Pain in the Lower Back and Hips: Female

The human body is closely interconnected. Pain in certain parts of the body can point to problems in other areas, or pain can occur in multiple areas simultaneously. With that in mind, pain in the lower back and hips in females can indicate various conditions and injuries. 

Read on to learn more about the possible causes of pain in the hips and lower back in women. 

What Causes Lower Back and Hip Pain in Females?

Lower back and hip pain in females can be caused by acute injuries, arthritis, spinal conditions, endometriosis, pelvic floor issues, pelvic inflammatory disease, dysmenorrhea, sacroiliac joint pain, piriformis syndrome, and certain lifestyle factors. 

Acute Injuries

Acute injuries like sprains and strains can lead to lower back and hip pain in women. Sprains occur when muscle tissue is stretched or torn; sprains occur when ligament tissue is stretched or torn. Usually sprains and strains are mild injuries, caused by overusing the back or hip, but can result from a sudden fall or accident. 

Arthritis 

Arthritis can break down the cartilage that protects your joints. It most often comes in the form of osteoarthritis, or “wear and tear” arthritis. When it impacts the spine and hip joints, it can cause lower back and hip pain. 

Spinal Conditions

Spinal conditions including herniated disc, spinal stenosis, sciatica, and scoliosis can cause lower back and hip pain. 

  • A herniated disc occurs when the tough disc exterior is damaged, allowing the soft disc interior to protrude into the spinal canal. It can press on spinal nerves, including the sciatic nerve, which can cause back pain that radiates to the hip and lower extremities. 
  • Spinal stenosis occurs when the spinal canal narrows abnormally. If the spinal canal becomes too small, it may press on spinal nerves, causing radiating back pain. 
  • Sciatica is inflammation of the sciatic nerve, which extends from the lower back down the backs of the legs. It can cause lower back that radiates to the hips, especially when you bend, twist, or sit or stand for prolonged periods. 
  • Scoliosis is a deformity that causes a sideways spinal curvature. Oftentimes, the exact cause is unknown, although it can be caused by genetics, vertebral malformations, or spinal degeneration. 

Endometriosis

Endometriosis is a chronic condition affecting an estimated 10% of women. It occurs when endometrial tissue grows outside the uterus, typically causing pain, fatigue, severe cramps, and difficulty getting pregnant. Endometriosis can trigger lower back and hip pain if the abnormal tissue presses on the nerves that supply these areas.

Pelvic Floor Problems

The pelvic floor muscles are a collection of muscles and ligaments supporting the uterus, bladder, and bowel. It also connects to the back. If these muscles become tight or imbalanced, they can cause dull pain that can be mistaken for back or hip pain.  

Pelvic Inflammatory Disease

Pelvic inflammatory disease, or PID, is an infection affecting one or more of the female upper reproductive organs. It’s often caused by sexually transmitted infections (STIs), including gonorrhea and chlamydia. Pelvic inflammatory disease can cause pain in the pelvis, abdomen, hips, and lower back, along with:

  • Abnormal vaginal discharge
  • Abnormal vaginal bleeding
  • Pain during intercourse

Dysmenorrhea

Dysmenorrhea is another word for menstrual cramps or period pain. It occurs as the uterus contracts to shed the uterine lining during menstruation. Dysmenorrhea may feel dull and achy or sharp and shooting. 

Usually, dysmenorrhea causes pain in the lower abdomen. However, it can also trigger pain in the lower back and hips. 

Sacroiliac Joint Pain

The sacroiliac joints connect the lower spine to the pelvis. They’re located above the sacrum and sit on either side of the spine. Sacroiliac joint pain occurs when these joints become inflamed (often due to arthritis). It can cause pain in the lower back, hips, and buttocks. 

Piriformis Syndrome

When the piriformis muscle compresses the sciatic nerve, it’s known as piriformis syndrome. This condition is rare, but can cause moderate to severe pain in the lower back and hip. It can also make it difficult to sit for extended periods. 

Often, piriformis syndrome results from overusing the hip rotator muscles or sitting on hard surfaces for extended periods. 

Lifestyle Factors 

Lifestyle factors that can trigger lower back and hip pain in women include:

  • Poor posture keeps the spine out of normal alignment, increasing strain on the spine and tissues around the hips. 
  • Wearing high heels can lead to back and hip pain by forcing the body out of its normal alignment and placing excessive stress on your joints. 
  • A sedentary lifestyle weakens the lower back and hip muscles, creating the risk of pain in these areas. 

What Diseases Cause Back and Hip Pain?

Diseases that can cause back and hip pain include arthritis, endometriosis, pelvic inflammatory disease, sciatica, scoliosis, and sacroiliac joint dysfunction. 

Hormonal Influences on Back and Hip Pain in Women

Hormones, including estrogen, progesterone, and relaxin can directly contribute to back and hip pain by influencing pain sensitivity, joint stability, and ligament laxity during the menstrual cycle. When these hormones become imbalanced or fluctuate throughout a woman’s cycle, the resulting muscle tension and joint instability can trigger back and hip discomfort. These hormones also contribute to PMS and hormonal disorders (like endometriosis), which can serve as the root of back and hip pain in women. 

  • Estrogen levels drop during menstruation, which can directly increase pain sensitivity. Estrogen deficiency has also been linked to reduced bone density and worsened musculoskeletal pain, which may contribute to pain independent of the menstrual cycle.
  • Progesterone affects levels of prostaglandins, substances that influence pain, inflammation, and menstrual cramps. When progesterone levels are low, prostaglandin levels can increase, leading to more severe cramps and pain. Additionally, since progesterone acts as an anti-inflammatory and natural pain-reliever, when levels are low, you may experience higher pain levels.
    • Imbalanced progesterone and estrogen levels can contribute to endometrial tissue growth outside the uterus in women with endometriosis. Chronic back and pelvic pain are common endometriosis symptoms. 
  • Relaxin increases muscle, ligament, and joint laxity, or looseness. It’s also involved in your mood and energy levels. As a result, when relaxin levels drop during menstruation, some women experience mood swings, fatigue, and pain related to increased laxity. 

Fluctuating estrogen, progesterone, and relaxin levels can also predispose women to SI joint pain. During ovulation and pregnancy, when relaxin rise, loosened ligaments and increased joint instability may cause SI joint discomfort.

While more recent research is required to confirm this finding, a 1998 study found that 50% of women with an SI joint injury became injured one to two days before menstruation. Additionally, a 2021 study found that 36% of women experience SI joint pain during pregnancy. 

Pregnancy and Postpartum-Related Back and Hip Pain

During pregnancy and the postpartum period, natural hormonal and biomechanical shifts often cause back and hip pain. This pain may stem from a combination of factors, including increased relaxin production, diastasis recti, postural changes, and pelvic girdle pain (PGP). Pregnancy can also make women more vulnerable to sciatica and lumbar strain, which may cause back and hip pain. 

  • Relaxin production ramps up and peaks during the first trimester of pregnancy, then rises dramatically again just before childbirth. This hormone loosens the joints and ligaments in the lower back and pelvis. While this prepares the body for birth, it can also cause SI joint instability and trigger postural changes that strain the lower back and hips. 
  • Diastasis recti, also known as abdominal separation, occurs when the rectus abdominus or “six pack” muscles separate during pregnancy to fit the growing fetus. This condition can cause weak core muscles, pelvic instability, and imbalances that may lead to postpartum back and hip pain.
  • Pelvic girdle pain (PGP) is pain around the pelvic joints, hips, lower back, and thighs, and it affects an estimated one in five women during pregnancy. PGP most often develops in the second trimester and may persist in the third trimester. It’s similar to symphysis pubis dysfunction, or SPD, but SPD specifically relates to pain in the symphysis pubis joint at the front of the pelvis. 

Back and hip pain during pregnancy can often be managed with conservative strategies, including support belts, prenatal exercises, support pillows, heat and cold therapy, and chiropractic care. 

Menopause, Bone Health, and Chronic Back Pain

Declining estrogen levels due to menopause can compromise women’s bone health, leaving them vulnerable to osteoporosis and vertebral fractures. It also raises the risk of spinal disc degeneration and can increase chronic pain perception. This combination of factors leaves women in mid- to late-life particularly sensitive to chronic back pain. 

Around half of the bone loss that occurs in a woman’s lifetime develops in the first decade after menopause. As a result, postmenopausal women are susceptible to osteoporosis and spinal compression fractures, both of which can lead to chronic back pain. But plummeting estrogen levels aren’t just responsible for bone density loss – they can also contribute to degenerative disc disease.

Research shows that postmenopausal women experience accelerated spinal disc degeneration due to low estrogen levels. This comes down to estrogen’s role in maintaining collagen production and tissue hydration, both of which are crucial for healthy discs. 

Hormone replacement therapy, or HRT, is widely used to help manage menopause symptoms, and it can provide preventative bone support for women in this life stage. By supplementing estrogen via pills, tablets, or skin patches, it’s possible to prevent significant bone loss before it occurs. One study found that menopausal hormone therapy significantly reduced fracture risk by 20 to 40%.

Pelvic Floor Dysfunction and Its Connection to Back Pain

Pelvic floor dysfunction refers to an imbalance or abnormality in the pelvic floor muscles, which extend across the base of the pelvis. This muscle group stabilizes the pelvis and spine and supports several bodily functions, including urination, continence, and sexual function. If these muscles become weak or excessively tight, it can trigger referred pain in the lower back and hips, particularly in postpartum and older women. 

The lower back and pelvic floor muscles are closely connected; the pelvic floor muscles attach directly to the sacrum and coccyx (tailbone), which directly link to the lumbar spine. They work together with the core muscles to keep you stable. Considering their close connection, it’s unsurprising that pain in one region can refer to the other – a 2018 study found that 95% of participants with lumbopelvic pain also experienced pelvic floor dysfunction. 

Pelvic floor dysfunction, including weakness or excessive tension (called hypertonicity), can cause symptoms including:

  • Pelvic pain
  • Pain while sitting or standing for prolonged periods
  • Urinary issues (leakage, difficulty urinating, urinary urgency, or frequent urination)
  • Painful intercourse
  • Pain radiating to the hip, buttocks, or leg

Pelvic floor dysfunction is commonly linked to other conditions that can trigger painful spasms, including:

  • Interstitial cystitis (IC), also known as painful bladder syndrome
  • Vaginismus, a condition involving involuntary pelvic floor muscle spasms in women, typically leading to painful intercourse

Thankfully, for women with pelvic floor dysfunction, conservative therapies like pelvic floor physical therapy, biofeedback, manual therapy, and lifestyle changes can offer relief. 

Targeted Exercises and Stretches for Women with Back and Hip Pain

Targeted exercises and stretches can help women with back and hip pain gain mobility and muscular strength for joint support.

Low-impact, joint-safe exercises for back and hip pain include:

  • Clamshells: Lie on your side with your knees bent, then lift your top knee upward without moving your hips. Start with 5 reps on each side, then progress to up to 20 reps over time.
    • Modification for pregnancy and postpartum: Make sure to keep your top hip from rolling forward, so that your pelvis is perpendicular to the ground. 
  • Pelvic tilts: Lie on your back with your knees bent, then engage your core to tilt the pelvis, pressing your lower back into the ground. Start with 10 reps for two sets every other day, increasing to daily reps over time. 
  • Glute bridges: Begin in the pelvic tilt position, but engage your core and glutes to bring your hips higher up, making a straight line from your knees to your chest. Start with 10 reps for two sets, gradually increasing to 20 reps for four sets.
    • Modification for pregnancy, postpartum, or osteoporosis: Position a rolled-up towel or cushion beneath the lower back. 
  • Good mornings: Stand with your feet hip-width apart and your hands behind your head. While keeping your back straight, shift your weight into your heels and hinge forward at the hips, aiming to reach hip-level. Start with 10 reps, increasing to three sets over time.
    • Modification for pregnancy, postpartum, or osteoporosis: Perform seated good mornings by sitting in a chair and hinging forward at the hips. 

Yoga-inspired stretches to help release the hip flexors, piriformis, and lower spine include:

  • Cat-cow
  • Knee-to-chest
  • Figure four stretch
  • Pigeon pose

Why Does My Back and Hip Hurt at the Same Time?

Your back and hip may hurt at the same time if you have an injury, chronic condition, or certain lifestyle factors, like poor posture. 

When Should I Worry About Hip and Back Pain?

You should worry about hip and back pain if it’s severe, comes on suddenly, doesn’t improve after a few weeks, or interferes with your day-to-day activities. 

  • Severe hip and back pain carries a risk of disability and nerve damage. 
  • Back and hip pain that comes on suddenly can point to a serious injury, kidney infection, or other serious condition that requires prompt medical care. 
  • Back and hip pain that doesn’t improve after a few weeks indicates that the injury or condition requires more extensive medical care. 

Back and hip pain that impacts your day-to-day activities can have lasting complications, both mental and physical.

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What Are Red Flags for Back and Hip Pain?

Red Flags for Back and Hip Pain

Red flags for back and hip pain include:

  • Numbness, tingling, or weakness indicate nerve compression, which requires more intensive medical care
  • Pain after a sudden trauma, like a big fall or car accident, as symptoms can be delayed after these events due to adrenaline
  • Loss of bowel or bladder control can point to serious conditions, like cauda equina syndrome, which poses the risk of permanent paralysis.
  • Fever, chills, or other signs of infection, which requires prompt care in a hospital with antibiotics
  • Unexplained weight loss is a possible symptom of more serious health problems.
  • Pain that occurs or worsens at night can point to serious medical conditions, like cancer, spinal bone infection, and ankylosing spondylitis.

If you experience any of the red flags for back and hip pain listed above, seek emergency medical care. Your physician will complete an evaluation to pinpoint the source of your pain and provide essential care.