Hip joint pain is usually felt in the groin or front of the thigh and flares with putting on socks or getting out of a car. Back-related pain more often sits in the buttock, travels below the knee and brings numbness or tingling. Many adults have both, so a hip and spine exam and X-rays are needed.
The hip and the lower back share nerves, muscles and a lot of territory, so pain from one is easily mistaken for the other. Some patients have hip replacements that do not fix their pain because the back was the real problem; others go through months of back treatment for a worn-out hip. Checking both at every visit is part of how Dr. Stride works, and it often saves patients months of the wrong treatment.
Written and medically reviewed by Dr. Stride, MD, board-certified orthopedic surgeonWhen the hip joint is the source, pain is usually felt in the groin and the front of the thigh, sometimes all the way to the knee. The hip loses rotation and gets stiff. Pain comes on with walking and weight bearing rather than with bending forward.
The clue: Groin pain plus difficulty with socks, shoes and getting out of a car points strongly to the hip.
Narrowing of the spinal canal from arthritis squeezes the nerves going to the legs. Standing and walking upright make it worse because they narrow the canal further. Leaning forward opens the canal and relieves the symptoms.
The clue: Leg heaviness or pain on walking that eases by sitting or leaning on a shopping cart is the classic sign of stenosis.
A disc in the lower spine can bulge and press on a nerve root. Pain runs from the buttock down the leg, often below the knee, with numbness or tingling in a specific strip of skin. Coughing or sneezing can make it worse.
The clue: Shooting pain below the knee with numbness or tingling usually means a pinched nerve.
The SI joint sits between the spine and pelvis. Pain stays mostly over the low back dimple and buttock, and can travel into the back of the thigh. It is often confused with both hip and spine problems.
The clue: Pain pointed to with one finger just beside the base of the spine suggests the SI joint.
Many adults have arthritis in both places at once, and each can make the other worse. A stiff hip forces the lower back to arch more when walking, and a stiff spine changes how the pelvis tilts. Treatment works well when the main pain driver is identified and treated first.
The clue: Groin pain and back or leg symptoms together, with arthritis on both hip and spine X-rays, suggests both are involved.
Dr. Stride examines the hip and the spine together. He rotates the hip while you lie on your back, since reproducing your groin pain with internal rotation strongly points to the hip joint. He checks how the back bends and extends, tests reflexes and strength in each leg, maps any numbness, and performs a straight-leg raise to look for nerve tension. Watching you walk shows whether the limp comes from a painful hip or weak muscles controlled by a pinched nerve. Standing X-rays of the pelvis and hips show the joint, and spine X-rays or an MRI are ordered when the nerves are in question. When both look worn, a diagnostic injection of numbing medicine into the hip joint answers the question: if your usual pain fades for a few hours, the hip is the main source.
“Bring your outside X-rays and MRI. I’ll go through them with you, but how your hip moves on the exam table tells me just as much as the pictures.”
Dr. Stride, MD
The exam and X-rays usually make the answer clear at the first visit. When they do not, an image-guided numbing injection into the hip joint settles which area is driving the pain.
A program that strengthens the hips and core and restores hip motion helps both hip and back pain, and is often the right starting point when both areas are involved.
Every pound of body weight adds force across the hip with each step. Our team helps you build a realistic plan for activity and weight that eases both the hip and the spine.
When the hip is the main source, a cortisone injection into the joint can calm arthritis pain for weeks to months.
If the back is the main pain driver, our team refers you to a trusted spine specialist and stays involved, so the hip is not replaced for a problem it will not fix.
When advanced hip arthritis is the main problem, a hip replacement usually brings dependable relief, and it can also take strain off the lower back.
Yes, a stiff, arthritic hip changes how the pelvis and lower back move when you walk, which can strain the back. Many patients notice their back feels better after a hip problem is treated. This overlap is called hip-spine syndrome.
Hip joint pain can travel down the front of the thigh, sometimes to the knee, but it rarely goes below the knee. Pain below the knee with numbness or tingling usually comes from a pinched nerve in the back.
A diagnostic hip injection places numbing medicine directly into the hip joint using ultrasound or X-ray guidance. If your usual pain mostly disappears for a few hours, the hip joint is the main source. It is one of the most useful tests when hip and spine both show arthritis.
If the pain is mainly in the groin or front of the thigh, start with a hip specialist. If it is mainly in the back and runs below the knee with numbness, start with spine. Dr. Stride examines both and refers to a spine specialist when the back is the source.
A diagnostic hip injection places a numbing medicine directly into the hip joint under ultrasound or X-ray guidance.
Read more →DiagnosisA hip exam with an orthopedic hip specialist is a hands-on check of range of motion, labral and impingement signs, tendon strength and walking pattern.
Read more →DiagnosisHip X-rays and MRI answer different questions.
Read more →ReplacementTotal hip replacement replaces the worn ball and socket of an arthritic hip with a metal, ceramic and medical-grade plastic implant.
Read more →Front of hip and groin pain usually comes from inside the hip joint itself.
Causes & treatment →Hip pain · Outside of hipPain on the outside of the hip is most often greater trochanteric pain syndrome, an irritation of the gluteus medius and minimus tendons and the bursa over the bony point of the hip.
Causes & treatment →Hip pain · Back of hipPain in the back of the hip and buttock most often comes from the lower back, such as a pinched nerve or sciatica, or from the sacroiliac joint.
Causes & treatment →Hip pain · symptomHip clicking or snapping, called snapping hip syndrome or coxa saltans, usually comes from a tendon sliding over bone.
Causes & treatment →
Trouble lifting your leg into a car usually means the hip cannot bend far enough or the muscles that lift the thigh are painful or weak.
Cycling hip pain usually comes from bike fit and repetition.
Golf hip pain usually comes from the rotation the swing demands.
Medically reviewed by Dr. Stride, MD against current guidance from these sources. Last reviewed October 2026. How we write and review content
