When a patient comes into our office complaining of pain that is located in the area of the hip and butt, getting the correct diagnosis may be difficult. In order to accurately diagnose sciatica, sacroiliac dysfunction, hip joint disease or lower back pain the doctor must be able to determine the source of the pain. Because there are so many overlapping pain pathways that relate to the cause of hip and back pain, the doctor will need to do a thorough examination, including imaging studies, to determine the actual cause of the symptomatic picture.
Determining the source hip/butt pain starts with an in-depth consultation. During the initial doctor-patient conference, I will typically ask the patient, “What activities make your pain worse?” If the patient replies that weight bearing activities like standing, walking, and getting up from sitting seems to initiate pain, a hip related problem is favored. When I ask a patient to point to the pain, a hip problem is to be suspected when there is groin pain. Hip joint pain will be relieved by non-weight bearing, sitting and lying down. Hip joint dysfunction makes it difficult to put on your socks because you can’t lift and rotate the hip.
There is one easy way to evaluate hip joint dysfunction. First of all, try to cross one leg over the other while you are sitting. If your right-side hurts, try to put your right ankle on your left knee. If this movement is difficult or impossible, you probably have hip joint dysfunction.
You can also try this test. While you are in a standing position perform these simple spinal movements. Bend side to side, forward and back, and twist your spine. If bending, twisting and turning the spine causes back or leg pain, the problem is most likely originating from the lower back. Typically, hip pain is not increased by isolated movements of the spine.
Perhaps the simplest testing procedure that I perform in the office to determine the cause of hip/back/leg pain is direct pressure. With the direct application of pressure over the vertebrae, muscle groups, sacroiliac joint, the bursa, and the hips, the doctor can determine the most likely source of the pain.
Finally, it is not uncommon for a patient to be experiencing BOTH a lower back problem and hip joint dysfunction. X-ray studies of the lower back and pelvis will often reveal a complex problem of hip joint arthritis, lumbar disc degeneration, pelvic imbalance, osteoarthritis and spinal curvature. When this happens, a multi-disciplinary approach of chiropractic, medical, and orthopedic treatment may be required.
My advice: Put an excellent chiropractor on your health team. Chiropractic care is a very safe and conservative way to evaluate and treat lower back, hip, butt, and leg pain.
(Dr. Craig Brue, an author, lecturer and chiropractic physician in SaddleBrooke, AZ.)