True hip pain, that is, pain originating from the hip joint itself, is usually felt in the front of the leg at the groin. Nonetheless, hip pain may be caused by a herniated disc, especially if the hip pain occurs at the side or the back of the hip. A herniated lumbar disc can lead to nerve compression, radiculopathy, and pain the extends to the hip and down the leg. It can be difficult to distinguish between the various causes of hip pain, but Dr. Lanman is an expert in this area with decades of experience. This article provides a detailed overview of herniated disc hip pain.
Can Herniated Discs Cause Hip Pain?
Unfortunately, yes, herniated discs can cause hip pain. While hip pain can have many potential causes, a herniated disc should be considered as a possible source, especially if the hip pain is accompanied by lower back pain, leg pain, numbness, or weakness. A herniated disc, where the inner gel-like material of the disc protrudes and puts pressure on nearby nerves, can cause pain that radiates from the lower back down into the hips and legs. This is because the nerves that control sensation and movement in the hips, legs, and feet originate from the lumbar (lower back) region of the spine. A herniated disc in this area can compress these nerves, leading to hip pain.
Symptoms and Diagnosis
The pain from a herniated disc is often described as a sharp, shooting pain that can be felt in the front or back of the hip. Patients may also experience weakness or numbness in the affected area. Dr. Lanman can usually diagnose hip pain caused by a herniated disc by taking your medical and family history and performing a physical examination, including a neurological examination. To confirm the diagnosis and prepare for surgery, you may need to undergo imaging studies like X-ray or MRI. In rare cases, nerve conduction studies and Electromyography (EMG) may be needed.
How to Help a Herniated Hip
It can be extremely difficult to live with the hip pain caused by a degenerated disc. A herniated lumbar disc can cause persistent, sharp, and burning pain that radiates from the lower back down into the hips and legs. Herniated discs can lead to weakness, numbness, and limited range of motion, making it difficult to perform normal movements and activities. Certain activities like sitting, bending, or lifting can worsen the pain from a herniated disc.
It is quite common for people to be unsure whether to try to heal on their own or to pursue treatments like medication, physical therapy, or surgery. Navigating the various treatment options and determining the best course of action can be complex. As always, we recommend that you speak with Dr. Lanman to get expert advice on degenerated disc hip pain treatment.
Non-Surgical Treatment Options
Physical Therapy: Physical therapy can help you strengthen muscles, improve flexibility, and alleviate pressure on the affected disc. This may include core stabilization exercises, stretching, and manual therapy techniques
Medication: Over-the-counter pain relievers such as ibuprofen, naproxen, and acetaminophen reduce pain and inflammation. Prescription pain relievers and muscle relaxants may be needed in more severe cases of hip pain.
Lifestyle Modifications: While it is important to continue to move with a herniated disc (bed rest is NOT recommended), strenuous activities and heavy lifting should be avoided. Ensure that your work and home environments are ergonomically optimized and maintain a good posture while standing and sitting. Heat or cold (not at the same time) can also be helpful.
Surgical Treatments for Herniated Hip
Indications for Surgery: When conservative treatments fail to provide adequate relief, it may be time to consider surgery for a herniated disc. If the pain is severe or the spine is unstable, you may need surgery as soon as possible. In most cases, however, surgery is only considered if conservative treatments fail to provide relief after 4 to 6 weeks.
Surgical Procedures: In general, there are four types of surgeries that are used to treat hip pain caused by a herniated disc:
Microdiscectomy/Discectomy: The surgeon removes the portion of the disc that is protruding and compressing the nerve. This can be done through a minimally invasive “microdiscectomy” approach using smaller incisions.
These procedures involve removing a portion of the vertebral arch (lamina) to relieve pressure on the nerve roots. A laminotomy makes a small opening, while a laminectomy removes the entire lamina. These may be done in combination with a discectomy.
Spinal Fusion: In this procedure, two or more vertebrae are permanently fused together using bone grafts and/or hardware like screws and rods. This stabilizes the spine and takes pressure off the affected nerve. An advanced, minimally invasive technique called transforaminal lumbar interbody fusion (TLIF) may be used.
Artificial Disc Replacement: The damaged disc is removed and replaced with an artificial disc made of plastic and metal. This preserves some motion in the spine, unlike fusion. It is typically only used for a single-level disc herniation in the lower back, but Dr. Lanman has successfully performed ADR on multiple levels.
Can L4-L5 Cause Hip and Groin Pain?
Yes, A herniated disc at the L4-L5 level in the lower back can compress the nerve roots, leading to referred pain that radiates down the leg, including the hip and groin area. About 4% of patients with lower lumbar disc herniations, particularly at the L4-L5 level, experience groin pain as a symptom. In most cases, groin pain indicates hip arthritis, especially in older patients. The Straight Leg Raise Test (examiner raises the patient’s straight leg) is commonly positive (hip pain is provoked) in lumbar disc herniation.
Disc Degeneration Effects
Degeneration or herniation of the L4-L5 disc can compress nearby nerves, leading to hip and groin pain. This is because the nerves that innervate the groin area originate from the lower lumbar spine, specifically the L2 and L3 nerve roots.
Referral Patterns
When the L4-L5 disc degenerates or herniates, it can put pressure on these nerves, causing referred pain to be felt in the groin and hip region. The sinuvertebral nerve, which innervates the posterior annulus fibrosus, posterior longitudinal ligament, and dura, is indicated as the afferent nerve responsible for transmitting this groin pain.
Diagnostic Imaging
To diagnose discogenic groin pain, clinicians can use a combination of techniques, including MRI to identify disc degeneration, lidocaine injection into the hip joint to rule out hip pathology, pain provocation on discography, and pain relief with anesthetic disc block.
Nerve Root Compression
The nerves that innervate the groin area originate from the lower lumbar spine, specifically the L2 and L3 nerve roots. When the L4-L5 disc degenerates or herniates, it can put pressure on these nerves, causing referred pain to be felt in the groin and hip region. In addition to groin pain, compression of the L4-L5 nerve roots can also lead to tingling and numbness in the lower extremities. The numbness may be felt in one leg that can begin in the buttock or behind the knee and extend to the thigh, ankle, or foot. This tingling and numbness can be constant or come and go depending on the position of the back.
Differential Diagnosis
Accurately identifying the source of the hip and groin pain, whether it is from the L4-L5 disc or another cause, is crucial for proper diagnosis and effective treatment. Other important causes of similar pain include hip arthritis, iliopsoas muscle strain, cauda equina syndrome, peripheral mononeuropathies, and spinal stenosis.
Treatment Implications
As you can imagine, knowing the correct diagnosis is absolutely critical to providing the correct treatment. For example, cauda equina syndrome requires immediate surgery. On the other hand, iliopsoas muscle strain can almost always be treated with conservative management. Hip and groin pain should be evaluated by a medical professional. Dr. Lanman is regarded as a leading expert in disorders of the spine and related conditions.
Hip Pain Management Strategies
Hip pain caused by a herniated disc can be managed conservatively with activity modification, heat or cold compresses, anti-inflammatory drugs, and directed exercises. When these fail, surgery may be required such as artificial disc replacement or spinal fusion.
Lifestyle Modifications
Weight Management: Maintaining a healthy weight is crucial, as excess weight puts additional strain on the joints, including the hips and spine. Even modest weight loss of 10% can reduce joint pain and symptoms.
Dietary Changes: Incorporating anti-inflammatory foods like fatty fish, dark leafy greens, and beans can help reduce inflammation and discomfort in the hips and spine. Avoiding processed foods and focusing on whole, plant-based foods can also promote overall joint and spine health.
Exercise and Physical Activity: Low-impact exercises like walking, swimming, cycling, and gentle stretching can help improve mobility, flexibility, and muscle strength around the hips and spine. Avoiding high-impact activities like running, stair climbing, and contact sports is recommended for those with hip or spine issues. Physical therapy can be beneficial to learn proper exercises and movements to support the affected areas.
Stress Management: Finding healthy outlets for stress, such as social connections, can help reduce the negative impacts of chronic stress on the body. Techniques like meditation, yoga, and deep breathing can also aid in stress relief.
Posture and Ergonomics: Maintaining good posture, especially when sitting for long periods, can help reduce strain on the spine and hips. Using ergonomic furniture and equipment, such as supportive chairs and standing desks, can also be beneficial.
Sleep Optimization: Ensuring adequate, high-quality sleep is important for the body’s natural repair and recovery processes. Avoiding blue light exposure before bedtime and establishing a consistent sleep routine can improve sleep quality.
Final Thoughts from Dr. Lanman
Herniated discs can cause hip pain. It is important to get an accurate diagnosis of the cause of hip pain so you can get the proper treatment. Dr. Lanman is an expert in various causes of hip pain, especially those related to herniated spinal discs. Contact Dr. Lanman today to discuss your hip pain.
FAQS:
Where is degenerative hip pain felt?
Degenerative hip pain is typically felt in the front/groin area of the hip. Interestingly, pain in the front of the hip, or groin, is true hip pain. This is the typical location of pain when there is pathology within the ball and socket joint itself. When pain is felt in the back of the leg or hip, it is more likely to be lumbar disc pain.
Can degenerative disc disease spread to the hips?
Yes, but it is uncommon. About 4% of patients with lower lumbar disc herniations, particularly at the L4-L5 level, experience groin pain as a symptom.1
How can I tell if my herniated disc is healing?
You can tell if you herniated disc is healing if you have less discomfort and pain in the affected area. Likewise, you may experience restored mobility and range of motion. Muscle spasms should decrease and you should ultimately sleep better.
How can you tell if hip pain is from hips or back?
True hip pain—pain from the hip joint itself—is typically felt in the front of the leg in the groin. Hip pain from a herniated disc is typically felt in the back of the hip. This isn’t always the case, but it is the most common way to distinguish the two.
Can a herniated disc make your hips hurt?
Yes, a herniated disc can make your hips hurt, but it isn’t really the hip that is causing the pain. It is referred pain from the compressed nerves near the spine.
When should you see a surgeon for hip pain?
Diagnosing hip pain accurately is surprisingly difficult. For most people with new hip pain, it is best to speak with a back pain specialist like Dr. Lanman. If you have new hip pain with fever, chills, loss of bowel or bladder function, or the pain is severe, seek medical attention immediately.
