscle strain, arthritis, kidney stones, or a kidney infection. If your one-sided pain is stemming from a non-muscular or non-skeletal issue — like kidney stones or a kidney infection — you will likely have painful urination, nausea, vomiting, and a fever.

However, one-sided hip pain often indicates tendinitis, bursitis, or tight muscles.

What Could Cause Lower Back and Hip Pain to the Right Side?

Lower back and hip pain on only the right side could also be muscle strain, arthritis, a trauma-related injury, tendinitis, bursitis, tight muscles, kidney stones, a kidney infection, or even appendicitis. 

The classic appendicitis symptom is pain in your right lower abdomen, but it could also radiate to your right lower back. If you happen to have appendicitis, kidney stones, or a kidney infection, you will likely also have fever, nausea, vomiting, and painful urination as well, which are not symptoms of muscular or skeletal issues.

Women experiencing lower back and hip pain on the right side could be experiencing another set of issues like endometriosis, uterine fibroids, pelvic inflammatory disease, pelvic floor dysfunction, or pelvic girdle pain.

Call SPORT Orthopedics + Physical Therapy Today

At SPORT Orthopedics + Physical Therapy, we want to make sure you’re not part of the 80-90% of Americans missing work from lower back or hip pain. Call one of our Dallas physical therapists or a sports medicine orthopedic surgeon today at (469) 200-2832 and we’ll get you back to your pain-free life.