Understanding the Root Causes of Lower Back and Hip Pain

Muscle strain or sprain
Short-term (acute) back pain is often caused by a muscle strain or sprain. These are common in the lower back because they support the weight of the upper body and are involved in moving, twisting, and bending. A low back strain occurs when the muscle fibers are overstretched or torn. A lower back sprain occurs when the ligaments (the tough bands of tissue that hold bones together) are torn from their attachments. Both of these can result from a sudden injury or from gradual overuse.
Symptoms of a muscle strain or sprain may include:
Pain that may radiate into the buttocks, but does not affect the legs
Stiffness in the low-back area, restricting range of motion
Inability to maintain normal posture due to stiffness and/or pain
Muscle spasms either with activity or at rest
Pain that persists for a maximum of 10-14 days
Pinched nerve
While technically not a medical term, a “pinched nerve” typically describes damage or an injury to a nerve or set of nerves. This occurs when too much pressure is applied to a nerve by surrounding tissues, such as bones, cartilage, muscles, or tendons.
Symptoms of a pinched nerve may include:
Numbness or less feeling in the area supplied by the nerve
Sharp, aching, or burning pain, which may radiate outward
Tingling or a pins and needles feeling
Muscle weakness in the affected area
Often feeling as if a foot or hand has “fallen asleep”
Herniated disk
A herniated disk—also called bulged, slipped, or ruptured—occurs when one of the cushioning disks between the small bones of the spine (vertebrae) slips out of place. Due to this displacement, the disk presses on spinal nerves, often producing pain, which may be severe. A herniated disk can occur in any part of the spine, but most often occurs in the lower back.
Symptoms of a herniated disk depend on where the disk is sitting and whether it is pressing on a nerve, but one side of the body is usually affected. These symptoms may include:
Pain: If your herniated disk is in your lower back, you’ll typically feel pain in your lower back, buttocks, thigh, calf, and potentially your foot.
Numbness or tingling
Weakness
Sciatica
Sciatica refers to pain that travels along the path of the sciatic nerve, which travels from the buttocks and down each leg. Sciatica most often happens when a herniated disk or an overgrowth of bone puts pressure on the lumbar spine nerve roots. This causes inflammation, pain, and often some numbness in the affected leg.
Pain almost anywhere along the nerve pathway. (It’s especially likely to follow a path from the low back to the buttock and the back of a thigh and calf.)
Numbness
Tingling
Muscle weakness
SI joint dysfunction
The sacroiliac (SI) joints connect the lower part of the spine to the pelvis. SI joint dysfunction is a condition that results from flawed movement of either one or both of two small, firm joints at the base of the spine. While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion (too much or too little movement) may be the culprit that causes sacroiliac pain.
Symptoms of SI joint dysfunction may include:
Pain
Numbness
Tingling
Weakness
A feeling of leg instability (buckling, giving way)
Disturbed sleep patterns
Disturbed sitting patterns (unable to sit for long periods, sitting on one side)
Pain going from sitting to standing
Arthritis
Different types of arthritis can lead to lower back and hip pain. Osteoarthritis of the back can lead to back and hip pain when there is a breakdown of the protective cartilage of the spine. With the loss of this cushioning, the bones will rub together and put stress on the nerves in the lower back and hips. Some types of inflammatory arthritis also cause back and hip pain, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and juvenile inflammatory arthritis.
Symptoms of arthritis in the lower back and hips may include:
Pain
Swelling
Stiffness
Decreased range of motion
Numbness
**Note: While younger folks are more prone to tears in the disc, disc herniation, and labral tears, older folks are more prone to arthritic type of causes of discomfort that affect the lower back and hip, says Rahul Shah, M.D., board-certified orthopedic spine surgeon with Premier Orthopaedic Spine Associates. “All age groups are also susceptible to rheumatic diseases (such ankylosing spondylitis),” he points out.
How to treat lower back and hip pain
The first line of treatment for hip and back pain typically involves physical therapy that focuses on improving your overall function and quality of life, says Jordan Miller, P.T., D.P.T., P.R.P.C., pelvic health program manager at Athletico Physical Therapy. “Your physical therapist will provide graded intensity exercises to get you moving safely again, as well as teach you ways to improve your postural control and how to stretch and mobilize your own muscles and joints,” Miller notes.
Because there are a variety of causes of lower back and hip pain, there is no one-size-fits-all explanation that is universally acceptable, says Dr. Shah. Therefore, “the initial steps toward treating lower back and hip discomfort should center around understanding the underlying cause.” With a spine specialist, this is often achieved by a combination of physical examination, X-ray diagnosis, MRI scans, CT scans, and possibly nerve conduction studies, Dr. Shah explains.
Depending on the reason for the pain, medications may be an important tool in treating rheumatic and autoimmune causes of low back and hip pain, Dr. Shah adds. On the other hand, “those who have a more degenerative cause of discomfort (such as from wear and tear arthritis), may benefit from activity modification (such as limiting bending, twisting, and stooping) to increasing specific exercises such as core strengthening, hip flexor stretching, and pilates.” Additionally, more advanced treatment options include possible steroid injection versus consideration of surgical solutions, he notes.
How to prevent lower back and hip pain
The best way to prevent lower back and hip pain is to stay active, says Miller. “Our bodies crave movement and variation in posture, so consistent participation in resistance training and aerobic activity can help prevent and improve lower back and hip pain.” These activities can include (but are not limited to) a walking program, aerobic training, strength training, yoga, pilates, water aerobics, or biking. “It is suggested to aim for about 150 minutes of physical activity per week, so the important thing is to find an activity you enjoy doing!” Miller advises.
Changing a sedentary lifestyle is a good start to pain prevention, agrees Michael Faloon, M.D., board-certified orthopedic surgeon with New York Spine Institute. “It is important to take breaks from sitting. When possible go for a walk around the block, stretch, or simply walk around the office.” Getting up and moving engages your muscles and will make a difference when it comes to reducing back and hip pain. Stretching and regular exercise, even low-intensity activities, will loosen up the leg, hip, and back joints and muscles, he advises.
In addition to strengthening muscles with exercise, sleeping in the proper position may also help reduce back pain, Dr. Faloon continues. “Regardless of whether a person is a side, back or stomach sleeper, it is best to fall asleep when the head, neck, chest and hips are in alignment.” With a proper sleeping position, most back pain will diminish over time. So, having the right mattress and getting seven to eight hours of sleep also supports long-term spinal health, he notes.
Miller also points out that learning how to look for signs and symptoms that may lead to increased back pain can help you get on top of rehab sooner rather than later. “For example, if you notice a burning or tingling pain that extends from the back into the legs, groin, or genitals, see a healthcare provider like a physical therapist right away to learn how to improve these symptoms,” she advises.
When to see a doctor for lower back and hip pain
When a person has persistent back pain that isn’t going away after stretching and exercising, it’s time to think about seeing a doctor, says Dr. Faloon. “The real trigger is when a person can’t complete their normal tasks in a day. For example, having trouble walking, picking up items, and going up and down stairs,” he explains.
Most low back and hip pain should begin to subside within a few weeks, says Dr. Shah. Additional warning signs of low back and hip discomfort that need more urgent attention include “having fevers, chills, weakness in the legs, inability to sit, numbness where one sits, or loss of bowel or bladder control,” he adds.
If you are experiencing persistent pain, it is never too late to see a doctor, and physical therapy can be a great place to start, says Miller. “Many people are not aware that they do not need a doctor’s referral to get started with physical therapy in most states through Direct Access.”
However, when there is structural damage or instabilities in the spine, surgery may be required, says Dr. Faloon. “Still, surgery should be looked at as an option when other treatments such as physical therapy and stretching have proven unsuccessful,” he says.
Madeleine, Prevention’s assistant editor, has a history with health writing from her experience as an editorial assistant at WebMD, and from her personal research at university. She graduated from the University of Michigan with a degree in biopsychology, cognition, and neuroscience—and she helps strategize for success across Prevention’s social media platforms.