In the last week, I have had five patients with pain stemming from either their back or hip

and into one or both legs with five different causes. So, if you’re one of those people, how do
you figure out where your pain is coming from, and more importantly, how do you make it
disappear? First, let’s figure out some potential causes via my five patients and you can
think of this blog as one of those books you read as a kid with alternate endings depending
on which road you take…the benefit of this book though is that no ending will land you in the
fangs of some monster…read and pick one below that sounds like you:
1) DJD or degenerative joint disease:
- it is arthritis, so you probably aren’t 16 with this problem, but it is a “wear and tear” type
condition
- bending backwards is usually painful and stiff, and the majority of the stiffness feels deep in
the spine versus in the muscles
- It is progressive, meaning, you probably weren’t perfectly fine yesterday, and then today in
excruciating pain.
- Stiffness is usually a more prominent feeling versus pain, but is can be sharp in certain
movements
- If there is pinching on a nerve, it can cause numbness and tingling into the legs in a
dermatome pattern.

2) Bulging or herniated disc:

- Although it can also be progressive, there was probably one particular thing that was the
proverbial straw that broke the camels back, like bending over and twisting.
- bending over or forward flexion of the spine probably makes the symptoms worse because
discs usually protrude backwards, so the further you round the spine, the more the disc can
protrude.
- Muscle spasms are common with this as the muscles are trying to add stability to the spine.
- more pain first thing in the morning or after sitting a long time is common. First thing in the
AM since that is the time the discs are filling up with water since you’re horizontal.
-Can cause numbness, tingling, cramps, and weakness into the legs in a dermatome
pattern, see below: If you are getting cross-eyed, basically it goes like this. Pain coming from
the upper area of your low back is in the front of the thigh, into the shin on the inside is from
the 4th lumbar nerve, and in the back of the leg in the hamstring and calf is from the lower
segments.
3) Sciatica:
- It can come from either of the two conditions listed above, but then it is also being
compressed in buttock area as well as the spine and symptoms may not be in the back at
all, but just in the buttock and further down the back of the leg in the hamstring.
- Can feel like a tight rope that is sharp all the way down the back of the leg
- Symptoms are worse when you try to straighten your leg
- Hurts to sit on the affected side so you might lean onto the buttock that isn’t bothering you.
4) Piriformis syndrome:
- In about 15-30% of the population (depends who you ask) the sciatic nerve (which is the
size of a pencil) goes through the piriformis muscle and may be caught in muscle spasms in
the piriformis muscle. In this case, it is actually coming from the hip versus the back and can
be distinguished by contracting the piriformis muscle or stretching it; both which will increase
symptoms.
- Another way to distinguish this is that back movements may not hurt it, but rather hip
movements increase pain, especially hip stretches.

5) SIJ or sacroiliac joint dysfunction

- Pain will be more to the side of the back over the PSIS (see below) and may go around the
hip into the groin
- This usually occurs in younger people because as we age, the sacroliliac joint fuses, and
once it fuses it won’t shift out of place and cause this pain
- Hurts to sit on affected hip, so you will probably lean towards unaffected side
- This might have been caused by something jarring, like falling on your buttock or side, or
you might just always lean on one hip in standing