Is Your Hip Pain Actually Coming From Your Back? How To Tell The Difference
Why hip pain is one of the most commonly misidentified conditions
Your brain interprets that signal as a hip problem.
What true hip pain actually feels like versus referred pain
This is where the distinction gets practical.
True hip joint pain, the kind that originates inside the hip joint itself, is typically felt in the groin. Deep, in the crease at the front of the hip. It worsens when you rotate the leg inward or outward. Getting in and out of a car is often specifically painful. Sitting for long periods and then standing produces a brief seizing sensation that eases with a few steps.
Referred pain from the lumbar spine presents differently.
It tends to sit more on the outside of the hip, into the buttock, or radiate toward the front of the thigh. It often comes with lower back stiffness that the person has stopped noticing because it has been there so long it feels normal. It may be worse in the morning and ease through the day, or worse after prolonged sitting at a desk, or worsen when the lower back is in sustained flexion, like driving.
The sharp distinction between groin pain and lateral or posterior hip pain is one of the first things a thorough clinical assessment identifies.
How to tell the difference at a glance
True hip
joint pain
rederred pain
from lumbar spine
DEep groin
location
outer hip,
buttock, or
front of thigh
worse with hip
rotation
Worse with
lumbar
flexion or
sitting
painful getting
in/out of car
often
accompanies
lower back
stifness
responsive to hip
treatment
does not
improve w/
treatment
alone
How to tell the difference at a glance
True hip joint pain
Referred pain from lumbar spine
Deep groin location
Outer hip, buttock, or front of thigh
Worse with hip rotation
Worse with lumbar flexion or sitting
Painful getting in/out of car
Often accompanies lower back stiffness
Responsive to hip treatment
Does not improve with hip treatment alone
The condition that gets misdiagnosed more than almost any other
Greater trochanteric pain syndrome is tenderness and pain along the outer side of the hip, at the bony prominence you can feel if you press the side of your upper thigh. It is one of the most frequently misidentified musculoskeletal conditions in clinical practice.
Research published in HCPLive in March 2026 noted that patients with this condition often present to multiple clinicians, undergo extensive diagnostic testing, and receive several rounds of treatment without improvement, frequently because the underlying source of the pain is not being correctly identified.
It shares its pain pattern with lumbar nerve root irritation, hip bursitis, and referred pain from the sacroiliac joint.
This matters because all three have different sources and different treatment approaches. Treating hip bursitis with cortisone when the source is L3 nerve root compression does not resolve the problem. It temporarily quietens a pain signal whose origin has not been addressed. disc issues
The condition that gets misdiagnosed more than almost any other
Greater trochanteric pain syndrome is tenderness and pain along the outer side of the hip, at the bony prominence you can feel if you press the side of your upper thigh. It is one of the most frequently misidentified musculoskeletal conditions in clinical practice.
Research published in HCPLive in March 2026 noted that patients with this condition often present to multiple clinicians, undergo extensive diagnostic testing, and receive several rounds of treatment without improvement, frequently because the underlying source of the pain is not being correctly identified.
It shares its pain pattern with lumbar nerve root irritation, hip bursitis, and referred pain from the sacroiliac joint.
This matters because all three have different sources and different treatment approaches. Treating hip bursitis with cortisone when the source is L3 nerve root compression does not resolve the problem. It temporarily quietens a pain signal whose origin has not been addressed. disc issues
Why this is showing up more in Shellharbour right now
Winter in the Illawarra is mild by most standards.
But the drop in temperature from summer to June is enough to change everything for someone whose hip or lower back is already sensitised. Muscles tighten in cold. People move less. The morning stiffness that was tolerable in January becomes the thing that makes getting out of bed a calculation.
In Warilla, Dapto, Calderwood and Shell Cove, we start seeing this pattern in May. People who managed through summer, who kept walking the esplanade or doing the school run or sitting at a desk in Stockland without too much complaint, come in because it has crossed a threshold.
The other thing winter does is reduce activity. And reduced activity means the stabilising muscles around the lumbar spine become less conditioned, which means the spinal structures take more direct load, which means the nerve referral into the hip region intensifies.
The hip feels worse. The back barely registers. So the hip gets treated.
What a proper assessment actually looks for
A clinical examination that differentiates hip joint pain from lumbar referred pain uses specific orthopaedic tests.
The FABER test, which stands for Flexion, Abduction and External Rotation, positions the hip in a way that stresses the hip joint itself while unloading the lumbar spine. A positive result that reproduces groin pain suggests true hip joint pathology.
A negative result, or pain reproduction in the back or outer hip rather than the groin, suggests a lumbar source.
The straight leg raise and femoral nerve tension tests assess lumbar nerve root involvement. Palpation of the lumbar facet joints at L2, L3 and L4 can reproduce referred hip and thigh pain when those levels are implicated. Neurological screening assesses the integrity of the nerve roots supplying the leg. lower back strain
Frequently asked questions
How do I know if my hip pain is from my hip or my back?
The clearest indicator is location. True hip joint pain sits deep in the groin. Pain on the outer hip, in the buttock, or radiating into the front of the thigh is more consistent with a lumbar spine source. If you also have lower back stiffness you have normalised and your hip pain has not responded to hip-specific treatment, the spine needs to be examined.
Can a chiropractor help with hip pain?
Yes, particularly when the source involves the lumbar spine. Chiropractic assessment looks at the full mechanical chain, including the lumbar levels that refer into the hip region. Where the hip pain is genuinely from the hip joint, manual therapy, soft tissue work and movement rehabilitation are all relevant. Where it is referred from the spine, addressing the spinal source is what produces lasting change.
Why has my hip pain not improved with stretching?
Because stretching the hip does not address the lumbar nerve root. If the pain source is at L3 or L4, no amount of hip flexor or glute stretching changes what is happening at those spinal levels. It may provide temporary relief through muscle relaxation, but the underlying cause remains unchanged.
Should I get an MRI for hip pain?
Book at thebackdr.com.au or call (02) 4295 7222. We are at 12 Station Road, Albion Park Rail.
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