American Hip Institute

2015- Domb et al. The Hip-Spine Connection: Understanding its importance in the Treatment of Hip Pathology. Orthopedics

Abstract: The hip and lumbar spine are closely related and can create similar patterns of pain and dysfunction. Diagnosis and treatment of hip and spine–related conditions can be challenging due to symptom overlap. Successful evaluation and treatment of hip and lumbar spine conditions requires a thorough understanding the hip-spine connection. Historically the hip-spine connection has been considered in the context of arthrosis; however, the hip-spine connection also needs to be considered in a younger athletic popula-tion. The purpose of this review is to describe the hip-spine connection, discuss the clinical implications of this connection, and offer an approach to diagnosis and treatment. [Orthopedics. 2015; 38(1):49-55.]

Clinicians are often faced with the diagnostic dilemma of a patient who presents with pain that is vague or doesn’t follow a familiar pattern. Often the answer can be found in a thorough history and physical examination. However, frequently there is more than one problem contributing to the pain, particularly in the hip, pelvic girdle, and spine—areas that are intimately related in function and anatomy. Disorders of these structures have overlapping presentations and symptomatology, which can create confusion as to the source of pain. This confusion can lead to a delay in diagnosis and treatment. It is imperative to understand this connection when treating patients who may be candidates for hip procedures.

The current authors introduce the hipspine connection, a term used to describe the relationship between the hip and spine that exists prior to the appearance of degenerative changes. Most descriptions of the hip-spine connection are limited to coexisting hip and spine dysfunction in the setting of arthritis. Symptoms can and do occur prior to the onset of degenerative changes, especially in the highdemand athletic population.

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