Spinal Stenosis: How is my Hip Pain Coming from my Back?
Many times in medicine there is cross over between conditions when considering symptoms. (A good example is how gallbladder pain can refer to the right scapula.) In this same manner, many times in the spine clinic we see patients complaining of hip pain and we identify a spinal condition responsible for the discomfort.
An important thing to consider is what region of the body you’re referencing when you say you have hip pain. The hip joint itself is in our groin and as such arthritic conditions or labral tears tend to refer pain to the groin region, especially with weight-bearing activities.
If the pain is present on the outer portion of the thigh or the upper-lateral buttock area the cause of the discomfort may be coming from a common spinal condition known as spinal stenosis. Image source: alignfitness.org
What is Spinal Stenosis?
Spinal stenosis is a narrowing of the open spaces within your spine. This narrowing can put pressure on your spinal cord and the nerves that travel through the spine.
When this happens the nerves being compressed become dysfunctional and cause symptoms such as pain, weakness or numbness radiating in the upper buttock region or down the legs in various patterns.
In more severe cases paralysis or incontinence could occur.
What are the Causes of Spinal Stenosis?
While some people are born with a narrow spinal canal, most spinal stenosis occurs when something reduces the amount of space available in the spine. This can occur with overgrowth of bone (bone spurs), herniated discs, loss of disc height from degeneration, thickened ligaments, spinal injuries or tumors.
Most individuals who develop spinal stenosis are over the age of 40 unless some genetic disorder is present that causes congenital narrowing of the spinal canal.
The wear and tear on the spine tends to go through a process where micro-trauma leads to thickened supporting structures that ultimately encroach upon the nerves within the spine itself. Image source: understand.com
Tests and Diagnosis of Spinal Stenosis:
The first step of proper diagnosis is achieved by gathering a thorough history and physical exam to help identify the pain generator. Key portions of the history include where the pain occurs, what makes the pain worse, what makes the pain better and any associated symptoms. Image source: ethertonchiropractic.com
Classic spinal stenosis causes a condition known as neurogenic claudication. In this situation, patients experience upper buttock pain that radiates down their thighs and possibly legs that is worse with standing or walking. Sitting tends to alleviate the discomfort.
Certain activities such as bike riding or skiing are usually better tolerated than walking due to the forward posture taken during these activities.
Imaging studies play an important role with baseline x-rays along with MRI’s or CT studies when indicated. Often, x-rays with the spine bent forward or extending backward will identify instability within the spine.
Treatment for Spinal Stenosis:
Many times conservative treatment is successful when dealing with spinal stenosis.
First line therapies include medical management with nonsteroidal anti-inflammatories (NSAIDs), Acetaminophen, muscle relaxers, pain medicine (non-narcotics preferably), or other medications such as antidepressants.
Physical therapy plays an important role in focusing on local modalities to help the discomfort such as muscular stimulation, dry needling, massage etc. The active portion of therapy focuses on mobility, stability and strength and endurance. Specialized stretching exercises called nerve glides attempt to mobilize the entrapped nerves.
When these first line attempts fail to appreciably improve symptoms injection therapy with steroids is often recommended. The steroids help to reduce the swelling and inflammation around the irritated nerve roots that may alleviate the discomfort.
Many times the conservative approach is successful. Unfortunately, some patients fail this type of treatment and surgery is considered. The appropriate surgical intervention depends on the situation at hand.
In most all cases spinal decompression helps alleviate the problem. In some cases, a spinal fusion is appropriate to stabilize the spine and add strength to the area to be treated.
Both approaches have their merits and the recommended treatment is customized to each situation based on several factors such as the level of degeneration, the type, and location of the stenosis, spinal stability, the presence or absence of back pain and overall patient health.
Many treatment options are available, but the first thing to determine is whether your hip pain is coming from your hip or your back.