Learning how to evaluate your symptoms of hip and lower back pain will help you decide when you need to see the doctor. When you educate yourself about your symptoms you become a more informed patient who can participate in your own treatment decisions.
"most common is arthritis"
Hip and lower back pain can have many causes, but most common is arthritis. You may have arthritis in your hip as well as your back. It is often difficult to distinguish hip and back arthritis, from back pain with sciatica in conditions such as spinal stenosis or a herniated disc. The difficulty is because in both situations, the back pain extends or radiates into the buttock and thigh.
If your symptoms are only mild hip and lower back pain, and you are able to continue with normal activities, you are probably safe treating this yourself. You can try some conservative therapies at home such as weight loss, pool exercises or other low impact aerobic activities, together with over the counter pain medication for relief of your hip and lower back pain.
"unable to go about your daily routine"
If your hip and lower back pain symptoms are more severe and you are unable to go about your daily routine, you need to see your doctor. If along with these symptoms you are having any weakness in your legs, or any problems with your bowels and bladder, you need to be seen by a doctor immediately. These are signs of cauda equina syndrome, a true emergency that requires immediate treatment.
"your doctor will search to find the cause"
When your hip and lower back pain prevents you from living your life your doctor will search to find the cause of your pain. Untangling a complicated web of pain and possibilities is often frustrating for you and your doctor. Because the same set of similar symptoms can be caused by arthritis, piriformis syndrome, herniated disc, spinal stenosis, etc., just to name a few.
"important to determine a correct diagnosis"
Even though it may be difficult, it is important to determine a correct diagnosis, before a treatment plan for your hip and lower back pain is implemented. Your doctor may order several different imaging studies, he may refer you to a neurologist, and one or more surgeons, before a conclusion is reached.
"two different cases"
To demonstrate the complexities involved in this evaluation, let's consider these two different cases of hip and lower back pain.
1) If you are over 50 years of age, and if your hip and lower back pain is a dull ache that has developed over several years, and has gradually gotten worse. If your pain is worse in the morning and gets slightly better after you get warmed up and start moving around. If you have stiffness in your back after sitting for a few hours. You may have arthritis in your back and hip or spinal stenosis.
2) If you are less than 50 years old and your back pain is sharp and stabbing. If it developed suddenly while lifting, or after a car accident or fall. If it does not improve with a few days of rest. You may have a herniated disc or a fracture.
"both can cause pain into your buttock, hip, and thigh"
Now is when it can get confusing, because each of these, can cause pain into your buttock, hip, and thigh. Also, these are not the only possibilities. Other things that must be considered must include, infections such as tuberculosis, musculosteletal conditions such as piriformis syndrome, and metastatic disease.
I have chosen these two common situations, to illustrate the point, that this is a very complicated situation to try and unravel.
"very similar to the pain of stenosis"
If you are having back pain from arthritis it may be pressing on a nerve causing symptoms of stenosis. Alternatively, you may have arthritis in your back and in your hip. Because, degenerative joint disease of the hip, will often radiate pain into the thigh, that is very similar to the pain of stenosis.
If you are having back pain from a disc injury, or from a fracture, the herniated disc or the fracture fragments may be pressing on a nerve causing sciatica. Or, you may have also damaged your hip or pelvis at the time of the original injury. The symptoms can be very similar, and difficult to analyze precisely.
"a complete history and perform a physical exam"
When your doctor sees you he will take a complete history and perform a physical exam. He may order labs and/or imaging studies, x-rays are often ordered. If when he examined you he was suspicious for arthritis in your hip, he may order x-rays of that as well. If the x-rays confirm the arthritis in your back and in your hip, he may send you for evaluation by a total joint specialist.
If your x-rays show arthritis in your back and not in your hip, you may need to be evaluated for lumbar spinal stenosis, with a CT myelogram. If the x-rays do not show arthritis in your back, you may be sent for an MRI or a nuclear bone Scan to look for other causes of your back pain.
"he may order x-rays"
If your doctor thinks your hip and lower back pain is more acute, and he is concerned about an injury, he will order x-rays. If when he examined you he was concerned about an injury to your hip or pelvis, he may order x-rays of those as well. If you have a fracture, he could refer you to an orthopedic surgeon for treatment, or care for you himself.
If the x-rays do not show any fractures or joint dislocations, he may send you for an MRI of your spine, to evaluate for a herniated disc. If a herniated disc is found, you will need to be seen by a spine specialist.
"When all of the studies are negative..."
If the MRI does not reveal a disc herniation pressing on a nerve. You might be sent back to the MRI for scans of the hip and pelvis to identify any soft tissue injuries, that could be causing your pain.
When all of the studies are negative, and back pain is not a major complaint, another consideration is piriformis syndrome. It may cause sciatica symtoms when the piriformis muscle puts pressure on the sciatic nerve. Piriformis syndrome can cause buttock and thigh pain that may radiate up into the lower back, or some mild arthritis in your back may be causing your back pain. Unfortunately, there are no studies that can clearly diagnose piriformis syndrome.
"When an exact diagnosis cannot be determined"
The evaluation of a problem like this, is complicated by the fact that the studies are not perfect. The x-rays, and MRIs, and CT scans, are often somewhat equivocal and open to interpretation. The doctors and surgeons and radiologists do not always agree on what the study shows. Making an exact diagnosis difficult.
When an exact diagnosis cannot be determined, your doctor will have to rely on his experience and whatever resources are available to determine a most likely diagnosis. If the diagnosis is not clear, he will likely start with the most conservative treatments, and proceed cautiously until an exact diagnosis can be decided.
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