Can a Herniated Disc Cause Hip Pain?

By Dr. Joseph Mejia, DO, FAAPMR, RMSK
Medical Director, Performance Ortho

A Real-Life Story

What I love most about being a physician is that no two days are ever the same.

Several weeks ago, I saw a patient in the office with sudden and severe left hip pain that began after lifting a trailer carrying two 500-pound ATVs. Interestingly, he had performed this task many times before without any issue, but not this time.

He described the pain as a “very deep” 10 out of 10, with only mild low back tightness and slight tingling extending into the left foot. He had previously visited the local emergency room, where an X-ray of the hip was performed and interpreted as normal. He was told to follow up with me. Over 15 years of clinical experience told me this was coming from his spine and likely a herniated disc, however the patient was animate it was coming from his hip.  It is not uncommon for patients to be confused and even frustrated when they experience hip pain, as the low back spinal disc can “pinch” nerves which are commonly over looked source of hip pain.

During the patient’s initial visit, I performed a complete patient history, examination, low back Xray and ultrasound of the hip (MRI would come over the next several days), it was clear the patient herniated a disc which was putting pressure on the L3/L4 nerves.

Taking the time to thoroughly evaluate each patient is essential in obtaining an accurate diagnosis, there is no room for guesswork. The working diagnosis drives all treatment recommendations going forward.

Understanding the Herniated Disc

The human spine is made up of 33 bones, called vertebrae, stacked on top of one another. Between each vertebra is a cushion-like structure called a spinal disc, think of a jelly donut. These discs help absorb shock and allow for movement. Nerves branch out from the spinal cord through openings between the vertebrae, traveling to the arms, legs, and other parts of the body.  That is why, if spinal disc is “pinching” a nerve, the patient could feel symptoms far away from the spine, like pain, burning, numbness or tingling into the hip, leg, foot or hands.

The spine is an incredibly complex and dynamic structure, perfectly designed for movement, flexibility, and support. But like any system with that much complexity and motion, it also comes with a higher risk of injury. The majority of spinal condition we treat at performance Ortho are related to spinal disc damage, arthritis or degeneration (wear and tear).

Problems occur when the inner “jelly” substance breaks through the “donut”, by either macro trauma (as we saw in the patient above) or much more commonly micro trauma-small repetitive stress over time. Often, resulting in intense pain inflammation, spams and “sciatica”.

Is a Herniated Disc the same as a bulging disc?

One of the most common questions asked by  patients with spinal disc problems is: What’s the difference between a bulging disc and a herniated disc? The simplest way to explain it is with a tire analogy. A bulging disc is like a tire that’s gone flat, the tire is distorted, but still intact. A herniated disc, on the other hand, is more like a tire that had a blowout, there’s a visible tear, and the inner material has pushed out through the damaged area. Bulging disc are very common on MRI and my not be problematic. MRI’s always need to be correlated with the patient symptoms and exams to pain the full picture of the patient’s condition.

Connecting the Dots

So how can a spinal disc issue cause hip pain, even when there’s little or no back pain? The answer lies in a deeper understanding of anatomy, and years of experience treating spinal conditions help reveal the pattern.

Think of a nerve like a cross-section of an onion, layered and complex. Each layer, or “ring,” can carry different signals (pain, burning, numbness, etc.) to specific areas of the body, often far from the spine itself.

Depending on where and how a disc herniation presses on the nerve, it may trigger only certain symptoms, like deep hip pain, without causing the more familiar signs like back pain or leg numbness. This is why spinal disc conditions needs a complete medical workup to fully understand the diagnosis, effective treatments are always diagnosis driven.

What Testing do I need?

Keep in mind, that testing is used to confirm or eliminate a diagnosis made by physician derived from the patient’s history and examination. The most common test, and very helpful is the MRI of the spine. An MRI will give the physician a detailed picture of the spine, disc and all related structures, it is the gold standard. For certain conditions a CT scan may be ordered, but in my practice, it is performed much less often then the MRI. If additional information is needed, a nerve function test called an EMG/NCV  is performed and can be very helpful in identifying exactly what nerve is affected.

Treatment options:

It is well supported in the medical research; the vast majority of herniated disc are managed effectively with conservative non-surgical treatments. However, there are several “red flags” that readers should beware of:

• Sudden loss of bowl or bladder function
• Numbness in the groin or rectum
• Dragging of your feet (foot drop)
• Unrelating pain not responding to aggressive and prolonged medical pain management

If you are experiencing any of these, it is not likely you are a candidate for non-operative care and should seek emergency medical care.

Performance Ortho Approach to Disc Management:

• Start Conservative, Escalate as Needed:
  I follow a stepwise treatment protocol, beginning with conservative care and progressing as necessary. Surgery is always a last resort, unless there are clear red flags such as severe weakness or loss of bowel/bladder control.
• Team-Based, Integrated Care:
  Outcomes are far better when care is collaborative. Pain specialists, surgeons, and physical therapists working together, side-by-side in one facility create a seamless, coordinated plan. This integrated model often leads to faster and more complete recovery and less likely to have spinal surgery.
• Epidural Steroid Injections for Acute Pain:
  In cases of sudden, severe pain (like the patient example above), an epidural steroid injection can dramatically reduce inflammation and pain, helping patients begin rehabilitation much sooner.
• Short-Term Use of a Spinal Decompression Brace:
  A well-fitted back brace can provide temporary but powerful relief by reducing spinal load and allowing tissues to calm down.
• Spinal Decompression Therapy (e.g., DRX 9000):
  non-surgical decompression, when combined with other treatments, has shown to be highly effective in reducing disc-related pain.
• Regenerative Medicine Options:
  For select patients, stem cell therapy and PRP (platelet-rich plasma) injections may help promote healing and reduce inflammation.

If a patient fails to respond to conservative treatment, typically over a period of 6 to 12 weeks, they may be considered a candidate for surgical intervention. Below is a brief overview of common surgical options used to treat spinal disc herniations. A more detailed explanation of each procedure will be provided in a follow-up blog post.

Surgical Options

• Discectomy
  Removes  part or all of a herniated or damaged disc that is pressing on a nerve  causing leg or sciatica pain.
• Laminectomy
  Relieves pressure on the spinal cord or nerves by removing part of the vertebra called the lamina to create more space for the spinal cord and nerves.
• Spinal Fusion
  Stabilize the spine and eliminate painful motion between vertebrae, whereby permanently joined using bone grafts and hardware (screws, rods). Often done in conjunction with laminectomy or discectomy when instability is a concern.

Why Performance Ortho?

For over 25 years, Performance Ortho has been a trusted leader in orthopedic, spine  and pain care in Somerset County, New Jersey. Our difference lies in our integrated team approach, orthopedic surgeons, pain specialists, physical therapists, and occupational therapists all work together side by side in one facility. With convenient locations in Watchung, Branchburg, Somerset, Hillsborough, and a state-of-the-art Surgery Center in Bridgewater, we make it easy for you to get the expert care you need.

Take the First Step Toward Relief

If spine pain is keeping you from living your life, don’t wait. Schedule a consultation with our team and explore what treatment options could be right for you. Relief is possible, without ongoing frustration, and without giving up on the life you love.

Meet Your Expert: Dr. Joseph Mejia

Dr. Mejia is a triple board-certified specialist in Pain Management, Physical Medicine & Rehabilitation, and Sports Medicine. With over 15 years of experience, he has helped thousands of patients restore function, reduce pain, and avoid unnecessary surgery.

He currently serves as Medical Director at Performance Ortho, with offices in Watchung, Branchburg, Somerset, and Hillsborough, NJ.

Next Steps: How to Get Evaluated

At Performance Ortho, we specialize in non-surgical, evidence-based treatments that change lives. If you’re struggling with acute or chronic spine pain, we may provide the solutions you are  looking for.

Book an appointment or call today and reclaim your mobility-908-756-2424. The first step toward a pain-free future starts here.