Hip arthritis and sciatica

Is the Pain Coming From Your Hip or Back?

Often people go to the doctor seeking help for hip pain. Sometimes, people try to treat it themselves. They are convinced there is something wrong with their hip and the treatments begin. However, one thing is for sure, hip pain is not always as it appears. Hip pain can be a result of a problem in the hip joint itself. However, it can also be a result of a back problem or a soft tissue problem around the hip region.

Obtaining an accurate diagnosis is the first step to resuming activities and living an active lifestyle. Let’s discuss the reasons for confusion and see if we can realize the causes and treatments for both hip and back pain. Some of a patient’s misunderstanding about the origin of the pain is due to not understanding hip and back anatomy. Sounds odd but it’s true. The hip joint lies just behind the groin area on each side of the body. At the same time, the spine runs from the base of the skull to the tip of the tailbone. The lumbar spine contains specific nerves that can influence the feelings in the region around the hip area.

Pain Originating in the Hip

If the problem originates in the hip joint itself, common symptoms include groin pain on the affected side, and sometimes down the inner aspect of the thigh in the front of the leg. This pain can move to the knee and sometimes feels like a knee problem instead of a hip problem. Walking worsens the pain and with continued activity, the pain increases. Rest relieves it; however, when hip arthritis becomes severe, you may have pain most of the time. Minimal activity such as slight movements while in bed can worsen the pain. Other conditions such as advanced congenital hip dysplasia or avascular necrosis of the hip can cause these symptoms as well.

When the pain originates in the hip from arthritis, motion of the hip is often limited. This limitation is often realized when attempting to get out of a chair or bed and standing up. Contrary to hip pain, pain coming from the back may worsen when sitting or lying down, depending on the origin of the back pain itself.

Sometimes pain on the side of the hip is a result of bursitis. A weak abductor muscle, a leg length discrepancy, overuse, and an underlying early degenerating hip joint can cause bursitis. At times, the origin cannot be determined. Symptoms include pain on the side of the hip with prolonged walking, side lying in bed or when rising from a chair or similar types of movement.

Pain Originating in the Back

Low back pain commonly is experienced in the back itself. However, due to the complexity of the spinal cord and associated nerves being an intricate part of the low back, pain may and frequently can radiate or travel further down the course of the nerves. This is similar to striking your “funny bone” in the elbow and feeling the sensation in the hand below the elbow.

Although some of us are familiar with a pinched nerve, which is associated with sciatic-like pain in the leg, irritation or inflammation of nerves in the low back region can also cause a sensation in the upper leg or hip region. It is important to realize there are many things that can go wrong in the spine. Remember, sciatica is not a diagnosis but, instead, a symptom of an underlying problem. It is possible to feel back-related pain in the hip region and upper leg as well. It depends on the nerves involved and ultimately the actual diagnosis. Back pain or hip pain is not a diagnosis but simply an explanation of the area of pain. Symptoms are correlated with physical examination and confirmed through x-rays and similar tests.

Some back pain is caused from a “ruptured disc”. This pain is often experienced in the gluteal region of the body. Many people call this the “hip” region although it is not usually indicative of a hip joint problem. This is actually behind the hip, an important anatomic thought when considering hip pain, rather than in the hip itself. A condition related to degeneration of the lower back creating narrowing of the spinal canal or adjacent areas is called spinal stenosis and frequently causes pain in the hip region. The history of stenosis has to be compared with hip joint pain. Spinal stenosis can cause leg pain while walking as well as fatigue in the legs even when rising from a chair. Stenosis pain is relieved with sitting and will re-occur when walking is resumed.

There are differences in symptoms between spinal stenosis pain and herniated or ruptured disc pain. A herniated disc often is more painful when sitting and relieved by standing or walking (opposite of stenosis). A herniated disc can cause sciatica (so can stenosis) and can be a result of degenerative changes in the disc. Sciatica will commonly radiate or travel down the backside of the thigh, into the calf and sometimes the foot itself.>

Getting an Accurate Diagnosis

A thorough history and physical examination is a good start when sorting out symptoms. X-rays will attest to specific bony/cartilage changes but x-rays don’t always correlate with the pain. It is possible to have little pain and much damage on the x-rays or visa versa. It is important to treat the patient, not the x-rays alone. Secondly, x-rays of the back can reveal degeneration of the discs or small joints in the spine but the person does well. Contrary, the back may look degenerative and because of the subsequent bone spurring and symptoms as arthritis progresses, it is important to obtain an MRI to confirm nerve impingements that are suspected. X-rays alone will not show nerve impingement. As you can see, it is important to undergo the history and physical examination and tests that can confirm your diagnosis before treatment begins.

Treatment

Both types of problems are frequently helped by anti-inflammatory medications particularly in mild to moderate situations. Some types of analgesics can be used intermittently as well. It’s important to realize that both problems can be helped significantly by weight loss, proper forms of exercise and conditioning. In fact, back pain can become chronic without a commitment to the appropriate exercises necessary to stabilize and strengthen the spine. Epidural blocks (corticosteroids are injected into the canal of the low back to reduce inflammation and pain) can help several types of back disorders. Using a cane when walking can help both hip and back pain.

Surgery, whether a hip replacement for hip arthritis or back surgery due to a herniated disc, vertebral disorders or spinal stenosis, is a last resort for the treatment of the pain. Both surgery of the hip and the back are quite successful. Full evaluation is necessary and conservative measures are always tried first.

The question of pain in the hip region is not always a simple one and frequently involves specialized evaluation. Once the diagnosis is determined, options are many and should be discussed with you prior to instituting a treatment plan. The purpose of this article is to help to better assess pain, whether it’s coming from the back or the hip itself. Remember, there are many options for treatment. Diagnosis is the first step to successful treatment.

Sciatica Pain – Hip Pain Causes, Symptoms & Treatment

Sciatica refers to pain that radiates along the path of the sciatic nerve — which branches from your lower back through your hips and buttocks and down each leg.

Sciatica most commonly occurs when a herniated disk or a bone spur on the spine compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

You are most likely to get sciatica between the ages of 30 and 50 years. It may happen as a result of the general wear and tear of aging, plus any sudden pressure on the disks that cushion the bones (vertebrae) of your lower spine.

The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.

Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.

Symptoms:

    • Pain that radiates from lower (lumbar) spine to your buttock and down the back of the leg.
    • Pain can vary from mild to sharp or electric shock.
    • Numbness, tingling or muscle weakness

Nonsurgical treatment such as physiotherapy or radial shockwave therapy, will be recommended by Dr Siow to help to strengthen the muscles that is supporting your back.

Surgery may be needed if you still have persisting pain after 3 months of nonsurgical treatment.

It is recommended to seek Dr Siow’s professional advise to help you recover.

Is the pain coming from your hip, spine or both?

Typically, groin pain, and/or difficulty putting on shoes or getting in and out of a car, are associated with a hip condition. Buttock or back pain, with or without a tingling sensation, most likely originates in the spine. However, patients with complex “hip-spine syndrome” have lower back and hip pain with no clear source of the discomfort. Hip arthritis, for example, can increase pressure on the lower back.

“In these instances, similar or overlapping symptoms may delay a correct diagnosis and appropriate treatment,” said article author Afshin Razi, MD, an orthopaedic surgeon and clinical assistant professor at NYU Langone Hospital for Joint Diseases.

The article recommends that patients provide a detailed health history and undergo a comprehensive physical examination that includes an assessment of gait (how the patient walks); hip and back range of motion; posture; pelvic, lower limb, and spinal alignment; loss of muscle (atrophy); previous surgical scars; and limb-length discrepancy.

“Plain and advanced imaging studies and diagnostic injections also can be used to further delineate the primary problem and guide the appropriate sequence of treatment,” said Dr. Razi.

Diagnoses for hip and spine pain can include hip osteoarthritis, a stress fracture, osteonecrosis of the hip (a blockage in blood flow to the hip), a labral tear (damage to the cartilage that surrounds the hip), disc herniation and possible pinched nerves, stenosis (narrowed spinal canal causing nerve pain), sacroiliac joint dysfunction, and other less common sources of pain.

“Focusing on both the spine and the hip as potential causes of pain and disability may reduce the likelihood of misdiagnosis, and the management of conditions affecting the spine and/or hip may help reduce the likelihood of persistent symptoms,” said Dr. Razi.

The Truth About Sciatica: Genetics, Low Back Problems, Piriformis, Arthritis, and More

Truth: The Sciatic Nerve Runs from the Low Back Down to the Toes

The sciatic nerve is located in front of the piriformis muscle (deep in the rear), including the lowest two nerves that exit from the lower spine (L4 and L5) and the first three sacral nerves (S1, S2 and S3).

Watch: Video: What Is Your Sciatic Nerve and Why Does It Hurt So Much?

Each of the nerves has two branches, one on each side of the spine. The root of each nerve exits the spine between two vertebra in the low back, travels down the back of each leg, and branches out to the leg and into each foot. The sciatic nerve is the largest single nerve in the human body.

See Sciatic Nerve and Sciatica

Sciatic pain that radiates along this nerve can be excruciating and debilitating for many patients.

Truth: Sciatica Leg Pain is Caused By a Problem in the Low Back

Patients often feel leg pain from sciatica, which leads them to believe that there is something wrong with their legs.

However, because the sciatic nerve extends through the low back, legs and feet, a problem causing nerve compression in the low back can cause low back pain and feelings of pain through the legs, feet and sometimes the toes.

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Truth: The Causes of Sciatica Are Not Genetic

As explained above, sciatica is the result of a problem in the low back that can develop from aging or from a spinal injury. These conditions are not passed on genetically, as patients may mistakenly believe.

See Diagnosing the Cause of Sciatica

There is no truth to the idea that sciatica is handed down from generation to generation.

In This Article:

  • The Truth About Sciatica
  • The Truth About Sciatica: Genetics, Low Back Problems, Piriformis, Arthritis, and More
  • Myths About Sciatica Treatment Options
  • Sciatica Causes and Symptoms Video

Truth: Piriformis Syndrome Feels Like Sciatica, But It Isn’t the Same

Piriformis syndrome is a condition that is often confused with sciatica. When the piriformis muscle becomes tight, it can irritate the sciatic nerve. This causes sciatica-like pain, tingling and numbness that often run from the low back to the rear, down the leg and into the foot.

Although the discomfort from piriformis syndrome feels similar to sciatica, the two have different causes. With piriformis problems, the pain is not caused by a compressed nerve root where it exits the spine as occurs with true sciatica.

Correctly identifying the cause of the pain is important because the treatments for each type of pain tend to be very different.

See What Is Piriformis Syndrome?

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Truth: Pain From Arthritis or Joint Problems Is Not True Sciatica

The pain from arthritis or other joint problems is actually more common than sciatica, and they are often confused. In reality, sciatica and arthritis are classified as different types of pain. Radicular pain like sciatica is caused by a pinched nerve.

In contrast, referred leg pain from arthritis is dull, achy and often moves around and varies in intensity. Although the leg pain from arthritis may feel similar, it is not truly sciatica. Distinguishing the correct problem is important because the treatments for each type of pain often differ.

Read more in the Arthritis Health Center

April 23, 2003 — A drug commonly used to ease the pain and inflammation of rheumatoid arthritis may also double as a potential sciatica treatment. A new study shows Remicade (infliximab) effectively reduced leg pain caused by severe sciatica and allowed many suffers to return to normal activities.

“These results are very promising for patients suffering from severe sciatica, for whom surgery is the only treatment option,” says researcher Jaro Karppinen, MD, of Oulu University Hospital in Oulu, Finland, in a news release. “While more research is needed, these findings indicate that infliximab may provide a potential new alternative to help fulfill this unmet medical need.”

The study appears in the current issue of the journal Spine.

Researchers say it’s the first time this class of drugs has been studied as a sciatica treatment. The condition can be caused by normal wear and tear on the body, but may also be caused by any sudden pressure on the disc that supports the spine, such as a herniated disc. Symptoms usually include leg pain, weakness, numbness, or a burning or tingling sensation that travels down the leg.

Remicade works by reducing the level of a chemical in the body called tumor necrosis factor alpha. Tumor necrosis factor alpha is a key factor in the inflammatory process that occurs in a variety of conditions and is increasingly thought to play a role in sciatica.

Remicade is currently approved by the FDA for use in treating rheumatoid arthritis and Crohn’s disease.

In the study, 10 people who had sciatica caused by a herniated disc were given an intravenous dose of Remicade over two hours.

One hour after the infusion, leg pain had been reduced by 50%. Two weeks after treatment, 60% of the patients were free of pain, compared with only 16% of those who received a placebo infusion, and those benefits continued for at least three months.

The study also found that within one month after treatment, all of the patients who received Remicade were able to return to work while 38% of the placebo group remained on disability leave.

4 Types of Arthritis That Cause Sacroiliac Joint Pain

When you feel pain in your lower back or hips, the pain can originate from muscles, soft tissues like tendons and ligaments, or joints.

But it’s not just the joints of the spine or the large hip ball-and-socket that may be the source of the problem—there’s also a pair of joints that can cause symptoms called the sacroiliac (SI) joints.

See Sacroiliac Joint Pain and Inflammation

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The first symptom of ankylosing spondylitis is often pain in the sacroiliac joint.
Watch: Ankylosing Spondylitis Video

The SI joints connect the base the spine with the pelvis on both sides of the body. They’re strong, supportive joints that don’t move much, but they still have the same structure as more common joints in the body, like the knee. This means the SI joints have cartilage, which can degenerate, and synovial fluid, which can become inflamed—causing pain and inflammation in the joint.

See Degenerative Arthritis

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Symptoms of SI joint dysfunction and sacroiliitis

Pain in the sacroiliac joint is known as SI joint dysfunction (sometimes also SI joint syndrome, disease, or disorder). Inflammation in the SI joint is known as sacroiliitis.

Regardless of the terms used to describe it, SI joint pain and inflammation cause these symptoms:

  • Pain in the lower back, buttocks, hips, and/or groin
  • Pain that radiates down the legs (similar to sciatica)

Types of arthritis that can cause SI joint pain

Symptoms in the SI joints can be the calling cards of several types of arthritis, including the following:

    Osteoarthritis
    Age, excess weight, and repetitive motion can all take a toll on the SI joint’s cartilage, causing it to wear away and bony growths to form and irritate the surrounding tissue.

    See What Is Hip Osteoarthritis?

    Ankylosing spondylitis
    This form of arthritis causes inflammation where ligaments and tendons attach to bone, which often affects the spine. In fact, SI joint pain is often the first symptom of ankylosing spondylitis.

    See What Is Ankylosing Spondylitis?

    Psoriatic arthritis
    About 10% of people with psoriasis develop pain and inflammation in their joints, known as psoriatic arthritis.The joints of the spine tend to be affected more, including the SI joints.

    See What Is Psoriatic Arthritis?

    Gout
    Like ankylosing spondylitis and psoriatic arthritis, gout is another inflammatory type of arthritis. Gout often affects just one joint. Most frequently this is the big toe joint, but it can also be in the SI joint.

    See All About Gout – Symptoms, Diagnosis, Treatment

There are also a few causes of SI joint pain that are not related to arthritis, such as:

  • Trauma to the joint
  • The relaxing of surrounding ligaments during pregnancy
  • Added stress to the joint from another cause or procedure, such as a lumbar spinal fusion

SI joint pain can be confused with many other conditions that cause pain in the lower back and torso, so it’s important to see your doctor for an accurate diagnosis if you are experiencing symptoms.

Learn more:

    Possible Causes of Sacroiliitis and SI Joint Pain

    Ankylosing Spondylitis Physical Therapy and Exercise

Ask the experts

What are the different types of psoriatic arthritis?

Doctor’s response

The type of psoriatic arthritis depends on the distribution of the joints affected. Accordingly, there are five types of psoriatic arthritis:

  • symmetrical (both sides of the body),
  • asymmetric and few joints,
  • spondylitis,
  • distal interphalangeal joints, and
  • arthritis mutilans.

Psoriatic arthritis is a chronic disease characterized by a form of inflammation of the skin (psoriasis) and joints (inflammatory arthritis). Psoriasis is a common skin condition affecting 2% of the Caucasian population in the United States. Signs and symptoms include patchy, raised, red areas of skin inflammation with scaling. Psoriasis often affects the tips of the elbows and knees, the scalp and ears, the navel, and around the genital areas or anus. Approximately 15%-25% of patients who have psoriasis also develop an associated inflammation of their joints. Patients who have inflammatory arthritis and psoriasis are diagnosed as having psoriatic arthritis.

The onset of psoriatic arthritis generally occurs in the fourth and fifth decades of life. Males and females are affected equally. The skin disease (psoriasis) and the joint disease (arthritis) often appear separately. In fact, the skin disease precedes the arthritis in nearly 80% of people. However, the arthritis may precede the psoriasis in up to 15% of patients. In some patients, the diagnosis of psoriatic arthritis can be difficult if the arthritis precedes psoriasis by many years. In fact, some patients have had arthritis for over 20 years before psoriasis eventually appears! Conversely, patients can have psoriasis for over 20 years prior to the development of arthritis, leading to the ultimate diagnosis of psoriatic arthritis.

Psoriatic arthritis is a systemic rheumatic disease that also can cause inflammation in body tissues away from the joints other than the skin, such as in the eyes, heart, lungs, and kidneys. Psoriatic arthritis shares many symptoms with several other arthritic conditions, such as ankylosing spondylitis, reactive arthritis, and arthritis associated with Crohn’s disease and ulcerative colitis. All of these health conditions can cause inflammation in the spine and other joints, and the eyes, skin, mouth, and various organs. In view of their similarities and tendency to cause inflammation of the spine, these health conditions are collectively referred to as “spondyloarthropathies.”

For more information, read our full medical author about psoriatic arthritis signs, symptoms, and treatment.

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