Hip and Back Pain
A guide to the arcane and mysterious world of hip and back pain, with tips for treatment and recovery.
Posted Saturday, 15 November, 1997
Hip and back conditions are often interrelated, and there's often a nasty domino effect of injuries. For example, tense lower-back muscles can contribute to piriformis syndrome which in turn can cause inflamation of the sciatic nerve. Not only can this be a painful experience, but it makes it rather difficult to track down the source. Often, these injuries in the hip or buttock tend to cascade from lower-back strain or injury. Wherever it hurts, look over the material here on lower back pain for some possible causes of your particular injury.
Back pain can be an indicator of a serious problem (though not necessarily). As always, keep in mind that the material in this section cannot replace the advice of your own medical doctor. If you are in severe pain, make an appointment.
> Lower back pain
> Hip & buttock pain (Piriformis syndrome)
> Pain at the side of the hip
Lower Back Pain
Back pain is a strange and mysterious thing. Every time your feet hit the ground, the shock is transferred up your legs to your hips and spine, and any biomechanical irregularity or imbalance can ultimately cause lower back pain. It could be that you have flat feet, and your over-pronation is causing a back ache. It could be that one of your legs is ever-so-slightly shorter than the other, or that your pelvis is just a wee bit uneven. You could have a curve in your spine. More seriously, one of the discs between the vertebrae of your spine could be degenerating.
Back pain can be a tough mystery to solve, but with a doctor's help you should be able to track down the cause. While muscle strain is the most common cause of back pain for runners, play it safe and visit an orthopedist, an osteopath, or perhaps a chiropractor to have your spine and vertebrae examined if you are experiencing severe pain.
If you have ruled out sciatica, you may have an uneven pelvis or unequal leg lengths. These conditions are relatively common; ask your doctor to examine whether one of them is the case for you. With either, the muscles on one side are being pulled. They're tense to begin with, and the added pounding of running can put them into spasm.
Relatively weak abdominal and lower back muscles might also contribute to the problem. Running generally tends to cause strength imbalances between these muscle groups. Add tight hamstrings, another common condition among runners, and you have a nifty recipe for back pain.
Finally, the root cause may be in your foot. Back pain is one of the many possible injuries associated with flat feet and over-pronation (i.e., your foot tends to roll inward too much when you run). Likewise, if your second toe is longer than the big toe (a condition known as Morton's Toe), this could cause a weight imbalance resulting in back pain.
For immediate relief, cut back on the mileage and try some damp heat: hot baths or the steam room. Heating pads and heat rubs may help somewhat, but wet heat seems to work better than dry.
As for fixing the root cause of your pain, it's a matter of figuring out which of the many possible factors is ultimately responsible.
If the problem is disc deterioration, surgery may be necessary, and an adjustment in training is absolutely required. Take this condition seriously, and see a doctor.
If your spine is merely out of alignment, manipulation by a chiropractor may help ease your pain. This may also ease your muscle strain.
If your doctor confirms that you have an uneven pelvis or unequal leg lengths, the solution will likely be to try to correct the problem with a heel lift on the short side. This may be as simple as putting a piece of 1/2" foam rubber into your running shoe; a makeup sponge would probably be just right. If you don't get any relief at all within a week, go ahead and take the sponge out. If it does no good, it's better just not to wear one; your body may have adjusted to different leg lengths, and "fixing" it may cause more discomfort. Whatever the case, make sure that the remedy matches the problem; do not use a heel lift if your doctor does not confirm that you have an uneven pelvis or unequal leg lengths, or you may only make your problems worse.
If your problem is in the structure of your foot, your solution may be as simple as wearing different running shoes. The folks at your local running store can make recommendations for motion-control shoes that will remedy over-pronation. If you severely over-pronate, if you have flat feet, or if you have Morton's Toe, orthotics may be necessary, and you should see a podiatrist for her recommendation.
In most cases of lower back pain, you will benefit from exercises to strengthen your back and abdominal muscles.
The sciatic nerve is the longest nerve in your body, stretching from the end of your spine all the way down to your feet. When it gets pinched, it can cause pain anywhere along its length. You might feel pain in your lower back on one side, in the lower buttock, or down one leg, possibly all the way down to the foot. It is common for sciatica to be confused with a hamstring pull, and it is important to determine which you have, since stretching the hamstring muscle can further aggravate sciatica. Try this test: lie on your back with the painful leg up, knee straight. Have a friend flex your foot, bending it down toward your knee. If you have sciatica, this will be very painful, marked by a burning sensation or a feeling of electric shock down your leg or in your upper back.
Your sciatic nerve is pinched. It could be caused by a pelvic tilt or by pressure on a disc, a cushion that separates your vertebrae. For a variety of reasons (a muscle spasm for instance, or more seriously, a degenerated disc), one disc may stick out so that it's not centered between the vertebrae.
You can't do much for this on your own, though it will help to keep good posture and avoid slumping (strengthening your abdominal muscles with bent-knee situps can help with this). Stop running and see a doctor. While whatever is causing the sciatica may be relatively harmless (tense or spasming muscles), it could also be a degenerated disc, which requires serious medical attention.
In the meantime, take anti-inflammatories (ibuprofen, for example) and try hot baths or the steam room. Sciatica is something that can hang around for months or may just flare up and disappear. It's not uncommon for it to come back, but it could also be years before it does so.
Hip and/or Buttock Pain
Pain in your upper leg, buttocks, hips or lower back -- all radiating from the piriform muscle, deep in the buttock. The back section of the buttock on the outside may be sensitive to the touch.
The piriform is the muscle that helps your hip to rotate. Tightness in the back or hamstring can make the piriform's work difficult and cause inflammation. This swelling in turn often causes pressure and inflammation on the sciatic nerve as well (see sciatica, above). Prolonged sitting can aggravate the injury, as can a tight lower back.
Icing and anti-inflammatories will help with the pain and swelling. Vigorous massage of the knot in the muscle will help it to relax and ease the pain. Meanwhile, work on strengthening and stretching your hip, hamstring and lower-back muscles. For stretching, focus on the hamstring stretch, the hip & lower-back stretch, and the hamstring & back stretch. For strengthening, try side leg lifts.
Pain at the side of the hip
Pain in the side of your hip, usually at the joint of your hip and thigh but sometimes a bit higher toward the hip bone.
A basic overuse injury. You've inflamed the fascia in your hips, the flexible fibers in the joint. The specific reasons for this pain vary for different runners. The culprit may be weak back muscles, the type of surface on which you run, the shoes you wear, or the length of your running stride. One of the remedies below will likely work for you, but it's difficult to predict which it will be. However, if you have pain in only one of your hips, you probably have either an uneven pelvis or unequal leg lengths. See the section above on lower back pain for details on treating this.
As mentioned, hip pain can come about for a variety of reasons. Try these remedies; one of them (or a combination) should get rid of the pain, albeit with a bit of persistence. Try shortening your stride when you run. Try switching running surfaces (if you've been running on a hard surface, try a softer one or vice versa). Reconsider your running shoes; your feet may demand a different style or fit. Finally, try some abdominal and lower back exercises to strengthen those muscles.