Back and Hip Injuries

The back is a very common area of pain and injury, especially the lumbar spine.  It is estimated that lower back pain may affect as much as 80 to 90 percent of the general population at some point in their lives.  This can range in intensity and duration. Pain levels can vary from mild to severe, while duration can be short-lived to sometimes chronic.

Lower back pain can often be mistaken for hip pain and vice versa.  The hip joint is located near the spine so injuries to the hip can resemble or actually be a cause of pain in the lower back.  Hip injuries themselves are a common injury in athletes such as runners, swimmers, cyclists, golfers, and baseball players.

The Primary Function and Anatomy of the Back 

The spine runs from the base of the skull to the pelvis.  The function of the spine is to support the weight of the body and protect the spinal cord.  The spine is made up of vertebral bones stacked on top of each other like blocks. There are cushions called discs located in between these bones.  The discs help support the load of the spine as well as help absorb shock. The spinal cord is a column of nerve fibers that are responsible for sending and receiving messages from the brain.  The spinal cord branches off into nerve roots and nerves that then travel to the whole body. 

The spine is naturally curved and from the side, it resembles an “S” shape.  This shape helps the spine evenly distribute body weight and ensures that it is able to withstand great amounts of stress.

The spine is divided into three regions:

• Cervical spine:  The cervical spine is the neck area and is the top part of the spine.  There are seven vertebrae in the cervical spine, the first two of which greatly assist with neck rotational movement.  
• Thoracic spine:  The thoracic spine is the middle or chest section of the spine.  There are 12 vertebrae in the thoracic spine and is the location where the ribs attach. 
• Lumbar Spine:  The lumbar spine is the lower back portion of the spine.  There are usually 5 vertebrae in the lumbar spine, although some people have 6.  The lumbar spine bears the bulk of the body’s weight and thus has the largest sized vertebrae.

The Primary Function and Anatomy of the Hip

The hip joint is formed where the femur (thigh bone) meets the acetabulum of the pelvis.  The hip joint helps to support the body’s weight while standing and while in motion. It also has an important role in balance.  The ball and socket nature of the hip joint allows for a plethora of emotions including flexion, extension, abduction, adduction, internal rotation, and external rotation.

The hip joint is extremely strong due to the reinforcement by strong ligaments and muscles that help provide stability.   There is cartilage at the ends of the bones that allow smooth gliding of the bones during joint motion. The labrum is a fibrocartilaginous extension of the pelvic acetabulum and helps hold the femoral head in place providing additional joint stability.

Common Types of Back and Hip Injuries Seen in Our Practice

• Back, Hip/Groin, Hamstring, Thigh Strains:  A strain is an injury to the muscle where the fibers are torn or overstretched.  It can also refer to damage to the attaching tendons, which connect the muscle to the bone.  Minor injuries involve only overstretching of the muscle or tendon, while more severe injuries may involve partial or complete tears in these tissues. 
• Degenerative Spine Conditions:  Usually with aging, the spine has a gradual loss of normal structure and function.  This can include degenerative osteoarthritis of the back where there is wear and tear of the cartilage between the facet joints.  It can also include degeneration of the spinal disc where the disc space between the vertebrae become thinner and place more pressure on the facet joints.  Spinal arthritis may cause bone spurs that can narrow the passages for the spinal cord and the nerves exiting the spine. This may lead to two painful conditions called spinal stenosis and radiculopathy.  
• Spondylolysis:  This is a condition often seen in young athletes with lower back pain.  Spondylolysis is a stress fracture in the vertebrae caused by repeated stress in sports such as gymnastics, football, and weight lifting.  The stress fracture can occasionally weaken the bone so much that it is unable to maintain it’s proper position and it slips out of place. 
• Hip Bursitis and Tendonitis:  Bursas are fluid-filled sacs resting between tissues such as muscle, bone, and tendons.  The trochanteric bursa is located on the lateral (outside) point of the hip. It can become inflamed and irritated, causing pain in the hip.  Similarly, the muscles around the hip connect to the bones through tendons. The tendons can become inflamed and irritated with overuse causing pain. 
• Degenerative Hip:  As with all joints, the cartilage in the hip can begin to wear down gradually with time and use.  The hip is a common area for this to occur.  

How are the Causes of Back and Hip Pain Diagnosed?

First and most important is a good thorough medical history intake and a physical exam. 

Imaging tests can also help with the diagnosis.

• X-Ray:  X-rays use radiation in the form of electromagnetic waves of high energy to pass to create pictures of the inside of your body.  X-rays show bones well and can help us identify things such as fractures. It is also very helpful in identifying things such as dislocations.  It can also help us identify signs of osteoarthritis.  
• MRI Scan: MRI scans use large magnets and radio waves to look at structures inside your body with great detail. It is a helpful imaging study to visualize soft tissues such as muscles and ligaments, as well as give an additional evaluation of bones.

• CT Scan: A CT scan is an imaging tool that combines x-rays with computer technology to produce a detailed cross-sectional image of your body.  In our field, it is helpful sometimes for further evaluation of bony structures.
• Ultrasound: Ultrasound uses high-frequency sound waves that echo off the body.  It is a non-invasive study that does not use any radiation. It is used in-office to help with the diagnosis of some musculoskeletal conditions.

Treatment for Back and Hip Injuries

There are many treatment options for back and hip pain.  However, the treatment option varies depending on multiple factors such as age, injury, medical history, etc.

• RICE therapy: RICE is a form of self-treatment or can be done under the guidance of trained physiotherapists. RICE stands for Rest, Ice, Compression, and Elevation. This therapy can help improve pain and swelling of many back and hip injuries. 
• Heat therapy:  Heat can help relax tense muscles and soothe stiff joints.  You can use a heated pad or hot water bottle. 
• Physical therapy: Manual therapy and a special exercise routine planned by a physiotherapist, keeping the condition of the patient in mind, can help strengthen the back and hip muscles and improve their flexibility.

• Medication:  Over the counter medications such as acetaminophen or ibuprofen can help ease the pain.  Stronger pain medications and muscle relaxers can also be of help temporarily.
• Steroid injections: Steroid injections, usually in conjunction with physical therapy, can be helpful to reduce inflammation and overall pain.
• Surgery: If conservative treatment does not work, surgery may be needed.  Sometimes surgery needs to be considered sooner depending on the injury itself. 

Stephen S. Chen, MD- Sports Medicine Doctor can help you evaluate and treat your back and hip pain. Contact us using our phone number 925-934-3536 or email us at stephen.chen@eastbaysportsdoc.com to book an appointment.