Low back pain (LBP) can have many causes. The primary goal of the chiropractic physician is to identify the main pain generator(s) and manage the patient accordingly.
When first presenting for care, the patient tells us (the doctor of chiropractic) about their complaint in the history portion of our evaluation. Here, we not only ask about the main reason for their appointment or what’s bothering them now but also their past history. We also discuss old injuries such as slips and falls, sports injuries that date back to high school, motor vehicle-induced injuries, as well as family history (we ask if family members have or have had low back trouble since it’s been reported that there is a genetic link identified for osteoarthritis). We also inquire about the patient’s current activity level and how well those activates are tolerated, often using tools completed by the patient that can be scored and compared periodically during care to track the benefits of treatment. When we finally return to the primary complaint history, we ask about the location, mechanism of injury, notable changes in the course of the condition, the onset date, pain related activities that increase or decrease pain, the quality of pain, radiation patterns, severity levels (such as a 0-10 scale), and timing issues such as, worse in the mornings vs. evenings.
When patients say, "…I have low back pain," they may point to anywhere between the lower rib cage and their hip area. In other words, everyone interprets where their low back is located differently. So, when differentiating between low back pain and hip pain, one would think that the patient would either point to their low back or their hip, right? Well, where does hip osteoarthritis usually hurt? That’s what makes it so hard! The pain location can vary and move around in the same patient anywhere in the pelvic region including the groin (which is common), to the side of the pelvis, to the buttocks, the sacrum, and in the low back. To make it even more challenging, degenerative or injured disks in the lower lumbar spine can refer pain directly into the hip area and also create localized low back pain. In fact, patients often have BOTH conditions simultaneously! Usually, during examination, we move the hip joint feel for reduced motion and watch for pain patterns in certain positions. An osteoarthritic (OA) hip is comparably more tight and painful with rotation movements. For example, the patient is seated with their leg crossed, trying to touch their knee to their opposite shoulder. In the OA-hip patient, they may only be able to get it half way there compared to the other side and often complain of groin pain. The "ultimate test" is the x-ray that reveals the loss of the joint space—the "cartilage interval"—which narrows on the side with OA.
How often is hip OA found? In a 2012 article, after reviewing 2000 patient files and 1000 x-rays of patients 40 years or older, 19% (~1 out of 5) demonstrated x-ray findings of hip OA. THAT’S A LOT! Chiropractic management of hip OA includes mobilization; manipulation; stretching the muscles surrounding the hip joint; leg length correction (sometimes requiring heel lifts in the short leg shoe); foot orthotics, if the ankles roll in too far as that causes the knees knock and hips move inwards (like a card table with the legs partially folded, making the table top—or pelvis unstable); PT modalities (like ultrasound or electric stim); exercise/stretch instruction; nutritional strategies; and more. If/when the time comes, your doctor of chiropractic can help set up a referral to the orthopedic surgeon for joint replacement, as any "quarterback" of your care should.
