How Are Hip Pain and Lower Back Pain Connected?
Hip back pain often occurs together because the hip joint, pelvis and lumbar spine work as a single mechanical unit. Stiffness or misalignment in one area changes how the others move and bear weight. That means the place you feel pain is not always the place the problem started. A standing whole-body image can show the full picture.
Key takeaways
- The hip, pelvis and lower back share muscles, nerves and load. A problem in one affects the others.
- Back pain radiating to the hip, or hip pain that triggers a sore back, are both common patterns.
- Lying-down scans relax the muscles and can hide alignment issues that only appear when you stand.
- A whole-body standing image captures the full chain from feet to spine in one view.
- EOS imaging uses about 90% less radiation than a standard X-ray, around ten times less.
Why do the hip and lower back affect each other?
The hip joint and the lumbar spine are neighbours that share a workload. Every time you stand, walk or bend, force travels through both structures. The pelvis sits between them like a platform. If your hip stiffens, your lower back bends more to compensate. If your lumbar curve flattens or deepens, your hip takes on extra strain. Clinicians sometimes call this relationship "hip-spine syndrome."
This chain effect also involves sagittal balance, the front-to-back alignment of your whole skeleton when you stand upright. When one link in the chain shifts, everything above and below adjusts. That is why back pain radiating to the hip, or hip and lower back pain on the same side, is so common.
How do I know if my pain is coming from my hip or my back?
It can be genuinely difficult to tell. Both can cause pain in the buttock, groin or thigh. Some patterns give useful clues, but overlap is common. That is why imaging the whole chain, not just one joint, matters.
Often points to the hip joint itself, especially if it worsens when you put weight through the leg.
Pain travelling past the knee or into the foot often suggests a nerve issue in the lower back, not the hip.
Trouble bending to reach your feet can signal reduced hip range. But a stiff lower back can cause the same difficulty.
Hip and lower back pain on the same side is a classic compensation pattern. Both areas may be involved.
A note on soft tissue. EOS imaging shows bones, joints and alignment clearly. If your clinician suspects a disc bulge, nerve compression or soft-tissue damage, MRI is usually the better tool. The two types of imaging complement each other well.
Seek urgent help if you have sudden numbness or weakness in your legs, or any loss of bladder or bowel control. Contact your GP, call 111, or go to A&E. Do not wait for a scan.
What causes hip and lower back pain together?
Several conditions can produce both hip and back symptoms at the same time. Often the root cause is an alignment or mobility problem that puts extra load on neighbouring structures.
A stiff hip reduces extension. The lumbar spine compensates by bending more, straining muscles and discs.
A forward or backward tilt of the pelvis changes the curve of the lower back and loads the hip joints unevenly.
SI joint dysfunction sits right at the junction of spine and pelvis, producing pain in both areas.
Nerves from the lower lumbar spine supply the hip and groin. A back problem can feel like a hip problem, and vice versa.
How does a standing scan show what lying-down imaging misses?
Most conventional imaging, including standard X-rays, CT and MRI, is done while you lie down. That position relaxes your muscles and removes the effect of gravity. Your joints settle into a resting position that may look normal even when your standing posture is not.
When you lie flat, gravity no longer pulls through your skeleton. A pelvic tilt may disappear. A lumbar curve may look normal. Your hip may appear well aligned. The image is accurate for that position, but it is not the position you live in.
Standing up loads your full weight through the hip, pelvis and spine. A tilt, a curve change, or a compensation pattern that only shows up under gravity becomes visible. With ScanAlign, whole-body standing EOS imaging, the entire chain from your feet to the top of your spine is captured in a single, weight-bearing image using about 90% less radiation than a standard X-ray, around ten times less.
This matters because treatment decisions, whether physiotherapy, injection or surgery, rely on understanding how your body behaves under load. A scan that shows you in a relaxed, lying position may not tell the full story. Read more about what EOS imaging reveals about back pain and posture.
Wondering whether your hip and back pain are connected? A standing whole-body image can show the full alignment picture.
Book a free video consultationWhat can be done about hip and lower back pain?
The most important first step is working out where the problem actually starts. Many people spend months treating one area when the driver sits somewhere else in the chain. Once you have a clear picture of your alignment, your clinician, whether a physiotherapist, osteopath or orthopaedic surgeon, can plan the right approach.
Common approaches include targeted exercises to improve hip mobility or core stability, manual therapy, and sometimes guided injections. In some cases, surgery on the hip or spine may be considered, but only after the whole alignment picture is understood. ScanAlign does not provide treatment. It provides the diagnostic imaging that helps your treating clinician make better decisions.
If you have already had lying-down imaging that looks normal but your symptoms persist, a standing whole-body scan may reveal the compensation pattern your previous images could not show. You can book a whole-body standing scan without a GP referral.
Frequently asked questions
Yes. A stiff or arthritic hip reduces your range of movement, forcing the lumbar spine to bend and twist more to compensate. Over time this extra demand can cause back pain, even if there is nothing structurally wrong with your spine.
Yes. Nerves from the lower lumbar spine supply the hip, groin and buttock. A disc issue or joint narrowing in the lower back can refer pain into the hip area, making it feel as though the hip itself is the problem.
Hip-spine syndrome describes the overlap between hip and spinal conditions. When both areas are affected, treating just one may not resolve your symptoms. Understanding the relationship between the two is essential for planning the right course of action.
Same-side pain often happens because the hip and lumbar spine share muscles and nerves on each side. Stiffness or misalignment on one side creates a lopsided load. Your body compensates on that side, producing pain in both areas.
Groin pain that worsens with walking often points to the hip. Pain that travels down the leg past the knee usually starts in the back. However, overlap is common, and many people have issues in both areas. A full assessment of your alignment can help clarify the source.
Lying-down scans remove the effect of gravity, so your muscles relax and your joints settle into a resting position. Alignment issues that only appear when you stand and bear weight can be missed. A standing whole-body image captures your skeleton in the position it actually works in.
EOS uses about 90% less radiation than a standard X-ray, around ten times less. The scan takes only a few seconds while you stand still. It is a very low-dose form of imaging.
No. ScanAlign is a private self-pay clinic. You can book directly without a referral. You start with a free video consultation to make sure the scan is appropriate for you.
Pricing details are available on the ScanAlign FAQs page. The free video consultation is at no cost and with no obligation.
They do different jobs. EOS excels at showing bones, joints and whole-body alignment under gravity. MRI is usually better for soft tissue, discs and nerves. In many cases, having both gives the most complete picture.
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- Offierski CM, MacNab I. Hip-spine syndrome. Spine. 1983;8(3):316-321.
- NHS. Back pain: causes, treatment and prevention. nhs.uk/conditions/back-pain.
- Deschênes S, et al. Diagnostic imaging of spinal deformities: reducing patients' radiation dose with a new slot-scanning X-ray imager. Spine. 2010;35(9):989-994.
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.