How to Tell the Difference

If you have leg pain without significant back pain, it can be hard to tell if the problem is your back or your hip. Vinita Mathew, MD, is a physical medicine and rehabilitation physician at Northwestern Medicine. Here, Dr. Mathew explains what to look for and what to expect if you see your physician for leg pain. 

Leg Pain From Back Disorders

Leg pain coming from the low back, or the lumbar spine, is commonly referred to as sciatica. Sciatica could involve pain in the buttocks, down the thigh, into the leg or in the foot. It is often associated with numbness or tingling, and sometimes weakness. 
Sciatica has multiple possible causes, such as:

• Herniated or ruptured disc
• Nerve root compression
• Arthritis in the spine
• Lumbar spinal stenosis (narrowing of the canal through which the nerve root travels) 

Leg Pain From Hip Disorders

When the hip is affected, you may have groin pain on the affected side, reduced range of motion of the hip, thigh pain, knee pain, or buttocks pain. The pain usually does not go down below the knee, and there is no associated numbness or tingling. You may feel more pain when walking or standing, and the pain improves with rest. You may sense a limited range of motion when trying to get out of the car, chair or bed. 

Occasionally, pain in the hip could be secondary to inflammation of a hip bursa. This can happen if you have tight hip abductor muscles, difference in leg length or hip arthritis. Hip pain can also be caused by something more serious but less common, like fractures, tumors, infection or avascular necrosis.

Accurate Diagnosis Is Key

If your physician examines your hip joint and notes no hip pain, and then examines your back and notes leg pain, the spine is usually the source of the problem. Some people may have localized hip pain without leg pain, but are found to have a normal hip and an abnormal spine. Others may have only leg pain, but are found to have an abnormal hip and a normal spine. Therefore, in addition to a good physical examination, imaging is important. 

Plain X-rays may be helpful, but sometimes an MRI is needed as well. If imaging does not determine the source of the pain, the next step would typically be to perform an injection of pain-relieving medication directly into the area suspected of causing pain. Whether you get pain relief from the injection can help your physician better understand where the pain is coming from. 

Treatment Options

Your physician may recommend anti-inflammatory medications, physical therapy or injections. If these treatments don’t help, or your condition continues to get worse, surgery may be an option. 
If you are experiencing leg pain, schedule an appointment with your physician for an evaluation. Treatment options exist that can help you return to the activities you enjoy.