Do I have Hip Bursitis or Back Pain?

It’s a common story that I hear in the clinic, and a frustrating one. A patient complains of prolonged lateral hip pain (outside pocket area) that came out of nowhere. They went to see their doctor and the doctor says “Congratulations, it’s a boy!” Just kidding, they take an x-ray which comes back negative (good thing) and then say “You have hip bursitis. Let’s give you some cortisone and send you on your way.” The only problem is that your hip doesn’t improve and you are left frustrated, questioning “Why?” The answer is, you probably don’t have hip bursitis, you probably have a back problem. Allow me to explain further. 

What’s Hip Bursitis?

Hip bursitis is an inflammation of the bursa sac on the outside part of your hip. Its job is to keep your muscles and tendons from rubbing on your greater trochanter and damaging them. Bursitis happens when the bursa sac gets compressed and inflamed which will cause pain in the area.

Most of the time the pain is due to activity and will improve if you rest. The patients that I see are the exact opposite. They hip hurts when they rest and will feel better with certain movements. If that is the case then you probably don’t have true hip bursitis. 

If I Don’t Have Bursitis Then What Do I Have?

Let me introduce you to my friends dermatomes and myotomes. These little characters are areas of the body that are innervated by our back. They tell our brain what we feel (myotome) and how we move that area (dermatome). 

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If you can’t tell from the pictures there are two different areas of the spine that innervate the lateral hip where you might be having pain. Let’s look at the dermatome on the left first. You can see the two blue circles around where the L2 spinal segment innervates the skin. As you can see it starts up high by the hip and travels down the thigh. If your back is causing your “hip pain” you will have irritation all along that pattern. Simply take a fork and lightly press it into your skin and compare your irritated side to your non-irritated side. If your irritated side is way worse, or you don’t feel anything at all, your pain is probably coming from your back. 

Now let’s take a peek at the myotome pattern in the picture on the right. You can see in that blue circle that your L5 controls hip abduction (move your foot out to the side), and external rotation (clam shell exercise). Both those movements might cause pain in a patient with hip bursitis so that doesn’t tell us anything. If you have issues coming from your back we can test other movements though. Hip extension (bridges), knee flexion (hamstring curl), and ankle dorsiflexion (bring your foot up) are all partially controlled by L5 as well. If you test the strength in those movements, and they are weak as well, guess what, its coming from your back not your hip. 

Why Do You Hate My Doctor?

I started this post talking about a problem that I see all the time. It’s true that doctors miss a lot when it comes to orthopedic problems, but it’s not their fault. Most general practitioners are not educated enough in ortho. Most Ortho docs are too busy to try to tease things out. I don’t hate any of them. Heck, some PTs miss this stuff too (I know I did when I was just starting out). I just want to educate you so if you are having a similar issue you can be an advocate for yourself. So if you are someone who has been dealing with hip pain for a while that hasn’t gotten better, it’s time to think outside the box. If you run yourself through these tests and start to get some positive results, stop working on your hip, and start working on your back. 

I hope this helps you if you are having hip pain that hasn’t improved. If you have any questions please contact me here at OrthoCore Physical Therapy. Thanks for reading!

Gardening and Back Pain

The weather is getting nicer and we’re all heading outside and getting active. For some of us that means working in the yard and playing in our gardens. For some of us, that also means a return of back pain. You know what I’m talking about. You are in the yard for hours having a great time and then the next day you feel like you can’t move and your back is in a complete spasm. It sucks! No one ever told you that gardening could be such a hazard to your health. Well my friend, have no fear:  I am here to help with some solutions to make your back feel better, and keep it from happening again.

Why Does Gardening Cause Back Pain?

Before we go over the solutions, let’s chat about why you are getting back pain with gardening in the first place. You didn’t think you were going to get off that easy did you? Don’t you know me by now? Most people get pain in their back with gardening because of weakness and positioning. When we work in the yard, and garden, we are usually in a bent over position. You know the one I’m talking about. For every plumber’s crack, there is a gardening crack too.


This position puts a ton of stress on the lumbar spine and supporting muscles. Sometimes, we do this because we aren’t strong or flexible enough to do anything different. Other times, we do this because it’s the same way we have done it for years. No matter what the cause may be, the solution is simple. Work on performing the deadlift exercise with a stick on your back (I prefer to use a golf club, but that is not necessary). It will ensure that you are bending from your hips and knees, rather than from your back. The more repetitions the better. The purpose being to re-train your brain to bend over the right way vs. the wrong way.


What if I have Pain?

If you have been dealing with back pain from working in the yard, I’m sure you want some relief. Most of the time the muscles that support the back go into spasm from being overworked. The joints of your spine will also get irritated which will cause even more irritation of the supporting muscles. The way to provide yourself with some relief is to give those muscles/joints some space. The best way that I know how to do that is with a little ELDOA. If you haven’t heard about ELDOA go back and read my last post . For the lumbar spine the position is a little different but the duration is still the same. You want to hold the stretch for a minute and actively try to improve the stretch as you hold it. This will help to give those joints and muscles some space and should give you some pain relief.

Now What?

Once you get those two things down it should help to give you some relief from your back pain. The biggest thing moving forward is getting away from what I call elephant gardening. You can do all the exercise in the world, but if you continue to get into that rounded forward position, I can guarantee you back pain will return. I hope that helps to make your back feel better. Now get out there and get those weeds before they take over your yard!

Facet Joint Back Pain

I treat a lot of people with back pain. The hard part about treating patients with back pain is getting the work we do on the table, to translate to standing and walking. Patients who are older (I’m talking 35+) will usually have pain due to a facet issue, degeneration in the back, or both. Lying down is a great position for those issues because it doesn’t put pressure on the back. Once you stand up, the back compresses, puts pressure on the joints, and the pain returns. If this sounds like you, let me give you a simple solution to provide you with some relief for your back pain with standing.

What’s a Facet Joint?

Unless you went to PT school, or some form of medical school, you have no clue what a facet is or what degeneration looks like in your back. Well...that is what I’m here for. Let me school you on some anatomy. Facet joints are the joints of the spine. Just like any other joint in the body, the spine moves. It requires joints to allow that to happen. In your spine you have facet joints on each side of every vertebrae from your head to your hips.


Like all your other joints, the facet joint can get inflamed. When you compress an inflamed joint, it hurts. Facet joints get compressed when you are standing and when you extend. Hence the reason why lying down feels better, and standing hurts.

What do I do for Standing?

Since most of us can’t lie around all day, what do we do when we’re standing to help alleviate back pain? The key to having less pain with standing is understanding the position of your pelvis. Most of us have what is called an anterior tilt at our pelvis. That means that the front of our pelvis sits lower than the back part of our pelvis.


Speaking in generalities, this usually happens because our hip flexors are tight and our abdominals are weak. In the game of tug-of-war, a tight muscle always beats a weak muscle. In therapy we will try to stretch the hip flexors, and strengthen the abdominals to correct the imbalance. That doesn’t always carry over to a standing position though. Sometimes, you have learned to stand like that so you need to retrain the brain to stand in a neutral pelvis. What is the best way to do that? Train your hips in a standing position. Here is a simple exercise that I like to give my patients that have back pain with standing.

Give this a try to help alleviate your back pain with standing. You can perform as many of these as you want. The exercise is meant to help you retrain your brains standing pattern. There is no resistance involved so you don’t have to worry about overdoing it.

I hope this helps correct your back pain you are getting with standing. If you have any questions please contact us. If you want a free session to review how to perform the exercise properly just mention this post and OrthoCore will give you a free 15 min session at any of our clinics. Thank you for reading!