Medically reviewed by Dr. Alexandru Florian Grecu, Senior Orthopedic Surgeon · Published: June 7, 2026 · Updated: June 7, 2026

Short answer: Not every "back pain" comes from the spine. In adults, pain felt in the lower back, the buttock or the hip can originate in the hip joint, in muscle, or in the spine. The confusion is common and it costs time: hip osteoarthritis often projects into the groin, the thigh, sometimes down to the knee. A clinical examination and an X-ray usually clarify the origin. What belongs to the hip and to a muscular cause is treated here; disc herniation, stenosis and sciatica of spinal origin, with a neurosurgical indication, are referred — once the diagnosis is clear.

"Back" does not always mean "from the spine"

"My back hurts" points automatically to the spine. Often, correctly. But the hip joint sits just below this region, and its pain projects deceptively — into the buttock, the low back, the thigh, sometimes down to the knee. The phenomenon has a name: referred pain. It is felt somewhere other than where it starts.

The confusion carries a clinical cost. Hip osteoarthritis treated as "lumbago" means months of physiotherapy on the spine with no result, because the source was in another joint. The distinction needs no complicated equipment — a correct clinical examination and an X-ray read carefully.

Where the pain called "back pain" can come from

From the hip — osteoarthritis or femoroacetabular impingement. Typically in the groin and thigh, worse on walking, on rotating the leg, on putting on socks.
From muscle — non-specific mechanical low back pain. Diffuse, linked to position and effort, no radiation down the leg, no numbness.
From the spine — disc herniation, stenosis, sciatica. Here the pain radiates along the nerve, down the leg, with numbness or tingling.

How it is told apart

A few signs orient quickly:

Groin pain on standing up from a chair or putting on shoes → points to the hip.
Diffuse low-back pain, no radiation, linked to posture and lifting → points to muscle.
Pain that starts in the back and travels down the leg, with numbness or tingling → points to the spine.

On examination, if rotating the hip reproduces the pain, the hip enters the discussion at once — regardless of whether the visit was for "the back" or "the knee".

Red flags

Some situations are not deferred. They need prompt evaluation:

weakness in a leg, the feeling the leg "gives way", or tripping;
loss of bladder or bowel control together with back pain — an emergency;
fever alongside back pain;
night pain, at rest, progressive, especially with weight loss or a past cancer (see orthopedic oncology);
pain after a strong trauma.

What I treat and what I refer onward

I examine clinically and radiologically to establish the origin of the pain. What belongs to the hip — osteoarthritis, conservatively or with a replacement when indicated — and muscular pain, I treat here. Disc herniation with a surgical indication, stenosis and sciatica of spinal origin are not my field: once the diagnosis is clear, I refer them to the spine surgeon or neurosurgeon.

The purpose of the consultation is triage. Pain labelled "back pain" for years sometimes proves, on examination, a hip problem — treatable. An early, correct diagnosis sets the course; hesitation lengthens it.

Frequently asked questions

Can back pain actually come from the hip?

Yes, often. Hip osteoarthritis is frequently felt in the groin, the thigh and sometimes the knee, not in the hip directly. That is why it can be mistaken for a spine problem.

How do I know if it is the hip or the spine?

Through a clinical examination and an X-ray. If the pain appears on rotating the hip and in the groin, the hip enters the discussion. If the pain travels down the leg with numbness, it points to the spine.

Do you treat disc herniations?

I do not operate on the spine. I evaluate the pain, treat what belongs to the hip and the muscular side, and refer what is outside my field to the spine specialist, after clarifying the diagnosis.

Why does my knee hurt if the problem is the hip?

Because it is referred pain: pain from the hip travels along a path that reaches the knee. It happens often and is one reason the hip is missed at diagnosis.

What imaging do I need?

Usually, an X-ray of the pelvis and hip is the first step. Depending on what we find, an MRI may follow. We decide exactly what is needed at the consultation.

About the author

Dr. Alexandru Florian Grecu, senior specialist in orthopedics and traumatology and Senior Lecturer at UMF Craiova. He evaluates and treats hip conditions and musculoskeletal pain; what is outside his field, he refers. Details on the About page.

Scientific references

Don't forget the hip! Hip arthritis masquerading as knee pain. J Orthop. 2017.

Back Pain That Actually Comes from the Hip