What’s Causing Your Lower Back and Hip Pain?

If you feel like your lower back and hip pain started at around the same time, it’s likely not your imagination. The lower back and hips are often partners in pain. Why? The hips and spine are connected by muscles, ligaments, and nerves, which can create common pathways to pain as a result of injuries, muscle strains, and chronic conditions like arthritis and sciatica. Lower back and hip pain can range from a dull soreness to tingling, radiating pain. 

The back and hips also share a common mission: to be a strong anchor for your legs. “If your back and hips are not strong and stable as your legs move, then they are going to move more than they should, which can lead to overuse issues,” says Lori Walter, PT, DPT, a physical therapist at Hinge Health.

When your hips and lower back hurt, you may find it challenging to complete daily tasks and engage in activities you enjoy. The good news: Hip and lower back pain is usually not serious and can be treated and prevented with conservative, at-home measures.

Read on to learn more about what causes back and hip pain and how to treat it, especially with exercises from our Hinge Health physical therapists. 

What Causes Lower Back and Hip Pain?

Here are some of the most common reasons you may experience hip and lower back pain:

• Muscle strain. There are countless ways you might strain your back or hips, from overusing these muscles to a traumatic fall or injury to sitting for hours at a time. Weak core muscles may also lead to strain, as your back muscles may compensate. Muscle strains often heal on their own in a few days. 

• Arthritis. The cartilage that facilitates smooth motion of the small joints in the spine can change over time. This can lead to osteoarthritis in the facet joints that support motion of the vertebrae. They may rub together, causing pain and stiffness. Similarly, osteoarthritis of the hip occurs when the cartilage that cushions the hip joint changes, leading to pain, stiffness, and limited range of motion in the hips.

• Herniated disc. This is another problem that can be caused by common changes in the spine. As the discs compress, the jelly-like center can push out, causing the disc to press into sensitive spinal nerves. You may feel a sharp or burning pain, along with numbness, tingling, and weakness. Depending on which nerves are irritated, the pain may radiate through your hip into the front thigh or all the way down to your toes. The majority of herniated discs heal over several weeks, with physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs like ibuprofen) as first-line remedies. 

• Pinched nerves. When muscle, bone, or tissue presses down and compresses a nearby nerve, the result is pain, tingling, numbness, and weakness. A pinched nerve in the lower back can cause these symptoms in the back, hips, buttocks, and lower legs. There are many reasons a nerve may become pinched, including arthritis, a herniated disc, a sports injury, repetitive motion, pregnancy, or excess weight. Pinched nerves often heal over four to six weeks with rest, ice or heat therapy, and over-the-counter medications. 

• Sacroiliac joint pain. The sacroiliac (SI) joint connects the lower back to the pelvis. The joint can become inflamed due to arthritis or injury, leading to sharp, stabbing or dull, aching pain in the back, hip, and buttocks. Sacroiliac joint pain may be involved in 10-25% of lower back pain cases. 

• Pelvic floor muscle imbalance. Your pelvic floor muscles line the bottom of the pelvis and connect to the back through the tailbone. If the pelvic floor muscles become tight or tense, this can lead to pain (often a dull ache). Pelvic floor pain is frequently mistaken for back pain, says Dr. Walter. As pelvic floor muscles struggle to support the internal organs of the pelvis, the back muscles work harder to compensate, leading to overuse and strain. 

• Sciatica. Sciatica refers to symptoms of pain, as well as numbness, tingling, or weakness, that’s felt along the sciatic nerve when the nerve gets inflamed or compressed. The pain often radiates from the low back down one or both legs. Areas like the back of the calf, the knee, and the foot can also be affected. 

• Piriformis Syndrome. The piriformis muscle is a small, band-like muscle located in the buttocks, near the top of the hip joint. When the piriformis muscle becomes inflamed, it can irritate or compress the nearby sciatic nerve. This can lead to pain in the buttocks and muscle spasms, as well as numbness, tingling, and pain down the back of the leg and into the foot. These symptoms are sometimes referred to as “piriformis syndrome,”  but there’s actually some debate about whether this is different from sciatica. 

• Spinal stenosis. Spinal stenosis occurs when the spaces within the spinal canal narrow. As space diminishes, there’s more pressure or irritation on the nerves, which can result in lower back pain and stiffness along with tingling or numbness down one or both legs. 

• Scoliosis. This condition causes your spine to curve sideways, which means your weight is distributed unevenly throughout your back. This, in turn, can cause strain on low back muscles.

And remember: While pain in the lower back and hip areas may be the result of an injury to the soft tissues, sometimes there is no obvious reason for your pain. In this case, it’s less important to focus on the why of what’s causing your pain. Rather, it’s better to think about how to get relief. 

Regular gentle movement is often the best thing you can do for chronic pain affecting your lower back and hips. And the majority of people heal from back and hip pain without surgery, using at-home remedies such as activity modifications, cold or heat therapy, physical therapy exercises, and over-the-counter medications. 

When to See a Doctor

Most of the time, pain that’s affecting your low back and hip will improve within a few days to a few weeks, with conservative approaches like ice/heat, over-the-counter medication, and gentle exercise. However, it’s a good idea to see a doctor if you notice any of the following:

• You experience weakness in your lower extremities.

• Your pain is severe, unrelenting, does not improve with time and home remedies, or interferes with your daily activities. 

• You’ve had a traumatic fall or injury.

• Your pain occurs with signs of more serious illness such as fever, chills, unexplained weight loss, or loss of bowel or bladder control. 

Hip and Lower Back Pain: A Hinge Health Perspective

Hip and lower back pain can feel frustrating, upsetting, or even a little hopeless, especially when it persists or interferes with your daily activities. No matter how bad your pain is, or how long it’s been going on, you can always do something to help improve it. 

Pain is more complex than simply what may or may not be happening in your hips and back. Other factors, like life stressors, can also play a big role in how you experience pain. And for most common musculoskeletal conditions, regardless of what may or may not be contributing to pain in your tissues, the solution is often the same. 

Movement — through physical and exercise therapy — builds strength, flexibility, and resilience to pain. While moving through hip and back pain can be scary and uncomfortable, small changes to your habits can yield benefits. We tend to feel extra nervous about pain that happens in or near our spine. But it’s safe and good to move. Even something as simple as going for a walk increases blood flow to the affected areas, which helps to calm your muscles and nerves.

Holistic Treatment Options for Lower Back and Hip Pain

For long-term relief from hip and lower back pain and prevention of future pain episodes, pain management experts recommend a holistic approach that treats the physical and psychological roots of chronic pain. 

The following lower back and hip pain treatment options from our Hinge Health physical therapists and medical doctors can help provide:

• Physical therapy. Physical therapists (PTs) can design a customized exercise plan to strengthen, stretch, and stabilize lower back and hip muscles and joints to relieve and prevent pain. “Physical therapy also helps desensitize the nervous system to pain,” says Dr. Walter. “By guiding people to move up to the point of pain, and then come out of it, and then move a little further next time, the brain starts to learn, ‘okay, movement is safe.’” You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Healthy eating. Researchers, who analyzed 10 years of studies on eating patterns and chronic pain, found that certain diets helped improve pain and quality of life by reducing inflammation or providing important nutrients, including antioxidants and prebiotics. Nutritionists recommend reducing your intake of pro-inflammatory foods, such as added sugar, processed meat, and refined grains. And instead, fill up on anti-inflammatory choices, such as fruits and vegetables, whole grains, fish, and olive oil.  

• Stop smoking. Smoking accelerates disc degeneration of the spine, according to the American Academy of Orthopaedic Surgeons, which may lead to hip and back pain.

• Massage. An analysis of 60 studies showed that massage therapy helped people manage their pain better than people who received only sham or placebo treatments.  Experts believe that massage helps people lower stress and deal with the emotional distress of pain better, and also soothe the physical discomfort of tight muscles.

• Meditation. Research shows that women with lower back pain who practiced mindfulness meditation reported lower pain and better quality of life and mental health after eight sessions, compared to those who received standard care. 

• Improved lifting mechanics. Asking your body to lift or carry more than you’re used to are common causes of muscle strain, says Dr. Walter. Avoid lifting when you are tired, and don’t lift much more than what you practice lifting regularly. Bring the object as close to your body as possible and exhale as you lift, using a wide stance for stability. These techniques can help prevent strains in the lower back and hips that can lead to pain.

• Change positions more often. Prolonged sitting can also strain the hips and lower back. When sitting, try to keep your sit bones (the bottom of your pelvis) higher than your knees. Use pillows or rolled-up towels for support if needed. Your computer screen should be at eye level and you want your feet flat on the floor with elbows bent and supported at about 90 degrees. Feel free to adjust how you sit, and take regular breaks to stretch every 30 minutes. 

• Counseling. Consider this: In a study of adults who participated in an eight-session telehealth counseling program that emphasized that pain is a non-dangerous brain activity rather than physical tissue injury, 66% reported being pain-free or nearly pain free after one month. This suggests that helping patients understand their pain could bring significant relief. 

Studies have shown that people’s reported pain levels often do not correspond to structural causes (like herniated discs) seen on imaging studies. Experts now believe this is because ongoing pain actually changes how our nervous system interprets pain. Chronic pain can make people more sensitive to pain, and people with chronic pain often develop emotional distress that makes their pain worse.

Holistic practices — exercise, stress management, healthy eating, and other positive lifestyle changes — can bring relief by addressing physical causes as well as psychological and emotional ones. Truly holistic pain management may involve different approaches and providers, including doctors, physical therapists, nutritionists, and mental health professionals.