Addressing Lower Back and Hip Pain
At home, in physical therapy, and with medication
Biserka Stojanovic / Getty Images
Medically reviewed by Amy Kwan, PT, DPT
Lower back pain and hip pain will often occur together. Different conditions or activities can lead to lower back and hip pain, including arthritis, overexertion, and injuries that affect the nerves of the back and hips.
Back pain is one of the most common reasons people see a healthcare provider and miss time from work. Back pain can range from a dull, constant ache to sudden sharp, shooting pains. It can affect your mobility and quality of life. It can also cause hip pain and discomfort.
Though these symptoms can be challenging, most people can successfully manage their underlying causes and in some cases even fully recover.
This article will cover what lower back and hip pain feels like, causes, self-care, medical treatment, and more.
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Describing Lower Back and Hip Pain
Back and hip pain can be acute (short-term) or chronic (long-term). Acute back pain can last a few days to a few weeks and may resolve without treatment or with self-care.
Chronic back pain is back pain that lasts for 12 or more weeks. It is typically caused by an underlying cause or injury that becomes a bigger problem.
Additional symptoms linked to lower back pain and hip pain can include:
Pain on one side of the body
Groin pain on the affected side
Stiffness and reduced range of motion
Tenderness
Pain with walking
Sleep troubles (back pain can keep you up at night or wake you up and make it harder to go back to sleep, and the lack of sleep can, in turn, aggravate back and hip pain)
Muscle pain and weakness
Pain that shoots down the leg
Increased pain with bending or sitting
Numbness or weakness in the leg or foot
Lower Back Pain vs. Hip Pain
Even though hip pain can occur with back pain, back pain can sometimes be mistaken for hip pain and vice versa. This is because the hip joint is located near the lumbar spine (lower part of the spine), and injuries to the hip can produce back pain. Back pain can also affect the hip and pelvis joints. Even so, it is still possible to tell the difference.
Hip pain can produce groin pain because of the joint's closeness to the spine. A hip problem could also cause discomfort that comes and goes and worsens over time. You might also have pain with standing and activity (including walking) or a limp while walking.
Back pain, on its own, is generally limited to pain in the back and buttocks, but stress on the back can affect the hip joints. Back pain can also lead to pain that shoots down the leg. It might worsen with sitting or bending and improve with standing and walking.
11 Causes of Back and Hip Pain
Lower back pain and hip pain have many different causes. These include muscle sprains and strains, pinched nerves, herniated discs, sacroiliac joint dysfunction, arthritis, among others. Here are 11 such causes:
Muscle sprains and strains: Acute back pain is often caused by a muscle sprain or strain. A back sprain occurs when the ligaments are overstretched or torn. A back strain is caused by stretching and tearing muscles and tendons.
Pinched nerve: The term "pinched nerve" describes damage or an injury to a nerve or set of nerves. It might be compressed, constricted, or stretched. Symptoms of a pinched nerve might include numbness, a pins-and-needles sensation, shooting pain, or pain radiating from the injured area.
Sciatica: Sciatica nerve pain occurs when there is injury or irritation to the sciatic nerve. You have two sciatic nerves—one on each side of the body, running through each hip and buttock and down the legs. In addition to radiating leg pain, sciatica also causes numbness or tingling in the back or buttocks. Sciatica symptoms affect the lower back, hips, buttocks, legs, and feet.
A herniated disc: A herniated disc occurs when one of the cushioning discs between the small bones of the spine (vertebrae) slips out of place. The disc may put pressure on nearby nerves and cause tingling and burning pain in the lower back. Pain can extend into the hips and legs and cause sciatica symptoms.
Sacroiliac joint dysfunction: The sacroiliac (SI) joints connect the lower part of the spine to the pelvis. People may feel back and hip pain when movement in the area is limited or when they have overexerted themselves. Symptoms of SI joint dysfunction include a stiff, achy lower back and pain that worsens with activity.
Arthritis: Different types of arthritis can lead to lower back and hip pain. For example, hip arthritis can lead to hip joint pain and stiffness, while spinal arthritis causes inflammation of the spine's facet joints or the SI joints. 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.
Spinal lumbar stenosis: This condition occurs when there is a narrowing of the spinal canal in the lower back. It is common in older adults because of degenerative changes. Symptoms include hip and back pain, leg pain and cramping, and numbness and weakness down the legs.
Piriformis syndrome: Piriformis syndrome is a rare condition affecting the sciatic nerve and piriformis muscle. The piriformis muscle is a thin muscle in the buttocks that allows the hip to rotate and the leg and foot to point outward. Piriformis syndrome occurs when the piriformis muscle presses against the sciatic nerve, causing pain, numbness, and tingling along the nerve. Pain worsens with sitting for long periods, walking, running, or climbing stairs.
Paget's disease of bone: This rare bone disorder affects the bones. It interferes with creating new bone tissue and causes bones to soften. People with this condition have a high risk for bone pain and fractures. Paget's disease often affects the hips, lower back, and pelvis.
Pelvic floor dysfunction: The pelvic floor is the sheet of muscle through which the rectum, urethra, and vagina pass. Pain syndromes in the pelvis, lower back, genitals, and rectum can develop when these muscles don't contract or relax as they should. A person can also have difficulty defecating and urinating.
Gynecologic conditions: Menstrual cramps, uterine fibroids, endometriosis, and adenomyosis can produce pelvic or lower back pain. This pain can be associated with menstruation.
Is Lower Back and Hip Pain Ever Cancer?
Cancer is rarely the cause of back or hip pain. Even so, it is possible to have lower back or hip pain linked to some cancers, including spinal, lung, colorectal, breast, and testicular cancers. A person with one of these cancers will often have additional symptoms, though—not just back or hip pain.
Self-Care for Lower Back and Hip Pain
Back and hip pain are usually temporary, and most people recover within a few weeks or months. You can generally treat and manage back and hip symptoms with self-care at-home therapies.
Self-care for lower back and hip pain can include:
Resting your back
Applying heat and cold to the affected area
Taking over-the-counter (OTC) pain relievers such as Tylenol (acetaminophen) or Advil/Motrin (ibuprofen)
Continuing to move as much as possible to keep muscles strong and flexible
Avoiding actions that further stress back and hip pain, especially heavy lifting
Maintaining a healthy weight and eating a nutritious diet that promotes bone growth
Wearing comfortable, low-heel shoes
Sleeping on your side to reduce pressure on the spine
Avoiding smoking to improve blood flow to the lower spine
Medical Treatment for Lower Back and Hip Pain
Most people who experience lower back and hip pain do not need extensive medical treatment. They can get relief from OTC pain relievers, OTC pain relief topicals (gels, patches, and creams), and self-care remedies.
But if you need further relief, your healthcare provider can prescribe medications or physical therapy. Complementary and alternative therapies might also help. Surgery is considered a last-resort option for treating back and hip pain.
Prescription Medicines
If you experience severe symptoms, your healthcare provider can prescribe stronger treatments.
Prescribed medicines might include:
Prescription-strength anti-inflammatory drugs.
Prescription-strength topicals that contain ingredients like lidocaine and ibuprofen.
Muscle relaxants if you have muscle pain or spasms.
Antidepressants, which can be prescribed off-label because they can alter pain response and manage nerve pain.
Steroid injections or oral corticosteroids: An injection can be given in an affected area to relieve pain or swelling. An oral corticosteroid can relieve pain from an inflammatory condition causing hip and back pain.
Opioids: These drugs are typically prescribed for severe pain and act on the brain cells and body to reduce pain. Opioids are prescribed with caution due to the risk of addiction.
Disease-modifying antirheumatic drugs (DMARDs) and biologic drug therapies to manage inflammatory arthritis conditions that affect the spine and lead to back and hip pain
Physical Therapy
If back and hip pain persists for longer than a few weeks and starts interfering with normal activities, your healthcare provider might recommend you start physical therapy. Physical therapy aims to reduce pain and improve mobility and function.
A physical therapist can teach you exercises to manage symptoms, offer manual therapy, and advise you on better ways to move and engage in activities to reduce pain and prevent it from worsening.
Do You Need a Referral to Physical Therapy?
According to the American Physical Therapy Association, all 50 U.S. states, the District of Columbia, and the U.S. Virgin Islands allow direct access to physical therapy. This means you do not need a referral from a physician to seek out physical therapy services.
However, some states may restrict the length of physical therapy you can receive without your physician’s input. Additionally, there might be specific rules about physical therapy treatment plans.
If you do not plan on paying out of pocket for physical therapy and do not want any surprise costs, it is a good idea to reach out to your health insurance carrier before starting treatment. Depending on the type of coverage, some providers may not be covered by your plan or require higher out-of-pocket costs.
For example, if you are covered by a preferred provider organization (PPO) plan, you will have a list of preferred providers to choose from, but you can also choose one that is not on the list. Unfortunately, choosing a non-listed provider could mean more out-of-pocket costs.
For a health maintenance organization (HMO), you must choose a primary care provider who can refer you to in-network specialists who accept your plan, and you cannot see a physical therapist without your primary care provider’s referral.
Lastly, a point-of-service (POS) plan offers coverage combining HMO and PPO plans. Like an HMO plan, you will need referrals to all specialists, including physical therapists. And like a PPO, you may go outside of the provider network for health care services.
If you take the direct access route to physical therapy, your physical therapist will perform a physical exam to determine the cause of your symptoms. When they have pinpointed a diagnosis, they can set up a treatment plan. However, if they cannot treat you, they will refer you to someone who specializes in the treatment you need or let you know you need to consult another medical provider.
Complementary and Alternative Therapies
Some evidence shows that various complementary and alternative therapies might help manage lower back pain. Complementary therapies are those that are combined with traditional medicine approaches, while alternative medicines are taken instead of traditional medicine.
Such therapies include:
Talking to your healthcare provider before starting any complementary or alternative treatment is always a good idea. They can advise you on safety and whether a particular therapy might suit your unique situation.
Surgery
Surgery is reserved for people with structural problems that have not responded to nonsurgical treatment. It might also work for people with nerve compression that has led to muscle weakness, limits daily activities, and causes adverse effects on quality of life.
Lower Back and Hip Stretches to Reduce Pain
Regular stretching can help reduce lower back and hip pain and manage symptoms like stiffness and tightness.
However, the stretches recommended in your case will depend on the condition causing the pain. For example, stretches that bend forward may not be recommended for a herniated disc or sciatica. Talk to your healthcare provider or physical therapist for the stretches recommended for your condition.
Some stretches that might help in managing some causes of lower back and hip pain are:
Knee-to-chest stretch: Start by laying down on your back with your knees bent and feet flat on the floor. Slowly bring one knee up to the chest and gently pull the knee closer using your hands. Hold for at least 20 seconds and switch sides.
Piriformis stretch: Sit on the edge of a chair, cross one ankle over the opposite knee, and let the knee drop to the side. Flex forward at the hip. Then, gently push down on the elevated knee until you feel the stretch in the buttocks. Hold for at least 20 seconds and switch sides.
Cat-camel stretch: Start on your hands and knees with the knees under the hips and hands over the shoulders. Slowly arch the back upward, tuck in the buttocks, and hold for five to 10 seconds. Return to the neutral position. Lower your belly toward the mat, arch your back, and flex your hips with your head slightly up and your eyes forward. Hold for five to 10 seconds.
Child's pose: Start on all fours. Sit back on your heels with your arms extended in front of you. Lower the forehead to the floor and relax the back. Hold for 20 seconds or longer if you can.
Seated hamstring stretch: Sit up straight with your legs extended in front of you. Bend one knee upward and let the leg drop to the side. Bend forward from the hips keeping your chest and chin up. With the tops pointed up, reach to your toes. Hold and switch sides.
Cobra stretch: Start lying face down on a mat. Place your hands under your shoulder, elbows tucked in. Press into your palms and slowly push up to lift your head and upper body off the mat. Hold for 30 seconds.
Glute bridge: Start lying on your back, arms at your side with palms down, knees bent, and feet hip-width apart on the floor. Engage your abdominal muscles. Raise your hips while squeezing your gluteal (butt) muscles, pushing through your heels, and pressing on your arms. Aim for a straight line from head to knees. Hold for five to 30 seconds.
Clamshell: Start lying on your side with your knees bent. Support your head with your arm. Engage your abdominal muscles. With feet together and knees bent, raise only your top knee to open your legs like a clamshell. Hold for five to 30 seconds.
Always listen to your body and only stretch as comfortably as you can. If any stretch causes pain, stop stretching and contact your healthcare provider.
Related: 8 Back Stretches
What Makes Lower Back and Hip Pain Worse?
To best manage lower back and hip pain, you must be mindful of what makes back pain worse.
Factors that can make your back and hip pain worse include:
A sedentary lifestyle could cause muscles of the lower back and hips to weaken and reduce flexibility in those areas.
Excess body weight can stress the lower back and hip, leading to pain.
Heavy and improper lifting can strain the back and hips.
Overusing the lower back and hips and repetitive movements can lead to pain and swelling.
Poor posture, especially slouching, can strain muscles and ligaments.
Prolonged sitting puts excess stress on the lower back and hips.
Stress and tension can cause muscle tightness and pain sensitivity.
Managing Chronic Lower Back and Hip Pain
Managing lower back and hip pain requires a comprehensive approach. It is a good idea to consult your healthcare provider or a physical therapist to assess you, diagnose your underlying conditions, and develop a treatment plan.
You may also want to consider some lifestyle modifications to manage symptoms. Lifestyle modifications include weight loss, low-impact exercise, improving sleep quality, practicing good ergonomics, and avoiding activities that aggravate pain and worsen symptoms.
Improvement will take time and effort, so being patient and following your treatment plan is essential.
Lower Back and Hip Pain Not Improving
Generally, back and hip pain that lasts longer than a few weeks is not normal, and you should contact a healthcare provider. You should also contact a healthcare provider for back pain that is:
Constant and severe: Back and hip pain can be serious and related to some painful conditions.
Numbness and tingling in the legs and feet: This symptom indicates nerve irritation or damage. It should be assessed by a healthcare provider to prevent permanent damage.
Radiating body pain: Radiating body pain is sometimes related to spinal stenosis. It causes pain and other symptoms to move from the back and spine to other body areas, including the arms and legs.
Pain that is worse at night: This might be a sign of nerve damage. Also, the back and hip should improve with time, but if the pain does not and gets worse at night, you should let your healthcare provider know.
Significant pain with coughing or sneezing: Pain that worsens with these sudden movements might be related to discs or nerve pain.
Pain that worsens with prolonged standing: Pain that gets worse the longer you stand is often related to pressure on disks.
Urinary troubles: Back and hip pain with difficulty urinating could indicate a kidney or urinary tract problem. Back pain with bowel or bladder incontinence (loss of control) is a sign of cauda equina syndrome, a medical emergency that may require surgery to decompress nerves.
Groin or buttocks pain: Back and hip pain in these areas might signal nerve compression.
Back or hip pain that appears inflammatory: When you injure your back from lifting or sleeping uncomfortably, you might experience mechanical back pain. However, persistent back and hip pain that lasts over three months, worsens with inactivity, and improves with nonsteroidal anti-inflammatory drugs (NSAIDs), and movement is considered inflammatory. Inflammatory back pain is linked to axial spondyloarthritis (axSpA)—a type of inflammatory arthritis affecting the spine and SI joints.
Summary
Lower back and hip pain can sometimes coexist and be a sign of an injury or an underlying condition. Hip and back pain can make daily activities harder, but getting treatment early can improve your outlook.
Lower back and hip pain treatments include rest, stretching, anti-inflammatory medicines, prescription medicines, physical therapy, alternative medicine, and as a last resort, surgery. Contact a healthcare provider for persistent pain or pain that lasts longer than three weeks, pain that is worse at night, or pain that seems inflammatory.
Treating lower back and hip pain is vital to keeping your mobility and function and improving your quality of life. You will also want to consider some lifestyle modifications to assist in your recovery. Lastly, understand that improvement takes time, so be patient and stay on top of your treatment plan.
