Could Your Back Pain Actually Be Coming From Your Hip?

Back pain is not always caused by a problem in the lower back itself. Stiffness or reduced movement in the hips, particularly hip internal rotation, can place extra strain on the spine and contribute to ongoing discomfort. Understanding how your hips move is often a key step in managing long-term back pain and improving how you walk, exercise and play sport.

How Hip Problems Can Cause Lower Back Pain

When back pain develops, most people focus on the painful area. However, at Costa Health we frequently find that limited movement in the hips is a major factor, especially in people with persistent or recurring lower back pain.

If the hip does not move well, the body usually finds another way to complete everyday tasks such as walking, standing up, climbing stairs or playing sport. Very often, that extra movement comes from the lower back, pelvis, knees or feet, which can gradually become irritated or overloaded.

What Is Hip Internal Rotation?

Hip internal rotation is the movement that allows your thigh bone to rotate inwards within the hip joint. It is involved in many daily and sporting activities, including:

Walking and turning
Climbing stairs or hills
Squatting and getting up from a chair
Changing direction during sport
Generating power in movements such as kicking, swinging a club or racquet

Many people gradually lose hip internal rotation with age, often without realising. Because the change usually happens slowly rather than after a single injury, the body adapts and uses different movement patterns. Problems tend to appear later, as stiffness, pain or reduced performance.

Quick Tip: If you notice that certain movements, such as getting out of the car or turning while walking, feel stiffer on one side, it may be an early sign that hip rotation is becoming restricted.

Why Loss of Hip Internal Rotation Matters

The body is very good at compensating when one area becomes stiff. If the hips do not move freely, other joints often have to work harder to make up for the loss of mobility. The lower back is a common area that takes on this extra demand.

Reduced hip internal rotation can contribute to:

Lower back stiffness or discomfort, especially with standing and walking
Reduced walking efficiency and shorter stride length
Changes in squat technique, such as leaning forwards more
Increased stress on the knees and feet
Reduced balance and overall mobility

A useful way to think about it is this: your body will usually find a way to move, but it may not be moving through the most suitable joint. Over time, this can irritate tissues that are not designed to take so much repeated strain.

A Simple Way to Check Your Hip Mobility at Home

A brief self check can give you some idea of how your hips are moving. It is not a diagnosis, but it can highlight differences between sides.

Hip Internal Rotation Self Test

Sit on a stable chair with your hips and knees bent to about 90 degrees.
Place your feet flat on the floor, hip-width apart.
Keep your thigh still and gently move your foot outwards to the side.
This movement is testing hip internal rotation.

Notice:

How far each side moves
Whether one side feels stiffer or tighter
Whether the movement feels restricted, uncomfortable or pulls in the groin, hip or back

Many people are surprised to find that one hip is clearly stiffer than the other. A difference does not automatically mean something is seriously wrong, but it may be worth having a professional assessment, especially if you also have ongoing back pain or hip discomfort.

Quick Tip: If you try this test, move slowly and stay within a comfortable range. Stop if you feel sharp pain, catching, locking, or if the movement feels very different from the other side.

Hip Rotation and Golf Performance

Golfers on the Costa del Sol often come to us with a mix of lower back stiffness and frustration about their game. In many ageing golfers, one of the most consistent findings is a loss of hip internal rotation, particularly on the lead or trail leg.

A powerful, repeatable golf swing depends on being able to rotate smoothly through the hips and pelvis while keeping control through the trunk. When hip rotation is restricted, golfers frequently compensate by:

Increasing movement through the lower back instead of the hips
Shortening the backswing
Altering their stance or foot position to create space
Leaning or swaying rather than rotating

These changes can contribute to:

Loss of distance
Reduced consistency of strike
Difficulty completing the backswing comfortably
Increased strain on the lower back during and after a round

For many golfers, improving hip mobility and control, alongside appropriate strength work, can be a practical way to support both performance and long-term enjoyment of the game. At Costa Health, our clinicians regularly assess hip and spinal movement as part of golf-related assessments.

Can Hip Internal Rotation Be Improved?

In many cases, hip internal rotation can be improved or better supported, but the right approach depends on the cause of the restriction. Common contributing factors include:

Joint stiffness in the hip or surrounding joints
Muscle tightness around the hip and pelvis
Movement habits, such as always standing with weight on one leg
Previous injuries or surgery
Spinal stiffness or pain that makes rotation uncomfortable

After a thorough assessment, treatment may include a combination of manual therapy, specific exercises, mobility work and advice on how to pace activities. The key is that the plan is individual, as forcing a stiff or irritable hip without understanding the cause can sometimes aggravate symptoms.

How We Assess Hip Mobility at Costa Health

When someone attends Costa Health with back pain, mobility problems or golf-related performance concerns, our chiropractors and physiotherapists assess more than just the painful area. A typical assessment may include:

Detailed discussion of your symptoms, activities and medical history
Observation of posture, walking and functional movements
Specific tests of hip mobility, including internal and external rotation
Assessment of lower back, pelvis, knees and feet where relevant
Strength and control tests to see how well muscles support the joints

By identifying restricted or overworked areas early, we can focus treatment on the likely contributors to your symptoms rather than only easing the sore spot in the lower back.

When To Seek Help

If you have noticed increasing stiffness, recurring back discomfort, or a gradual loss of mobility or power in activities such as golf, it can be helpful to have your hips and spine assessed. Early advice often makes it easier to manage symptoms and stay active.

Seek urgent medical help if: Your back or hip pain is associated with recent significant trauma, sudden inability to walk, loss of bladder or bowel control, numbness around the groin or genitals, unexplained weight loss, fever, or if you feel generally very unwell. These can be signs of more serious conditions and should be checked immediately.

For non-urgent problems, a structured assessment can help clarify whether your hips are contributing to your back pain and what you can safely do about it.

At Costa Health, Mijas and Marbella our multidisciplinary team works with English-speaking residents and expats across the Costa del Sol. We regularly help patients understand how their hips and lower back are working together, and we design individual treatment and rehabilitation plans to support more comfortable movement.

If you would like to find out how your hips are moving and whether they may be linked to your symptoms or performance, you are welcome to contact the clinic to arrange an assessment.

Frequently Asked Questions

Can hip problems really cause back pain?

Yes, hip stiffness or altered hip mechanics can increase the load on the lower back and surrounding joints. Over time this extra strain can contribute to pain or a feeling of tightness in the back, especially with standing, walking or twisting. A proper assessment is needed to confirm whether the hip is playing a role in your particular case.

How do I know if my hip or my back is the main problem?

It can be difficult to tell on your own, as pain can be felt in a different area to the underlying cause. Clues that the hip may be involved include difficulty crossing your legs, stiffness getting in and out of a car, or a clear difference in movement between hips. However, the most reliable way to distinguish between hip and back causes is a structured examination by a chiropractor, physiotherapist or other qualified clinician.

Is it safe to do hip mobility exercises if I have back pain?

Gentle, well-chosen hip mobility exercises are often safe and can be helpful, but they should be appropriate for your condition. If you have strong pain, recent injury, or are unsure which exercises to do, it is best to seek professional guidance first. Avoid forcing movements into pain, bouncing at the end of range, or copying advanced stretches from others without advice.

Will improving my hip rotation fix my back pain?

Improving hip rotation can reduce strain on the lower back and is often one useful part of a broader treatment plan. However, back pain usually has several contributing factors, such as muscle tension, joint stiffness, activity levels, stress and previous injuries. A comprehensive approach that addresses these factors alongside hip mobility tends to be more effective than focusing on one element alone.

How long does it take to see improvement in hip mobility?

The timescale varies widely between individuals. Some people feel a difference within a few weeks of consistent, tailored exercises, while others with long-standing stiffness or arthritis may progress more slowly. Factors such as age, general health, previous injuries and commitment to the exercise plan all play a role. Your clinician can give you a more realistic timescale after assessing you.