True Chiropractic Heidelberg • Chiropractic Blog
Hip Pain vs Lower Back Pain — How to Tell the Difference
Hip pain and lower back pain frequently refer to each other, making them easy to confuse. Treating the wrong source leads to poor outcomes, here is how to distinguish them.
Written by Dr Nicholas Lee • AHPRA Registered Chiropractor • True Chiropractic, Heidelberg VIC 3084
Why they are so often confused
Why Hip and Lower Back Pain Are Frequently Mistaken for Each Other
The hip and the lower back are anatomically and biomechanically interconnected. The hip flexors (iliopsoas) attach to the lumbar vertebrae and run through the pelvis to the femur. The gluteal muscles connect the pelvis and femur and play a critical role in lumbar spine stability. The sacroiliac joint sits at the junction of the sacrum and pelvis, adjacent to both the hip and the lower lumbar spine.
This means that dysfunction in one region often produces symptoms that are felt in the other. A lumbar facet joint problem at L3/L4 can refer pain into the buttock and upper thigh which can be indistinguishable from hip pain to the patient. Equally, hip joint degeneration can produce groin and thigh pain that extends into the lower back through altered movement patterns. Getting the diagnosis right is the starting point for effective treatment.
Key Differentiating Features
Signs pointing toward the hip joint:
• Pain felt in the groin — this is the classic presentation of true hip joint pathology
• Pain that worsens with weight-bearing, walking, and rotating the leg
• Reduced range of motion in the hip joint on physical examination
• Clicking, locking, or giving way of the hip
• Pain that is reproduced by passively moving the hip through its range (FADIR/FABER test positive)
Signs pointing toward the lumbar spine:
• Pain that worsens with spinal flexion (bending forward) or extension (leaning back)
• Pain that is worse with sustained sitting or driving
• Morning stiffness that eases with movement through the day
• Pain localised to one side of the spine or buttock without groin involvement
• Neurological symptoms (tingling, numbness, weakness) into the leg or foot
The assessment approach
How Chiropractic Assessment Differentiates Hip and Back Pain
A thorough clinical assessment covering your symptom history, functional limitations, and physical examination, is usually sufficient to identify whether the primary source is the hip joint, the lumbar spine, the sacroiliac joint, or a combination.
The physical examination includes: lumbar range of motion assessment, hip range of motion assessment, specific orthopaedic tests for the hip (FADIR, FABER, Thomas test), palpation of the relevant structures, and neurological screening if lower limb symptoms are present.
In some cases, particularly where hip joint degeneration or labral pathology is suspected, imaging (X-ray for bony changes, MRI for soft tissue) may be indicated. If so, Dr Lee will refer you for the appropriate imaging and explain why it is needed.
The most common scenario is that both the hip and the lower back are contributing to symptoms, in which case treatment addresses both regions, usually starting with whichever is the primary pain generator.
Frequently asked questions
Common Questions About Hip and Back Pain
My pain is in my buttock — is that hip or back?
Buttock pain can originate from the lumbar spine (particularly L4/L5/S1 facet joints or nerve roots), the sacroiliac joint, the piriformis muscle (piriformis syndrome), or — less commonly — the hip joint itself. The groin test is useful: if pressing deep in the groin and rotating the hip reproduces the pain, the hip joint is involved. If not, the lumbar spine or sacroiliac joint is more likely.
Can I have both hip and back problems at the same time?
Yes — this is actually the most common presentation. Hip joint degeneration leads to altered movement patterns that increase lumbar load. Lumbar dysfunction leads to altered gait and hip mechanics. The two regions influence each other constantly. Assessment identifies which is the primary driver so treatment can be prioritised appropriately.
I have been told I need a hip replacement — can chiropractic help in the meantime?
Yes. Even in the presence of significant hip joint degeneration, chiropractic care can address the contributing spinal and soft tissue factors that compound the pain and functional limitation. Reducing lumbar restriction and improving gluteal function can meaningfully reduce overall pain levels and improve quality of life while you await or prepare for surgery.
Book an assessment in Heidelberg
See Dr Nicholas Lee at True Chiropractic
Dr Nicholas Lee • BSc, BHSc/BAppSc (Chiropractic) • AHPRA Registered • 9 years clinical experience
True Chiropractic is located at 124–126 Mount Street, Heidelberg — 2 minutes from Heidelberg Station. Same-week appointments available. No referral required. HICAPS on-site.
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True Chiropractic • 124–126 Mount Street, Heidelberg VIC 3084 • No referral needed • Same-week appointments
Important: The information in this article is general in nature and is not a substitute for professional health advice, diagnosis, or treatment. True Chiropractic complies with AHPRA guidelines for health practitioner advertising.