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    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
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      • Sphinx Test
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      • Supine to Long Sit Test
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      • External Rotation Lag Sign
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      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
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      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
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      • Sulcus Sign
      • Thoracic Outlet Tests >
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        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
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      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
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      • Moving Valgus Stress Test
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      • Ulnar Nerve Compression Test
      • Valgus Stress Test
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    • Knee >
      • Anterior Drawer Test
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      • Joint Line Tenderness
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      • McMurray Test
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      • Pivot-Shift Test
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      • Thessaly Test
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      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
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Hip vs. Low Back: Identifying the Source of Pain

12/12/2018

1 Comment

 
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I recently evaluated a patient who came into the clinic with the self- diagnosis of right hip pain. When I asked him where his hip hurt, he pointed to the back of his hip joint, just lateral to his sacroiliac joint. Upon further subjective history, he stated the current pain was very similar to his left hip pain that forced him to have a hip replacement 3 years prior. Needless to say, he was worried his current hip pain would lead to another hip replacement in the future. 

​During the objective examination, I found this patient to have decreased hip flexion, internal rotation, and extension. While he had limitations in joint mobility, general hip quadrant and scour testing was negative. Looking at regional joints, the patient reported exquisite tenderness to palpation with PA assessment from L4-S1. Additionally he experienced pain with end range lumbar flexion and right rotation as well as various core stability tests. Most notably, his primary report of hip pain was reproduced during the lumbar cardinal plane testing. Since this gentleman had both hip and lumbar impairments, where was the BEST place to start? 

Initiate Treatment at the Hip or Low Back?

During any hip examination, I always assess the lumbar spine. Since these body regions are connected via the pelvis, pain or symptoms in one region can directly impact the other. Additionally, I always use the patient's location of symptoms and mechanism of injury to help guide my diagnosis. As a general rule, if the patient reports that their pain is located anteriorly, symptoms are likely coming from the hip joint. From a movement perspective, less motion exists in hip flexion, adduction, and internal rotation, which places the anterior hip joint in a compromised position if pathology, such as hip OA or FAI, is present. If the patient reports their pain is located posteriorly, symptoms are likely coming from the low back region. Both the lumbar facet joints and regional nerves often refer posteriorly. While the L1-2 dermatomes can refer to the anterior hip joint, these nerve roots are less often irritated, which decreases the likelihood that the spine is causing anterior hip pain. There are always exceptions to this rule, but it is a great starting point to help guide your treatment selection. 
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What Did I Do with My Patient on Day 1?

Since his pain was reproduced with low back cardinal plane testing, I focused FIRST on the lumbar spine, then SECOND on the hip joint. During the initial visit, I did Trigger Point Dry Needling at the L4-5 multifidus and gluteal muscles. Then, I performed L5-S1 joint PA mobilizations to improve lumbar mobility and a hip long axis distraction manipulation. For his exercise prescription, he was given quadruped hand to heel rocks & repeated supine hip internal rotations. These both focused on improving mobility in general and desensitizing the patients pain. 
Hand Heel Rocks
Hip Internal Rotations

Interested in learning more about the hip? 

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Orthopedic Management of the Hip Joint
This course provides an in-depth assessment of the hip region. We cover several different assessment and treatment models, incorporate advanced examination and evaluation strategies from our training as Orthopedic Clinical Specialists and manual therapy fellowship trained therapists, and much more!
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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test