A large number of patients arrive at my clinic having been treated for a back problem for months, when the joint causing their pain is the hip. The reverse happens too. Both situations waste time and money — and in the case of avascular necrosis of the hip, they waste the window in which the joint could still have been saved.
I am a knee, hip and shoulder surgeon. What I can do is tell you reliably which of the two it is — and that single piece of information changes the entire treatment plan.
Dr. Sunil Choudhary, FRCS (Trauma & Orthopaedics). This page is about getting the diagnosis right before anyone starts treating you.
Why this confusion happens so often
The hip joint and the lower spine share nerve supply, sit close together, and refer pain into overlapping areas. Hip arthritis can produce pain in the buttock and down the thigh that feels exactly like sciatica. Lumbar nerve root compression can produce pain in the groin and front of the thigh that feels exactly like hip arthritis. And in older patients, both conditions are frequently present at once — so the real question becomes which one is causing the symptoms that bother you.
How hip pain and back pain are told apart
- Groin pain — almost always the hip joint
- Buttock pain running below the knee, with pins and needles or numbness — almost always the spine
- Difficulty putting on socks and shoes — points to hip stiffness
- Pain worse bending forward or sitting for long periods — points to the spine
- Pain worse on walking and weight-bearing, relieved by sitting — points to the hip
- Pain relieved by leaning forward on a trolley while walking — suggests spinal stenosis
- Loss of internal rotation of the hip on examination — one of the earliest and most reliable signs of hip arthritis
Sciatica pain in Faridabad — is it really your spine?
Sciatica describes pain radiating along the sciatic nerve, from the buttock down the back of the leg, usually caused by compression of a nerve root in the lower spine — most often by a disc herniation or by spinal stenosis.
Genuine sciatica follows a nerve distribution, typically extends below the knee, and is commonly accompanied by numbness, pins and needles or weakness in a specific pattern. Pain that stops at the thigh, without neurological symptoms, is frequently not sciatica — it is referred pain, and the hip is a common source.
Sciatica pain treatment in Faridabad should therefore begin with establishing the source. If it is genuinely spinal, the treatment is spinal — and I will refer you to a spine surgeon rather than treat it myself.
Nerve pain from a trapped nerve — and when it is not the nerve at all
Some nerve-related symptoms in the limbs do fall within orthopaedic assessment: meralgia paraesthetica causing numbness over the outer thigh, cubital tunnel symptoms at the elbow, and nerve-type symptoms referred from hip or shoulder pathology. These I assess and treat.
Nerve pain treatment in Faridabad for neuropathic pain arising from diabetes, chemotherapy or an autoimmune condition is a different specialty altogether. That is managed by a physician, neurologist or pain specialist, and I will refer you rather than treat it. Saying so clearly is more useful to you than claiming otherwise.
What the assessment involves
- Examination of both the hip and the lumbar spine at the same visit
- A standing pelvis X-ray — a lying-down film can under-represent hip joint space loss
- Neurological examination of both legs — power, sensation and reflexes
- Where the picture remains unclear, a diagnostic local anaesthetic injection into the hip joint. If the pain disappears for a few hours, the hip is the source. This settles the question definitively
- MRI where spinal pathology is suspected
Red flags — symptoms that need urgent assessment
Seek urgent medical attention, the same day, if back pain is accompanied by:
- Loss of bladder or bowel control, or difficulty passing urine
- Numbness around the back passage, genitals or inner thighs
- Progressive weakness in one or both legs
- Fever with back pain
- Unexplained weight loss, or a history of cancer
- Severe pain following significant trauma
Frequently asked questions
I have been having physiotherapy for my back for six months with no improvement. What should I do?
Ask for your hips to be examined and for a standing pelvis X-ray. Prolonged failure of correctly delivered spinal treatment is a common presentation of unrecognised hip arthritis.
Can hip and spine problems both be present?
Yes, frequently in patients over 60 — sometimes called hip-spine syndrome. The task is to determine which is generating the dominant symptoms, because treating the wrong one first produces disappointment. A diagnostic injection is often the deciding test.
Do you perform spine surgery?
No. My subspecialty is knee, hip and shoulder. I assess back and leg pain to establish whether the hip is responsible, and refer to a spine surgeon when it is not.
Where is this assessment available in Faridabad?
At the Bone & Joints Clinic, Sector 42, and at Dr. Sunil Choudhary’s Bone & Joints Clinic — the back and hip pain assessment clinic in Faridabad, with imaging and diagnostic injection available.
Author & Medical Review
Medically reviewed by Dr. Sunil Choudhary, MBBS, MS, DNB, MRCS, FRCS (Tr & Orth).
