The condition is cauda equina syndrome. It involves “acute loss of function of the neurologic elements (nerve roots) of the spinal canal below the termination (conus) of the spinal cord,” where the nerves spread out like a horse (equina) tail. Again, this condition causes symptoms in the “saddle” of the body: butt, groin, inner thighs. BACK TO TEXT
Iliopsoas syndrome, which is also called psoas syndrome or iliopsoas tendonitis, occurs when the iliopsoas muscles are injured. Lower back pain is the most common symptom; however, pain can also occur in the hip, thigh, or leg. The iliopsoas bursa, which is a fluid-filled sac located on the inside of the hip that reduces rubbing and friction, is also likely to become inflamed due to the proximity of the two structures. When this happens, the inflamed bursae will make it difficult to move.
Or anything else. Pain is a poor indicator, period! The human nervous system is really terrible about this: it routinely produces false alarms, and alarms that are much too loud. See Pain is Weird: Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it. BACK TO TEXT
There are many causes of hip joint pain. Some hip pain is temporary, while other hip pain can be long-standing or chronic. Causes of hip pain include arthritis, inflammatory and noninflammatory arthritis, fracture, sprain, infectious arthritis (septic arthritis), avascular necrosis, Gaucher's disease, sciatica, muscle strain, iliotibial band syndrome (IT band syndrome), and hematoma.

Poor Sitting Posture: The correct position of your low back should have a slight forward curve called a lordosis. When you sit slouched, this lordosis straightens out-or even worse-reverses itself. This loss of the forward curve in your spine can cause increased pressure on the small shock absorbing discs in your back. This increased pressure can displace your discs and lead to low back pain. Your physical therapist can teach you the proper way to sit to decrease, eliminate, or prevent your back pain.
Moist heat may help relax your muscles. Put moist heat on the sore area for 10 to 15 minutes at a time before you do warm-up and stretching exercises. Moist heat includes heat patches or moist heating pads that you can buy at most drugstores, a wet washcloth or towel that has been heated in a microwave or the dryer, or a hot shower. Don’t use heat if you have swelling.
Take a step back and think about where you spend most of your day. If you're a young athlete, you probably spend most of your time at school or maybe work or practice and  even a little time at home, if you're lucky. Now think about what position your body is in during those periods. I would bet that you spend most of your day sitting down. You may walk to class or run in practice, but the majority of your day is spent in a seated position.
In this study, one patient with sciatica was sent for ten MRIs, which produced 49 distinct “findings,” 16 of them unique, none of which occurred in all ten reports. On average, each radiologist made about a dozen errors, seeing one or two things that weren’t there and missing about ten things that were. Yikes. Read a more detailed and informal description of this study.
Endometriosis (when the uterus lining grows somewhere else) can cause pelvic tenderness, which some women describe as hip pain. Pain from the back and spine also can be felt around the buttocks and hip, Siegrist says. Sciatica, a pinched nerve, typically affects one side of the body and can cause pain in the back of the right or left hip — the pain from sciatica can start in your lower back and travel down to your buttocks and legs.
Back “spasms” are a largely a myth — there’s no such thing a sustained painful contractions of muscles in otherwise healthy people (see Cramps, Spasms, Tremors & Twitches) — but the kernel of truth in the idea of “spasms” may be the idea of trigger points, which are hypothetical “micro cramps,” tiny patches of painfully contracting muscle. Although this idea is controversial, it is nevertheless one of the most likely explanations for common aches and pains that mostly stick to one area (especially the back) and have no other obvious cause. See Back Pain & Trigger Points. BACK TO TEXT
An injury to a ligament is called a sprain, and an injury to muscle or tendon is called a strain. Sprains and strains may be caused by repetitive movements or a single stressful incident. Symptoms and signs include pain and swelling. Though treatment depends upon the extent and location of the injury, rest, ice, compression, and elevation are key elements of treatment.
Pain in the hip can result from a number of factors. Sometimes diseases that affect other joints in the body, such as the inflammation resulting from arthritis, can be the cause of pain in the hip. Depending upon the cause of hip pain, the pain may occur when walking, running, or engaging in activity. Trochanteric bursitis is the most common type of hip bursitis and causes pain at the point of the hip.
2016 — More editing, more! Added some better information about pain being a poor indicator, and the role of myofascial trigger points. This article has become extremely busy in the last couple months — about 4,000 readers per day, as described here — so I am really polishing it and making sure that it’s the best possible answer to people’s fears about back pain.
Sit in a chair with good lumbar support and proper position and height for the task. Keep shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. During prolonged periods of sitting, elevate feet on a low stool or a stack of books.
Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. As people grow older, loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.
Located deep in the front of the hip and connecting the leg, pelvis, and abdomen, the hip flexors— surprise, surprise— flex the hip. But despite being some of the most powerful muscles in our bodies (with a clearly important role), it’s easy to neglect our poor hip flexors— often without even knowing it. It turns out just working at a desk all day (guilty!) can really weaken hip flexors since they tend to shorten up while in a seated position. This tightness disrupts good posture and is a common cause of lower back pain. Weakened hip flexors can also increase the risk of foot, ankle, and knee injuries (especially among runners) Hip muscle weakness and overuse injuries in recreational runners. Niemuth, P.E., Johnson, R.J., Myers, M.J., et al. Rocky Mountain University of Health Professions, Provo, VT. Clinical Journal of Sport Medicine, 2005 Jan; 15 (1): 14-21.. So be sure to get up, stand up every hour or so! And giving the hip flexors some extra attention is not just about injury prevention. Adding power to workouts, working toward greater flexibility, and getting speedier while running is also, as they say, all in the hips The effect of walking speed on muscle function and mechanical energetics. Neptune, R.R., Sasaki, K., and Kautz, S.A. Department of Mechanical Engineering, The University of Texas, Austin, TX. Gait & Posture, 2008 Jul; 28 (1): 135-43..
Workers who experience acute low back pain as a result of a work injury may be asked by their employers to have x-rays.[102] As in other cases, testing is not indicated unless red flags are present.[102] An employer's concern about legal liability is not a medical indication and should not be used to justify medical testing when it is not indicated.[102] There should be no legal reason for encouraging people to have tests which a health care provider determines are not indicated.[102]
Meanwhile, it’s extremely common for non-life-threatening low back pain to be alarmingly severe and persistent — to have a loud bark! Your doctor may not appreciate how true this is, and may over-react to all persistent low back pain, even without other red flags. In most cases, you shouldn’t let them scare you. Being “freaked out” about persistent back pain is the real threat: it can make low back pain much worse, and much more likely to last even longer (a tragic irony).
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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Low and lower back pain can vary from dull pain that develops gradually to sudden, sharp or persistent pain felt below the waist. Unfortunately, almost everyone, at some point during life will experience low back pain that may travel downward into the buttocks and sometimes into one or both lower extremities. The most common cause is muscle strain often related to heavy physical labor, lifting or forceful movement, bending or twisting into awkward positions, or standing in one position too long.
Prolonged sitting and activities like running or cycling can lead to tight hip flexor muscles and a variety of skeletal imbalances. Think: if you only cycle for exercise, certain muscles in your legs will get stronger (in a lot of cases you overwork these muscles) yet your core and outer hip muscles might get weaker from lack of engagement. So what? Well, these muscle imbalances often lead to skeletal imbalances and injuries down the line. If you have particularly tight hip flexors, your body will start to create an anterior pull on the pelvis (anterior pelvic tilt). You can identify an anterior pelvic tilt if your belly protrudes slightly in the front while your butt sticks out in the back (what some people refer to as “duck butt”).
Hip flexor strains and injuries are often caused by “over doing it” (such as exercising) or periods of prolonged sitting combined with weak hip muscles. While hip flexor strains are typically not serious, they can be quite painful and severely limit your activity and mobility. Airrosti rapidly resolves most hip flexor injuries in as few as 3 visits — without the need for injections, medications, or long periods of rest.
Magnetic resonance imaging (MRI) uses a magnetic force instead of radiation to create a computer-generated image. Unlike x-ray, which shows only bony structures, MRI scans also produce images of soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumor, inflammation, disc herniation or rupture, or pressure on a nerve is suspected. MRI is a noninvasive way to identify a condition requiring prompt surgical treatment. However, in most instances, unless there are “red flags” in the history or physical exam, an MRI scan is not necessary during the early phases of low back pain.
The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon” online tool. 

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.
When was the last time you got on your gym's abductor or adductor machine and got in a good workout? It's probably been a while. Both are machines that don't get a lot of use, and they are often the target of coaches' ridicule on those "useless gym moves we should all skip" lists. Perhaps rightly so, especially if you're hopping on those machines hoping for a slimming effect.
Strong muscles support and protect your joints. “Strengthening the lower body takes some of the pressure off of the hip and knee joints,” says William Oswald, DPT, a physical therapist and clinical instructor of rehabilitation medicine at NYU Langone Health. This can relieve some of the pain and protect against more damage. “It can also make daily tasks, such as climbing the stairs, easier,” he says.
Approximately 15 degrees of hip extension is required to walk normally. If hip flexors are tight then in order to walk, compensatory movement needs to take place through the lower back causing back pain and premature disc degeneration. Like other joints, if we fail to take them through their full range on a regular basis we eventually lose mobility.
Stop listening to other people’s horror stories. You know the scenario: You are bent over in obvious pain, waiting to see the doctor, and the person next to you tells you a 10-minute tale of how their Uncle Gordon had low back pain that required injections and surgery. But the pain still didn’t go away. Stop listening to these terrible stories. Most low back pain is short-lived and can be managed quite effectively with exercise and postural correction. Of course, some low back conditions are serious and require surgery, but that is a conversation you should have with your doctor, not the guy in the waiting room.
For example, your quadriceps muscles are a group of four that are located at the front of the thigh; one of the group members, the rectus femoris flexes the hip, which brings your lower extremity (thigh, lower leg, and foot) forward, in front of you. On the other hand, your hamstring muscles are located at the back of the thigh. When they contract, they extend the lower extremity, bringing it behind you.
Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax), for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.
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Using heavy weights: Whether you’re a novice weightlifter or a pro, if you suffer from hip pains you should definitely be putting the kettlebell down! Weight-lifting can place too much stress on your body, especially your knees, lower back and hips. You should be focusing instead on gentle strengthening exercises and stretches in order to support your body as it recovers.
Kidneys — The kidneys are a matched pair. One painful kidney can cause back pain on one side or the other. Kidney pain can feel like back pain, and may occur on only one side. It is usually quite lateral, and just barely low enough to qualify as “low” back pain. However, when kidney stones descend through the ureters, they can cause (terrible) pain in the low back. Kidney stone pain is often so severe and develops so rapidly that it isn’t mistaken for a back pain problem.
Nonsteroidal anti-inflammatory drugs (NSAIDS) relieve pain and inflammation and include OTC formulations (ibuprofen, ketoprofen, and naproxen sodium). Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription. Long-term use of NSAIDs has been associated with stomach irritation, ulcers, heartburn, diarrhea, fluid retention, and in rare cases, kidney dysfunction and cardiovascular disease. The longer a person uses NSAIDs the more likely they are to develop side effects. Many other drugs cannot be taken at the same time a person is treated with NSAIDs because they alter the way the body processes or eliminates other medications.
The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon” online tool.
There are many causes of hip joint pain. Some hip pain is temporary, while other hip pain can be long-standing or chronic. Causes of hip pain include arthritis, inflammatory and noninflammatory arthritis, fracture, sprain, infectious arthritis (septic arthritis), avascular necrosis, Gaucher's disease, sciatica, muscle strain, iliotibial band syndrome (IT band syndrome), and hematoma.
Hip flexor strains and injuries are often caused by “over doing it” (such as exercising) or periods of prolonged sitting combined with weak hip muscles. While hip flexor strains are typically not serious, they can be quite painful and severely limit your activity and mobility. Airrosti rapidly resolves most hip flexor injuries in as few as 3 visits — without the need for injections, medications, or long periods of rest.

The hip is a basic ball-and-socket joint. The ball is the femoral head—a knob on the top of the thigh bone—and the socket is an indentation in the pelvic bone. There is cartilage lining the joint (called the labrum) and ligaments that attach the pelvic and thigh bones. Numerous muscles attach around the hip, too, moving the joint through the basic motions of flexion (bending), extension (extending the leg behind you), abduction (lifting the leg away from the body), adduction (moving the leg inward), internal rotation, and external rotation.
Marvelously progressive, concise, and cogent guidelines for physicians on the treatment of low back pain. These guidelines almost entirely “get it right” in my opinion, and are completely consistent with recommendations I’ve been making for years on PainScience.com. They are particularly to be praised for strongly discouraging physicians from ordering imaging tests only “for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected.”
In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty or kyphoplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra. Pain is relieved as the height of the collapsed vertebra is restored.
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