Is Your Hip Pain Actually From Your Back?

A Cromwell Osteopath’s Guide

Hip pain is one of the most misunderstood complaints we see in clinic.

People are often convinced they have a “hip problem”, yet months of stretching, rolling, strengthening, or rest make little difference. The frustrating truth is that pain location does not always equal pain source.

In many cases, hip pain is actually being driven by the lower back. And just as importantly, sometimes persistent back pain is coming from the hip due to poor load sharing.

Let’s unpack how this happens and why getting it right matters.

Why Hip Pain Is Often Misleading

The hip, pelvis, and lower back work as a unit. They share muscles, joints, and nerves, and they all contribute to how load is absorbed during walking, lifting, running, and daily life.

When one part is irritated or not coping well, the brain does not always send pain neatly to that exact spot. Instead, pain can be referred.

Hip pain that actually originates from the back commonly shows up:

• In the side of the hip

• Deep in the buttock

• Around the groin

• Down the outer thigh

• Occasionally into the knee

This is why scans and local treatments do not always provide answers.

How the Back Can Cause Hip Pain

1. Lower Back Joint Referral

Irritated lumbar spine joints frequently refer pain into the hip and buttock region.

This type of pain often:

• Feels deep and hard to pinpoint

• Changes with movement or posture

• Worsens with prolonged sitting or standing

• Improves once you get moving

2. Disc-Related Pain

Disc irritation does not always cause classic shooting sciatica.

It can present as:

• Hip or buttock pain

• Flare-ups with bending or lifting

• Pain that feels unpredictable or inconsistent

3. Nerve Sensitivity

Nerves that exit the lower back supply the hip and leg.

When irritated, they may cause:

• Burning or sharp hip pain

• Pins and needles

• Pain that is difficult to localise

But It Can Work the Other Way Too: When Back Pain Comes From the Hip

This is the part that often gets missed.

Back pain is not always a “back problem”.
Sometimes the hip is failing to tolerate load, and the back is forced to compensate.

We see this commonly in:

• Runners and hikers

• People with previous hip injuries

• Those who avoid hip loading due to pain or fear

• Physically demanding jobs

When the hip is underperforming, the lumbar spine picks up the slack.

How Hip Loading Compensation Drives Back Pain

If the hip cannot absorb force effectively:

• The lower back takes more load than it should

• Movement becomes inefficient

• The back works outside its ideal role

Over time, this can result in:

• Achy or stiff lower back pain

• Pain that flares after activity rather than during it

• Recurrent back “niggles” that never fully resolve

• A sense that your back is doing all the work

The back is not broken here.
It is simply over-contributing.

Signs Your Pain Might Be Coming From Somewhere Else

Your hip or back pain may be referred if it:

• Changes with spinal movement

• Is worse after sitting

• Improves as you warm up

• Does not reproduce clearly with local testing

• Comes and goes rather than steadily worsening

These patterns matter more than what a scan says.

Why Treating Only the Painful Area Often Fails

When treatment focuses only on where it hurts:

• The true driver of pain is missed

• Relief is short-lived

• Movement confidence drops

• Fear and avoidance increase

This is how pain becomes persistent, not because tissues are damaged, but because the system is not being challenged or reloaded appropriately.

How Osteopathy Approaches This Differently

Osteopathy does not stop at “where is the pain?”

A proper assessment looks at:

• The lumbar spine

• The pelvis

• Hip mobility and strength

• Load tolerance

• Movement patterns

• Nervous system sensitivity

Hands-on treatment can help settle symptoms, but long-term change comes from restoring capacity, not chasing pain.

Why Strength Work Is Usually the Missing Piece

Once the true driver is identified, progressive loading becomes essential.

This often includes:

• Gradual spinal loading

• Targeted hip and trunk strength

• Rebuilding tolerance to avoided positions

• Reducing fear around movement

Avoidance feels protective in the short term, but it reinforces the problem long term.

The Key Takeaway

Hip pain does not always mean a hip injury.
Back pain does not always mean a back problem.

Pain is often a load management issue, not a damage issue.

If your pain:

• Keeps returning

• Does not match imaging

• Feels inconsistent

• Or has stalled despite treatment

There is a strong chance the problem is not being looked at broadly enough.

Need Help ?

If you are dealing with hip pain from your back, or ongoing back pain in Cromwell, Central Otago, Queenstown Lakes or elsewhere we can help untangle what is really driving it. We also offer online appointments, where we assess movement, load tolerance, and rehab strategy remotely, and build a clear plan you can follow from anywhere.At The Recovery Project, our approach focuses on:

• Identifying the true source of pain

• Rebuilding strength and load tolerance

• Creating long-term, sustainable results

You do not need another quick fix.
You need clarity, confidence, and a plan that actually matches how the body works.