Hip Pain Radiating Down Your Leg: Is It Your Hip or Sciatica?

Why is it hard to tell hip pain from sciatica?

The hip and the lumbar spine sit next to each other and send pain into overlapping areas. A peer-reviewed review on hip-spine syndrome in PubMed Central states plainly that the pain patterns from the lumbar spine, the pelvis and the hip overlap, which makes evaluation harder. Many people also have problems in both places at once.

That overlap is why Dr. Stride checks the lower back at every hip exam. Treating a hip that is not the main source, or missing a hip problem blamed on the back, are both common reasons pain lingers.

What does pain from the hip joint usually feel like?

The same review notes that groin pain is the most common pattern for pain coming from inside the hip joint. The pain often reaches the front of the thigh and can be felt in the knee. People describe a deep ache that worsens with walking, rotating the leg or getting in and out of a car.

Hip joint pain can travel farther than many people expect. The review cites a study in which nearly half of people with hip arthritis pain reported symptoms below the knee. So pain below the knee does not rule out the hip on its own. What usually separates hip pain from nerve pain is the quality of the pain and the movements that trigger it.

What does sciatica feel like?

Sciatica is nerve pain from a squeezed nerve root in the lower spine, most often from a herniated disk or spinal stenosis. AAOS OrthoInfo describes it as pain in the lower back or hip that spreads to the back of the thigh and into the leg. It can feel sharp, electric or like a bad cramp, and it may come with weakness, pins and needles, numbness, burning or tingling.

Spinal stenosis has its own pattern. AAOS OrthoInfo explains that it often causes burning buttock and leg pain that worsens with standing straight or walking and eases when you sit or lean forward, such as on a shopping cart.

• Pain that shoots below the knee, sometimes into the foot
• Tingling, numbness or burning in the leg or foot
• Pain made worse by coughing, sneezing or sitting
• Relief when sitting or bending forward
• Back pain along with leg pain, though some people have little back pain

What if the pain is mostly in my buttock?

Buttock pain is the true gray zone. It can come from the lower spine, the sacroiliac joint, the hamstring tendon where it attaches to the sit bone, the piriformis muscle or, less often, the hip joint itself. Hamstring tendon pain tends to hurt with sitting on hard surfaces and with long strides, while spine-related buttock pain often comes with leg symptoms.

Because several structures sit so close together, the exam matters more here than anywhere else. Pressing on specific spots, testing strength and checking the nerves usually narrows the source quickly. Pain that started with a sudden pull while sprinting or water skiing, especially with bruising on the back of the thigh, raises concern for a hamstring tendon injury and deserves prompt attention.

How does a hip specialist tell the difference?

The exam starts with how you walk and which movements reproduce the pain. Rotating the hip while it is bent, for example, tends to provoke joint pain. AAOS OrthoInfo notes that sciatica testing may include walking on heels and toes, squatting and rising, and a straight-leg raise. Reflexes and sensation help show whether a nerve is involved.

Imaging adds detail. X-rays of the hip show arthritis and bone shape, while an MRI of the spine may be needed when nerve signs are present. When the picture is still unclear, a diagnostic injection of numbing medicine into the hip joint can help: if the pain disappears for a few hours, the hip is likely the main source. AAOS OrthoInfo describes using this kind of numbing injection to confirm that pain is coming from inside the hip.

Imaging findings have to match the symptoms. The hip-spine review notes that hip arthritis seen on X-ray, even when severe, does not always line up with where a person hurts. Spine changes are just as common: AAOS OrthoInfo notes that by age 50, up to 95% of people have some wear and tear in the spine, so a finding on a scan does not automatically explain your pain. The exam ties the pictures to your actual symptoms.

When is leg pain an emergency?

Go to the emergency room right away if leg pain comes with any of the signs below. Cleveland Clinic explains that these can point to cauda equina syndrome, a compression of the nerve roots at the bottom of the spine that can cause permanent damage if treatment is delayed. AAOS OrthoInfo also lists foot drop and loss of bowel or bladder control as warning signs in spinal stenosis.

• Numbness in the groin, buttocks or inner thighs
• New trouble urinating, or loss of bladder or bowel control
• Leg weakness that is getting worse, or a foot that slaps or drags when you walk
• Sudden severe back and leg pain after a fall or injury

What is the next step if your hip pain travels down your leg?

The good news is that both hip pain and sciatica usually start with non-surgical care. AAOS OrthoInfo reports that 80 to 90% of people with sciatica improve over time without surgery, often within several weeks when a herniated disk is the cause. Hip pain from arthritis, tendons or the labrum also often responds to physical therapy and activity changes.

If you are not sure whether your pain is coming from your hip or your back, a single visit can usually sort it out. The Saturday Hip Pain Clinic in Memorial City is a good place to start, and our team will review any X-rays or MRIs of your hip or spine that you bring.

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