DLouis M. Day, MD
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Hip & Spine

When hip pain and back pain disguise each other

If you've been sent back and forth between a spine specialist and a hip specialist without a straight answer, there's a reason — and there's a way to sort it out.

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The hip and the lower back sit in the same mechanical chain. When one stiffens, the other compensates — so by the time a patient reaches a specialist, both frequently look abnormal on imaging and both are capable of producing the pain.

That is where treatment goes wrong. A hip is replaced and the pain persists. A back is decompressed and the limp remains. The structure treated wasn’t the one generating the symptoms.

Before his sports medicine fellowship, Dr. Day spent years in spine research at the NYU Spine Research Center and the Hospital for Joint Diseases, publishing repeatedly on exactly this relationship — how hip arthritis changes spinal alignment, and how the two should be sequenced when both need treatment. It is an unusual background for a sports medicine surgeon, and it is directly useful to this group of patients.

Does this sound familiar?

Signs the hip and the spine are both involved

  • Pain in the groin, buttock or thigh that nobody has been able to place
  • Back treatment that helped less than expected — or not at all
  • Stiffness getting in and out of a car, or putting on shoes and socks
  • A limp that developed gradually, alongside longstanding back pain
  • Being told the imaging looks abnormal in both the hip and the spine
  • Having been referred back and forth between a spine surgeon and a hip surgeon
The approach

Finding the real source first

1

Sort the source

A careful history and physical exam that provokes each joint separately. Where the pain reproduces matters more than what an MRI report says.

2

Image the whole picture

Standing imaging that captures how the pelvis, hips and spine balance against each other — not just one segment in isolation.

3

Sequence the treatment

When both are contributing, the order of treatment changes the outcome. Which problem to address first is a clinical decision, and one Dr. Day has published on.

The research behind it

Published work on the hip-spine relationship

Selected peer-reviewed papers. Dr. Day’s abstract “Categorizing the Hip-Spine Syndrome” took first place at the Brooklyn Orthopaedic Society resident competition, and his group’s work on sequencing spine surgery in patients with prior hip replacement won Best Paper at the North American Spine Society annual meeting.

Radiographic Categorization of the Hip-Spine Syndrome in the Setting of Hip Osteoarthritis and Sagittal Spinal Malalignment

Journal of the AAOS. 2019 Sep 1;27(17):659–666

View on PubMed

Validation of the Recently Developed Total Disability Index: A Single Measure of Disability in Neck and Back Pain Patients

Journal of Neurosurgery: Spine. 2019 Dec 6;1–9

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The Impact of Different Intraoperative Fluid Administration Strategies on Postoperative Extubation Following Multilevel Thoracic and Lumbar Spine Surgery

Neurosurgery. 2019 Jul 1;85:31–40

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Full-Body Radiographic Analysis of Postoperative Deviations from Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction

International Journal of Spine Surgery. 2019 Apr 30;13(2):205–214

View on PubMed
All research & publications
Common questions

Hip & spine, answered

It's the term for having degenerative changes in both the hip and the lumbar spine at the same time, where symptoms from each overlap and can be mistaken for the other. It's common in adults over 50, and it's a frequent reason a patient's treatment doesn't work as expected — the treated structure wasn't the one causing the pain.

Ready to get back in the game?

Schedule your visit with Dr. Day and take the first step toward feeling like yourself again.

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