The hip joint is designed to withstand a fair amount of wear and tear, but it’s not indestructible. For example, when you walk, a cushion of cartilage helps prevent friction as the hip bone moves in its socket. With age and use, this cartilage can wear down or become damaged, or the hip bone itself can be fractured during a fall. In fact, more than 300,000 adults over 65 are hospitalized for hip fractures each year, according to the Agency for Healthcare Research and Quality.
Pain along the inside of the hip may be due to tendinitis or strain of the adductor muscles. Adductors (or inner thigh muscles) pull the leg inward as it is moving forward—the faster the movement, the greater the degree of adduction. Since footprints of a runner are almost single file as opposed to the side-by-side footprints of a walker, there is some degree of adduction occurring during running.
Congenital bone conditions: Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.

In terms of diagnosing hip pain, typically a patient will expect when they come in to be asked about their symptoms, and it’s very important to find out when did these symptoms start, how long they have been going on, how frequent they are, if they come on in the morning or the evening, do they come on with any certain activity, and if there is something that makes it better or worse. The intensity of the pain is also important. Does it have any associated radiating symptoms? Is it localized in one spot or does it move? After getting a history and finding out what type of pain the patient is having, which also includes whether the pain is dull, aching, sharp, or intense, then it’s important to do a good physical exam. The physical examination involves testing the muscle strength, testing for sensation, doing provocative maneuvers which might help us rule out one type of injury from another.

Grade II (moderate): A larger tear in your muscle that makes it difficult to move and causes a moderate amount of pain, especially when you move the affected muscle, swelling, and tenderness. You may have 5 percent to 50 percent loss of function and you may be limping. You can't go back to sporting activities until the tear is completely healed. These injuries can take anywhere from a couple weeks to a few months to heal, depending on how bad they are.


Spondylolisthesis. This condition occurs when one vertebra slips over the adjacent one. There are 5 types of spondylolisthesis but the most common are secondary to a defect or fracture of the pars (between the facet joints) or mechanical instability of the facet joints (degenerative). The pain can be caused by instability (back) or compression of the nerves (leg).
The lumbar spine (lower back) consists of five vertebrae in the lower part of the spine between the ribs and the pelvis. The bones (vertebrae) that form the spine in the back are cushioned by small discs. These discs are round and flat, with a tough, outer layer (annulus) that surrounds a jellylike material called the nucleus. Located between each of the vertebra in the spinal column, discs act as shock absorbers for the spinal bones. Thick ligaments attached to the vertebrae hold the pulpy disc material in place. Of the 31 pairs of spinal nerves and roots, five lumbar (L1-L5) and five sacral (S1-S5) nerve pairs connect beginning in the area of the lower back.
The multifidus muscles run up and down along the back of the spine, and are important for keeping the spine straight and stable during many common movements such as sitting, walking and lifting.[12] A problem with these muscles is often found in someone with chronic low back pain, because the back pain causes the person to use the back muscles improperly in trying to avoid the pain.[31] The problem with the multifidus muscles continues even after the pain goes away, and is probably an important reason why the pain comes back.[31] Teaching people with chronic low back pain how to use these muscles is recommended as part of a recovery program.[31]
The hip is a common site of osteoarthritis. To help protect the hip joint from "wear and tear," it is important to strengthen the muscles that support it. Your hip also controls the position of your knee, and strengthening your hips may be one component of your rehab program for knee pain. Your physical therapist may also prescribe hip exercises after total hip replacement if you have a hip labrum tear or as part of your hip exercise program for hip pain.
Disc degeneration remains a key cause of chronic low back pain and the pain often persists despite surgery. NIH-funded basic science and preclinical studies are investigating molecular-level mechanisms that cause discs in the spine to degenerate, as well as protective mechanisms involved in disc remodeling that may diminish with advancing age. Such studies may help identify future therapeutic strategies to block degenerative mechanisms or promote remodeling processes. NIH also is funding early research on stem cell approaches to promote disc regeneration and rejuvenate cells of the nucleus pulposus, the jelly-like substance in the center of intervertebral discs that loses water content as people age.

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.
There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.
Two types of strength-training moves that may benefit the lower back are flexion and extension exercises. In flexion exercises, you bend forward to stretch the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. One example is doing leg lifts while lying on your stomach. Depending on the cause of your back pain, there are some exercises you should not do. If you have back pain, make sure to talk to your doctor about what exercises are safe for you.
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