Hip-Spine Syndrome: Managing Lower Back and Hip Pain

A patient with arthritis may experience hip or groin pain, as well as trouble walking. A patient with lumbar spinal stenosis (the narrowing of the spinal canal) may have pain down their leg, or neurologic symptoms such as numbness, tingling, or weakness.

“Hip-spine syndrome is a distinct syndrome where both hip and spinal problems occur together,” says James D. Kang, MD, a Mass General Brigham orthopedic surgeon who specializes in spine surgery.

“Because hip and spine disorders have overlapping presentations and symptoms, it often can be challenging for doctors to determine if a patient’s symptoms come from the hip, spine, or both,” says Jeffrey K. Lange, MD, a Mass General Brigham orthopedic surgeon.

This can delay diagnosis and treatment. Many patients with hip-spine syndrome have seen several physicians and therapists, or they may have undergone various procedures that did not completely relieve their pain.

Dr. Lange specializes in hip surgery and works closely with Dr. Kang on treating patients with hip-spine syndrome. In this article, they provide tips to help patients manage pain.

How is hip-spine syndrome diagnosed?

“The first order of business is to make sure that the treating physician considers hip-spine syndrome in their evaluation,” says Dr. Kang. “The problem is that many centers are so sub-specialized that hip surgeons only see hip problems, and spine surgeons only see spine problems.”

“We’re at the forefront of public and academic awareness of this complicated syndrome. We spearhead several efforts in orthopedic research, including clinical investigations and patient outcome studies, trying to determine the optimal treatment plans for patients with hip-spine syndrome,” says Dr. Kang.

As a result of their ongoing studies, Drs. Kang and Lange authored a textbook to share approaches for managing hip-spine syndrome with other surgeons.

How is hip-spine syndrome treated?

For patients with minor hip or back pain, Drs. Kang and Lange typically prescribe rehabilitation and physical therapy. Only patients with more advanced hip-spine syndrome who do not respond to physical therapy require invasive treatments, such as an injection therapy, or surgery.

Exercises for lower back pain and hip pain

Rehabilitation and physical therapy help relieve minor hip-spine syndrome symptoms. Certain exercises help strengthen your muscles and reduce your back and hip pain.

A physical therapist may help you with these exercises and stretches for hip-spine syndrome:

• Core strengthening. These exercises target the muscles in your back and abdomen. Strengthening those muscles helps them better support your spine.
• Hip strengthening. These exercises target different muscle groups that support your hip, mostly in your thighs and butt. For example, hip abductor strengthening targets the muscles in your inner and outer thighs.
• Hip mobility stretching. Stretching, especially before and after completing strengthening exercises, helps you move better. It also helps to prevent injury and sore muscles.

If you do have surgery for hip-spine syndrome, Drs. Kang and Lange emphasize that physical rehabilitation is still important to help with pain and function. After surgery, you will likely work with a physical therapist to help rebuild and restrengthen your muscles.

Lifestyle changes to reduce hip and back pain

Drs. Kang and Lange also recommend lifestyle changes to those with hip and spinal disorders, including:

• Weight loss through diet and exercise may reduce pain and inflammation in your back and hips. Since many patients with hip-spine syndrome have trouble walking or running, Drs. Kang and Lange recommend lower-impact forms of aerobic conditioning, such as swimming and stationary biking.
• Quitting smoking is also important. Long-term exposure to cigarettes has been shown to impair the flow of oxygen to tissues, and may cause damage to the discs and joints.
• Using anti-inflammatory medications can help improve symptoms. Eating more anti-inflammatory foods, like plant-based meals, also helps reduce arthritis and joint pain.

Surgery for hip-spine syndrome

If physical therapy and lifestyle changes don’t relieve symptoms, you may need to consider surgery.

Drs. Kang and Lange recommend working with a provider who recognizes you have hip-spine syndrome and focuses your treatment on resolving the syndrome as a whole.

Surgery on your hip or spine is invasive, and you’ll need time to recover. A surgeon can’t perform both surgeries at the same time because it would be too difficult for you to recover. Your surgeon identifies if your hip or spine is causing the most problems, so you can have surgery for that first. Once you recover from the first surgery, you can then have the second, likely 3 to 6 months later.

For example, you may have a hip replacement surgery, in which a hip specialist replaces your joint (the ball and stem where your leg meets your hip). Then you may later have surgery on your lumbar spine by a spine specialist to address the spinal condition, such as a lumbar laminectomy or spinal fusion surgery. The surgeries together address the problems in both your hip and spine to help relieve your pain from both conditions.

Choosing an experienced team to treat your back and hip pain

Dr. Kang emphasizes finding a care team with experience treating hip-spine syndrome, not just in treating hip problems or spinal problems separately.

“Whether it’s physical therapy or surgery, treating the two areas in tandem is important for achieving a better outcome and quality of life,” he says. “At Mass General Brigham, we have developed care teams that work side by side to treat this difficult condition to ultimately get the best clinical outcomes and a satisfied patient.”