When lower back and hip pain are experienced simultaneously, there are numerous potential problems which must be explored as the source of pain. Often more than one on the list below is involved: 1) Postural Distortion – Postural distortion, which often involves a torsion in the pelvis, can create chronic compensations in both the lower back and muscles of the hip. Such a torsion, which usually creates a functional leg-length discrepancy, forces the body to hold itself up in gravity by stabilizing the body wherever it needs to in order to maintain an upright posture. Over time, compensating muscles become ischemic (reduced blood flow to the muscles) which makes them painful and may result in active trigger points. 2) Iliopsoas Syndrome – The two muscles which form the iliopsoas muscle, the psoas and the iliacus, are both often implicated in cases of lower back and hip pain. When the psoas is tight or strained, pain is often produced when moving from sitting to standing, though pain during other movements is possible as well. Hip pain that is otherwise unexplained can frequently be sourced in a locked and ischemic iliacus muscle. When standardized tests for hip capsule problems are negative, and direct manual therapy of the gluteal and hip muscles does not provide any relief for persistent hip pain, iliopsoas dysfunction (especially iliacus dysfunction) should always be explored. 3) Piriformis Syndrome – Piriformis Syndrome is the result of the entrapment of the sciatic nerve by a chronically tight piriformis muscle. The sensation of pain is typically located in the buttocks though many individuals may feel pain into the hip joint as well. 4) Tight Leg Muscles – Tight and short leg muscles is one of the most frequent contributors to pain in the lower back and/or pain in the hip, yet it is one of the easiest to remedy. If the muscles of the legs are tight and short, compensation may occur in the lower back and hip muscles. This can be easily tested by exploring one’s range of motion. Can’t touch your toes? Your hamstrings are likely tight. Can’t sit on the ground in a cross-legged position? Your hip muscles are likely tight. 5) Trigger Points – Myofascial trigger points in muscles such as the quadratus lumborum, gluteals, piriformis, deep hip rotators, and iliopsoas (see Iliopsoas Dysfunction above) can produce significant lower back and hip pain. If the pain seems to move around, it can indicate that more than one of these muscles has active trigger points. Such multiple trigger points can present a confusing fluctuation of pain. 6) Sacroiliac Joint Dysfunction – When one of the sacroiliac joints is stuck and unmoving, as can often occur with pelvic torsion (see Postural Distortion above) sacroiliac joint dysfunction may result leading to lower back and hip pain. Sometimes the pain is located in the stuck SI joint itself. Sometimes the opposite sacroiliac joint may become hypermobile (too loose) as a compensation for the stuck side and the hypermobile SI joint can be the primary source of pain.
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