I have seen many patients over the years with low back pain, hip pain, or a combination of both and it can sometimes be difficult to distinguish exactly where the pain is coming from unless you know what you are looking for. In this article I will talk about herniated discs aka slipped discs and hip pain, and how you can find out if your pain is coming from your back or your hip. You can also learn more about slipped discs, back pain and hip problems here at Healthwords.
Our spines are made up of backbones – called vertebrae – with circles of tissue between them that have a jelly-like centre. These are the discs, which act as shock absorbers and also allow for our spines to flex. Running down the middle of our spine is the spinal cord that contains our central nerve supply, and which is usually very adequately protected from damage or undue pressure by our normal anatomy. If at any time some of the soft central part of a disc pushes through the outer part then pressure can arise on the spinal cord and nerves, and it is this ‘bulging out’ of the soft part of the disc that is commonly known as a herniated or ‘slipped’ disc. The peak times for these to occur are between the ages of 30 and 55, and are more commonly felt in the lower back although they can occur in any area of the spine including the neck, often in younger people in these cases. Trauma may be a precipitating factor – such as road accidents or falling from a height – but just as often there may be little obvious reason although a history of twisting or bending awkwardly is common.
Around 1 in 5 people with a herniated disc may not have any symptoms but of those that do, their severity depends on the degree of pressure on the spinal cord and nerves. These range from pain in the back, buttocks or legs and there may also be feelings of numbness or weakness in the affected area with the whole leg sometimes being affected. Certain positions may be severely painful whereas others may bring relief, and the pain is often described as being like an ‘electric shock’ that can literally bring someone to their knees. The key point to make about any symptoms of a slipped disc is that if there is any limb paralysis, severe muscle spasticity or definite changes in bladder control then these require urgent medical attention and should be viewed as an emergency.
Yes it can, but this is quite uncommon. When a disc herniates (‘slips’), the inner gel-like material leaks out and puts pressure on the spinal nerves, causing a range of symptoms. In some cases this may involve lower back pain travelling into the hips, and occurs because the location of the herniated disc affects the nerves that travel from the lower back to the hips. If this occurs, the pain may be described as a sharp pain that is felt in the front or back of the hip, and in some people there may also be some weakness or a loss of sensation in the hip too.
Spinal stenosis happens when the spaces in the spine narrow and so put pressure or ‘squeeze’ the spinal cord and nerve roots. The spinal cord is the thick cord of nerves that runs from the base of the brain down the centre of our back, and nerve roots branch out from this cord. Spinal stenosis usually happens slowly and involves different parts of the spine. The symptoms it causes depend on where the narrowing in your spine is. If it occurs in your lower back then these can include low back pain, pain that goes down into the legs and which may get better when leaning forward, weakness in the feet or legs and numbness or cramping in the legs.
Sciatica is defined as pain or discomfort associated with the sciatic nerve which runs from the lower back, down the back of the legs to the feet. It most commonly occurs in adults in the 20 – 60 year age group and in older people sciatica most commonly occurs as the result of conditions caused by spinal degeneration, such as spinal stenosis. This is where the pathways through which the sciatic nerve travels are narrowed. Again, this causes compression and/or irritation of the sciatic nerve.
The sciatic nerve is the largest and longest nerve in the body. It originates in the lower spine, branches into the pelvis, then travels through the buttocks and the back of the legs and branches into the lower legs and feet. Sciatic pain occurs when there is pressure on, or damage to, the sciatic nerve.
The most common cause of sciatica is a disc prolapse (also known as disc herniation or slipped disc). This occurs when one of the soft, gel-filled discs between the vertebrae of the spine bulges or ruptures, compressing and/or irritating the sciatic nerve. Another common cause is muscle spasm that causes sciatica by compressing the sciatic nerve as it travels through the muscles. Other less common causes of sciatica include infection and tumours.
Factors that increase the likelihood of developing sciatica include pregnancy, being overweight – a very common cause – and smoking but basically any injury or process which causes compression of the sciatic nerve can cause sciatic pain. In many cases however, no specific cause for the sciatic pain can be identified.
Despite its name, degenerative disc disease is not a disease as such but simply a natural occurrence that comes with getting older. The discs of firm jelly-like material that sit between our backbones (vertebrae) normally allow us to flex and bend our back easily, and work in a similar way to shock absorbers. However, over time they can become worn and so no longer offer as much protection as before. This can cause the back to become inflamed and trigger back pain and stiffness. Treatment options include anti-inflammatory painkillers, physiotherapy, mobility exercises, losing weight, and (occasionally) surgery. Another option is to inject the joints next to the damaged disc with steroids and a local anaesthetic to provide pain relief - these are known as facet joint injections.
Piriformis syndrome occurs when the piriformis muscle in the body presses on the sciatic nerve and inflames it. The piriformis muscle is a flat, narrow muscle that runs from the bottom of your back, through the buttock area to the top of the thighs and is very important in moving the lower body. If the sciatic nerve is pressed on by this muscle it can cause pain or numbness in your buttock and down the back of your leg, on one side of your body or both. However, piriformis syndrome is not particularly common, causing around 0.5% to 6% of cases of lower back pain.
Arthritis is a term used to mean inflammation of a joint. There are a number of possible types of arthritis but osteoarthritis is the most common, sometimes known as ‘wear and tear’, or degenerative joint arthritis that becomes more common as we get older. Commonly affected joints include the hips and knees, and with hip arthritis there is typically hip pain, reduced mobility in the hip joint and difficulty in walking normally. The pain may also occur in other areas such as the knee, groin, buttocks or thigh and may be a dull ache or a sharp intense pain. Being overweight can also increase the likelihood of osteoarthritis developing in a large joint. Treatment is with weight reduction, painkillers, mobility exercises and sometimes hip replacement surgery.
Hip dysplasia is a condition that is usually present at birth in most people, but does not usually cause symptoms until adulthood if it is not diagnosed in childhood. Women are typically more often affected than men, and it occurs when the socket of the hip joint is too shallow to hold the ball-shaped head of the thigh bone in its correct place. If it is left untreated, it can cause osteoarthritis over time with the need for a hip replacement as treatment. Symptoms include pain in the groin (often worse with activity), limping, reduced hip movements and trouble sleeping on the hip.
The sacroiliac (SI) joint is one of the large joints in our body and is formed where the sacrum and pelvic bones connect. The sacroiliac joints are not very mobile and are vital in transmitting the forces of the upper body to the lower body, acting like a shock-absorber. If the SI joints do not work normally this is known as SI joint dysfunction, and can cause increased movement around them, with the most common symptom as a result being pain. Causes of SI joint dysfunction include trauma, muscle imbalances, pregnancy and inflammatory joint conditions such as arthritis. Treatment options include rest, painkillers, wearing a sacroiliac belt to stabilise the joint, and physiotherapy. Corticosteroid injections may also occasionally be used to reduce back pain and inflammation caused by SI joint dysfunction.
Because it may be difficult to distinguish between hip pain caused by a disc problem and that from a hip condition, your doctor will examine you initially to see if there are any obvious signs pointing to the cause, and then arrange some imaging tests to look at the area of the body affected. These include X-rays, CT or MRI scans that help to show if there is any disc problem or whether there is damage to the hip joint.
Although the exact treatment for hip or disc problems depends on the cause in each individual, there are treatment options common to all of these. These include painkiller medication (including NSAIDs) that can help reduce inflammation around the affected area, as well as physiotherapy, steroid injections, TENS machines and - occasionally - surgery to remove a herniated disc or replace an arthritic hip. You can purchase appropriate painkillers to treat hip or back pain from the Healthwords shop.
If you have pain in your back or hip and are unsure what is causing it, seek an opinion from your doctor. They will be able to provide an accurate diagnosis as well as recommend individual treatment for you. If you would like to know more information about any conditions mentioned in this article, Healthwords can provide medically certified articles on these - we’re here for you!
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