The hip-spine connection: understanding its importance in the treatment of hip pathology
EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Discuss the kinematic relationship between the hip and lumbar spine. 2. Explain the innervation of the hip and lumbar spine and how they relate to one another. 3. Recognize the effect of hip disease on the lumbar spine in an athletic population, prior to the onset of degenerative changes. 4. Describe an algorithm for diagnosis and treatment of patients who present with concomitant hip and lumbar spine pain. 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 population. 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.