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Other Hip Treatments
Hip or Back? Pain Down the Leg Explained
Hip problems and back problems are confused more often than any other pair in orthopaedics, and getting them mixed up is one of the commonest reasons people are treated for the wrong thing for months. True hip pain is usually felt in the groin. Pain in the buttock or running down the back of the leg is more often the spine. This page explains how to tell them apart, and why the distinction changes everything about what happens next.
The most expensive confusion in orthopaedics
I see it constantly. A patient has a hip replacement and the leg pain does not go, because it was coming from the back all along. Or a patient has spinal injections for months while an arthritic hip quietly worsens. Both are the two-sided failure I built my practice to prevent: the wrong clinician treating the wrong structure at the wrong time. The single most valuable thing a specialist does here is not the treatment. It is working out, correctly, what is actually causing your pain.
Where hip pain is really felt
Genuine hip joint pain is usually felt in the groin, sometimes wrapping to the front of the thigh, and it is typically worse on weight-bearing, twisting and getting out of a chair. People often show me their hip pain by cupping the groin with a C-shaped hand. Pain over the outer hip is usually the tendons, not the joint, and pain in the buttock or down the back of the leg is usually the back. These are patterns, not rules, which is exactly why examination matters.
When it is the back
Pain that starts in the lower back or buttock and travels down the leg, especially past the knee, with pins and needles or numbness, is more likely to be coming from the spine, where a nerve is irritated. A hip cannot usually send pain below the knee. If your leg pain has that travelling, electrical quality, the back needs to be part of the conversation even if the hip looks worn on an X-ray, because an arthritic hip on a scan and the pain you feel are not always the same thing.
At a Glance
How I tell them apart
Most of the answer comes from listening carefully to where the pain is and what provokes it, then examining both the hip and the back in the same appointment, something that too rarely happens when patients are sent to a hip clinic or a spine clinic in isolation. Specific movements load the hip without the back, and the back without the hip, and the pain gives itself away. Where it remains genuinely unclear, targeted imaging, or occasionally a diagnostic injection, settles it. The point is to be certain what we are treating before we treat it.
Why getting this right protects you
Because the right diagnosis is what stops you having the wrong operation. If your pain is truly from the hip, you can read about hip arthritis and the modern replacement approaches. If it is from the back, I will tell you plainly and point you to the right person, rather than operate on a hip that was never the problem.
Frequently Asked Questions
As a general pattern, true hip pain is felt in the groin, while pain in the buttock or running down the back of the leg, especially below the knee with pins and needles, is more often from the spine. Examination of both is how it is confirmed.
Hip pain can spread to the front of the thigh, but a hip rarely causes pain below the knee. Pain travelling down past the knee with numbness or tingling points more to a nerve from the back.
Because an arthritic hip on a scan and the pain you feel are not always the same thing. Many people have worn hips on X-ray without symptoms, and the leg pain can be coming from the back. This is exactly why examination matters more than the scan alone.
Because treating the wrong structure is the commonest reason people do not get better. Assessing the hip and the back together, in one appointment, is how you avoid the wrong injection or the wrong operation.
Book a consultation and bring any imaging you have. I will examine both your hip and your back and tell you honestly which is causing your pain. Call 0207 859 4016 or email admin@ortholongevity.co.uk.
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