You may have heard the claim that 70% of all hip pain actually comes from the back. It's a catchy number but there's no solid science behind that specific figure. What is well studied is something more useful the different mechanisms behind pain in this region and the structures it can be referred from. The area everyone calls "the hip" is really a crossroads where pain from several different sources can show up.

A pinched nerve root, say a disc herniation or stenosis around the first or second lumbar vertebra can compress the L1 nerve root which happens to have a distribution area right over the hip. So pain that originates in the upper lower back can genuinely be felt in the hip.

I've had patients treated for months for trochanteric bursitis (gluteal tendinitis) with zero improvement only to discover the real culprit was a trapped L1 nerve root. Once that nerve root was numbed the pain vanished completely. It's a real cause of hip pain just not a common one.

More often the culprit is the lower lumbar spine or the pelvis. When these structures are involved the pain tends to sit a bit further out and lower down. This is often the point where people especially past sixty panic and assume it must be hip osteoarthritis and time for surgery.

Here's a twist actual hip joint pain from osteoarthritis in the joint itself usually doesn't show up where people point when they say "my hip hurts." When the hip joint is genuinely the problem pain typically starts in the groin and radiates down the front of the thigh toward the knee. Most people don't associate that with the hip at all they assume they've pulled a groin muscle and worry a lot less about it.

Trochanteric bursae. These are fluid filled sacs around a muscle attachment site on the femur the bony bump you can feel on the side of your hip. Several major muscles attach there including the gluteal muscle some of the strongest in the body essential for walking, standing up from a bend and balancing the pelvis. Because multiple tendons converge and slide against each other at this spot a bursa naturally forms usually at least three sometimes up to seven. When one becomes inflamed, that's trochanteric bursitis pain in the hip that can radiate down the outside or occasionally the back of the thigh closely mimicking sciatica.

Gluteal tendinopathy. The same tendons can develop tendinosis irritation and degeneration at the muscle attachment. This is closely related to bursitis and often it's genuinely hard to tell whether the pain is coming from the bursa the tendon or both at once.

Piriformis syndrome. The piriformis muscle also attaches near this area, deep in the buttock. Its main job is stabilizing the pelvis during movement (externally rotating the hip is more of a side effect). When it spasms it causes intense pain in the middle of the buttock not technically "the hip" but people describe it that way anyway. It can also irritate the sciatic nerve, sending pain down the back of the thigh and making people fear a disc herniation when it's really just a muscle spasm.

A careful physical exam is essential to pinpoint which structure is actually responsible, and it's worth checking the pelvis and spine for imbalances that might be feeding the problem.

For an irritated tendon the treatment with the strongest evidence, and the best long term results is loading exercise training the tendon with gradually increasing load roughly every second or third day over an extended period. It's slow but it works steadily.

In my own practic I also work to kickstart healing directly

For tougher case some patients arrive having already tried cortisone injections. Under the right circumstances this can work almost like a miracle if the injection lands precisely on the irritated spot pain can disappear and ideally, stay away. But cortisone is never a substitute for rehab. Without continuing the exercises symptoms tend to creep back regardless of what treatment was used. The real key to lasting recovery is sticking with the exercises even after the pain is mostly gone.