Pain guide · Back pain

Lower back and hip pain: back or hip, the SI joint, sciatica, the outer hip and the warning signs

The lower back and the hip share pain easily: back problems can be felt only in the buttock, down the back of the leg or over the outside of the hip, and the hip joint is felt in the buttock, thigh and groin. Groin pain, a limp and a stiff hip point to the hip; pain above the buttock, tingling and pain below the knee point to the back. Often both are involved, and the sacroiliac (SI) joint and the tendons on the outside of the hip are easily mistaken for either.

Call 999 or go to accident and emergency (A&E) for numbness around the genitals or bottom, new bladder or bowel problems, sudden, severe pain in the tummy or back, or not being able to stand or put weight on the leg after a fall. Get help the same day, through an urgent general practitioner (GP) appointment or the National Health Service's 111 line (NHS 111), for pain in your side or back with a high temperature and pain when you pee, or a hot, swollen hip with a fever. This guide covers how to tell the causes apart, what to change in sitting, walking, stairs and sleep, and a three-stage plan with 3D demos that works the back and the hip together.

3-stage exercise plan When to get help 49 sourcesUpdated 25 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.
Call 999 or go to A&E: severe hip pain after a fall or injury, or you cannot stand, walk or put weight on the leg. In an older adult this can be a broken hip; the leg may be at an odd angle or look shorter. Don't drive yourself.
Call 999 or go to A&E: tingling or loss of feeling in the hip or leg after an injury.
Call 999: sudden, severe pain in the tummy or back, which can come with breathlessness, pale or grey skin, or collapse. It can be a burst abdominal aortic aneurysm, most common in men aged 65 or over and in people who smoke or used to smoke.
Call 999 or go to A&E: pain spreading from the tummy to the back, with vomiting.
Call 999 or go to A&E: back pain with chest pain, or back pain that started after a serious accident, such as a car crash.
Ask for an urgent GP appointment or get help from NHS 111 if you have severe hip pain that started suddenly but you've not had a fall or injured your hip, your hip is swollen and feels hot, the skin around your hip has changed colour, or you have hip pain, feel generally unwell and have a high temperature (or feel hot, cold or shivery). A hot, swollen hip with a high temperature can be a joint infection.
Same day (GP or NHS 111): back pain and you feel hot, cold, shivery or generally unwell, or severe pain that starts suddenly or is getting worse quickly.
Same day (urgent GP appointment or NHS 111): you think you may have a kidney infection (pain in your lower back or side, often with a high temperature, burning or stinging when you pee or needing to pee more often), and you have a very high temperature or feel hot, cold or shivery, a very low temperature (below 36C), pain in the lower tummy or in the back just under the ribs, or blood in your pee, or you're feeling or being sick, haven't had a pee all day or are pregnant. Call 999 or go to A&E if you're confused, drowsy or have difficulty speaking. Don't take ibuprofen for it unless a doctor advises you to.
Same day (urgent GP appointment or NHS 111): severe pain that usually starts in the side of your tummy or your lower back, may spread to the area at the top of your inner thigh (groin), your testicles or the area around the opening of your vagina, and may come and go, or this pain with a high temperature or feeling hot, cold or shivery. It can be a kidney stone.
Same day: you have or have had cancer, and new back pain that is severe and doesn't let up, is getting steadily worse, is worse at night and disturbs your sleep, is worse when you cough, sneeze or strain, or comes with tenderness over the spine. Contact your cancer team or GP urgently. With cancer, new weakness, difficulty walking, numbness or bladder or bowel problems are an emergency.
Same day: leg weakness that is getting worse.
Same day (urgent GP appointment or NHS 111): new difficulty lifting the front of your foot or toes (foot drop), or a foot that slaps down or catches as you walk, especially if it is getting worse. Weakness in both legs, or with numbness around the genitals or bottom or bladder or bowel changes, is the 999 emergency above.
Contact your GP or midwife urgently: back pain in the second or third trimester of pregnancy, or back pain in pregnancy with a fever, vaginal bleeding, pain when you pee, or pain in one or more of your sides (under your ribs). It could be early labour or an infection.
Call 999 or go to A&E immediately: a combination of a sharp, sudden and intense pain in your tummy, feeling very dizzy or fainting, feeling sick, or looking very pale, if there's any chance you could be pregnant. It could be an ectopic pregnancy that has split open (ruptured).
Contact your GP or call NHS 111 straight away: you might be pregnant, even without a positive pregnancy test, and you have a combination of tummy pain low down on one side, vaginal bleeding or a brown watery discharge, pain in the tip of your shoulder, or discomfort when peeing or pooing. It can be an ectopic pregnancy.

See a doctor or physiotherapist if

Hip pain that stops normal activities or disturbs sleep, keeps getting worse, or has not improved after 2 weeks of looking after it at home.
Back pain that hasn't improved after a few weeks of looking after it at home, stops you doing day-to-day activities, or worries you.
Stiffness lasting more than 30 minutes after waking.
Hip or groin pain that hasn't settled after 6 weeks, especially with a normal X-ray, or new hip pain if you take high-dose steroids, drink heavily, or have sickle cell disease or lupus: ask your GP about an MRI (magnetic resonance imaging) scan and a hip specialist. It can be avascular necrosis, which an X-ray can miss early on.
Bone pain that is constant or worse at night, especially with a lump, unexplained weight loss, fever or tiredness, or a past history of cancer.
Pain that doesn't improve with rest or is worse at night, or pain that is worse when you sneeze, cough or poo.
Unexplained weight loss, or a lump, swelling or change in the shape of your back.
Back pain that started before 45 and has lasted more than 3 months, especially if it wakes you in the second half of the night, comes with buttock pain, eases with movement or within 48 hours of anti-inflammatories, or you have psoriasis or a parent, sibling or child with spondyloarthritis. These can point to inflammatory back pain (axial spondyloarthritis, such as ankylosing spondylitis); the National Institute for Health and Care Excellence (NICE) refers people with four or more of these features to a rheumatologist.
Pain, tingling or numbness spreading below the knee that isn't settling after a few weeks, is getting worse or stops your normal activities: see a GP.
Leg ache when you walk that goes after a few minutes' rest: possible peripheral arterial disease (narrowed leg arteries), especially if you smoke or have diabetes.
An ache in the buttock or thigh that comes on as you walk and eases after a few minutes' rest: see a GP. It can come from narrowed arteries higher up, in the tummy or pelvis, NHS Scotland's vascular pathway says.
Tummy or back pain that doesn't go away or keeps coming back, or a lump you can feel in your tummy: see a GP.
Urgent GP appointment or NHS 111: pain in your back, under your ribs, that doesn't go away, a lump or swelling in your back or under your ribs, or blood in your pee. These need checking, as they can be signs of a kidney problem.
Pain in your lower tummy and back (your pelvic area), severe period pain that stops you doing your normal activities, or pain when you poo or pee or during or after sex: see a GP if you think it could be endometriosis.
Pelvic pain in pregnancy that makes it hard to move around, hurts when you get out of a car or turn over in bed, or makes going up or down stairs painful: call your midwife or GP. You may be referred to a physiotherapist who specialises in pelvic joint problems in pregnancy.
Unexplained back pain with muscle spasms, loss of height, or a curved spine or change in posture: a possible osteoporotic spinal fracture, more likely with older age or long-term steroid tablets.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

Across the low back, spreading into one or both buttocks or over the outside of the hip, varying from day to day

Usually the lower back itself, which can be felt only in the buttock or over the outside of the hip.

Read: Back pain →One side of the lower back, without hip or buttock pain

Our lower back pain on one side guide covers it, including the kidneys.

Read: Lower back pain on one side →The buttock and the back of the leg past the knee, with tingling, numbness or weakness

Usually sciatica, a trapped nerve, and the leg often hurts more than the back.

Read: Sciatica →Low on one side, by the dimple at the back of the pelvis, into the buttock

Possibly the SI joint, often tender over the joint itself.

Read: SI joint pain →The groin crease, the front of the thigh or the buttock, with a stiff hip, a limp, and trouble with socks or getting out of a car

Usually the hip joint, often arthritis from about 45.

Read: Hip arthritis →The bony point on the outside of the hip, worse lying on it, crossing your legs or on stairs

Usually the tendons on the outside of the hip (greater trochanteric pain syndrome), often called bursitis.

Read: Hip bursitis (gluteal tendinopathy) →Deep in the buttock, worse sitting

Possibly piriformis or deep gluteal syndrome, or the hamstring tendon at the sitting bone.

Read: Piriformis syndrome (deep gluteal syndrome) →Both buttocks and legs, heavy or tingling on standing and walking, easing when you sit or bend forward

Possibly spinal stenosis, which is commonest in older adults.

Read: Lumbar spinal stenosis →A buttock or calf ache that comes on after walking a set distance and goes with a few minutes' rest

Possibly narrowed arteries, especially if you smoke or have diabetes: see a GP. Our buttock pain guide covers it.

Read: Buttock pain →In pregnancy, at the front or back of the pelvis

Usually pelvic girdle pain, which affects up to 1 in 5 pregnant women.

Read: Pelvic girdle pain (SPD) →

Back and buttock pain that started before 45, wakes you in the second half of the night and eases with exercise

Possibly inflammatory back pain (axial spondyloarthritis): see a GP.

The side or back under the ribs, with a high temperature or pain when you pee

Possibly a kidney infection: get an urgent GP appointment or help from NHS 111.

Sudden, severe pain in the tummy or back, especially in an older man or someone who smokes

Possibly a burst abdominal aortic aneurysm: call 999.

Understand it

Why the back and the hip are easily confusedEmerging evidence

The lower back can send pain to the buttock, the outside of the hip and down the leg. Arthritis UK says back problems can be felt only in the buttocks, down the back of the legs, over the outside of the hip and occasionally the front, and NHS inform says a problem felt in the hip can occasionally come from the back 'even though you don't feel pain in your back'. An NHS physiotherapy leaflet says low back pain affects 80% of adults at some point, can spread into the hips, buttocks or a leg, and is rarely serious.

The hip joint is felt mainly in the buttock, thigh and groin: when 51 people's hip joint pain was confirmed with an injection, 71% felt it in the buttock, 57% in the thigh, 55% in the groin and 22% below the knee. The SI joint is felt in the buttock too: 94% of 50 people whose SI joint pain was confirmed with an injection felt it there, and 72% low in the back. And in 60 people with hip arthritis, 47% had pain below the knee, which most trainee surgeons in the study didn't expect.

Sources 1, 2, 3, 4, 5, 6

Other causes to know

The tendons on the outside of the hip (greater trochanteric pain syndrome, often called hip bursitis) cause pain over the bony point on the outside of the hip, worse lying on that side, crossing the legs or on stairs. It is commonest in women aged 40 to 60, affected 15.0% of women and 6.6% of men aged 50 to 79 on one side in a US study, and is often mistaken for back pain: 20.2% of 252 people referred to spine surgeons with back pain had it. Deep buttock pain can come from the piriformis area (deep gluteal syndrome) or from the hamstring tendon at the sitting bone, a US family doctors' review says.

Two patterns need a GP. Heavy, aching or tingling buttocks and legs on standing and walking that ease when you sit or bend forward point to spinal stenosis, mostly in older adults: having no pain when sitting was one of the strongest clues. Back and buttock pain that started before 45, wakes you in the second half of the night and eases with exercise points to inflammatory back pain (axial spondyloarthritis), which the National Institute for Health and Care Excellence (NICE) asks GPs to refer to a rheumatologist, and which takes 6.7 years on average to be diagnosed.

Some causes aren't in the back or hip at all: the kidneys (pain in the side or back under the ribs with a high temperature and pain when peeing, or a kidney stone's severe pain that can spread to the groin); an abdominal aortic aneurysm (sudden, severe tummy or back pain, most common in men aged 65 or over and in people who smoke, and NICE adds high blood pressure and age over 60); endometriosis (pain in the lower tummy and back); and, in pregnancy, pelvic girdle pain, which affects up to 1 in 5 pregnant women.

Sources 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19

How to tell the back from the hipEmerging evidence

In 97 people with leg pain, a limp, groin pain or a hip that wouldn't turn inwards made a hip problem (alone or with a spine problem) 7, 7 and 14 times more likely than a spine problem alone, and groin pain was much commoner with hip arthritis than with spinal stenosis. Pain in the low back above the buttock, a history of back trouble, tenderness over the lower spine and tingling or pain below the knee point to the back, a US family doctors' review says, and in people about to have a hip replaced, pain below the knee went most closely with spine problems.

Buttock pain on its own doesn't decide it, because the buttock is the commonest place for both hip joint pain and SI joint pain. No single test confirms SI joint pain: three or more positive pain tests out of six picked up 94% of people whose SI joint pain was confirmed with an injection. When it remains unclear, a hip X-ray and, in specialist care, an anaesthetic injection into the hip joint help separate the two.

Sources 20, 6, 10, 21, 4, 5, 22

When a scan helpsStrong evidence

Routine imaging isn't recommended for low back pain, and NICE diagnoses osteoarthritis without imaging in people aged 45 or over with joint pain on activity and no morning stiffness, or stiffness lasting no more than 30 minutes. When the hip is imaged, a standing X-ray of the pelvis comes first. After a fall, a magnetic resonance imaging (MRI) scan is offered if a broken hip is suspected despite normal X-rays. Scan findings are common without pain: disc bulges in 30% of pain-free 20-year-olds and 84% of 80-year-olds.

Sources 23, 24, 10, 25, 26

How it usually goesEmerging evidence

New low back pain mostly improves within 6 to 8 weeks, an NHS physiotherapy leaflet says, and the NHS says sciatica usually gets better in a few weeks to a few months. Outer hip pain is slower: with education and exercise, 51 of 66 people reported success at 8 weeks in a trial, and an NHS trust leaflet expects improvement over 8 to 12 weeks, sometimes up to a year. In spinal stenosis, physiotherapy gave similar function to surgery at 2 years in people who were candidates for an operation, though 57% of the physiotherapy group went on to have surgery. No one can promise a timescale.

Sources 3, 27, 28, 7, 29

What helps, and how strong the evidence is

Hip and spine trouble often turn up together, though the hip joint rarely refers pain to the low backMixed evidence

Hip and spine problems often turn up together in older adults, a pattern surgeons call hip-spine syndrome. Before a hip replacement, 49.4% of 344 people had low back pain, and it went away after the operation in 66.4% of them; in 25 people with severe hip arthritis, back pain scores fell from about 5 to 3.7 out of 10 after the hip was replaced. NHS inform says a hip problem can bring pain in the back as well.

But in the injection study, pain from the hip joint itself didn't reach the low back in any of the 51 people. These findings come from small surgical and clinic series, and they pull in different directions. In our reading, the hip joint rarely refers pain to the low back itself, but the two problems often coexist, so a stiff, painful hip and back pain are worth treating together.

Sources 30, 21, 31, 4, 2

Exercise is the core treatment for each causeStrong evidence

In long-lasting low back pain, exercise cut pain by about 15 points out of 100 against no treatment, usual care or placebo (moderate certainty, 249 trials). In hip arthritis, it cut pain by about 8 points out of 100 (high-quality evidence, 9 trials, 549 people), and NICE makes therapeutic exercise the core treatment, warning that joint pain may rise at first. In outer hip pain, 8 weeks of education plus exercise succeeded in 51 of 66 people, against 38 of 65 after a steroid injection and 20 of 68 with wait and see.

Sources 32, 33, 24, 28

Keep moving, and sit lessStrong evidence

The NHS says carry on with your normal activities as much as you can, start gentle exercise as soon as you can, and don't sit or lie down for long periods: even if moving hurts, it's not harmful and can help you get better faster. Advice to stay active did slightly better than bed rest in a Cochrane review, and more than 5 hours' sitting a day went with back pain coming back.

Sources 27, 34, 35, 36

Outer hip pain: education and exercise beat an injectionStrong evidence

In the LEAP trial of 204 people aged 35 to 70, 8 weeks of education plus exercise did better than a steroid injection or wait and see, with less pain at 8 weeks; at a year, more people rated themselves much improved after exercise than after the injection, though pain was then similar. An NHS trust leaflet's home programme starts with a lying hip press against a band, bridges and chair squats, and leaves side-lying leg lifts for later.

Sources 28, 7

Spinal stenosis: the clues, and physiotherapy or surgeryEmerging evidence

In 4 studies of 741 older adults, spinal stenosis was likelier over 70, and no pain when sitting, symptoms that eased on bending forward and pain in both buttocks or legs were among the strongest clues. In 169 people who were candidates for surgery, physiotherapy and surgery gave similar function at 2 years, though 57% of the physiotherapy group crossed over to surgery.

Sources 11, 29

The SI joint, and a pelvis 'out of place'Emerging evidence

No single test confirms SI joint pain. Against an anaesthetic injection, three or more positive pain tests out of six picked up 94% of people with SI joint pain and correctly ruled it out in 78% of those without it, and in a pooled review the thigh thrust was the strongest single test. In 43 people with long-lasting back pain, 30% had relief from an SI joint injection, and groin pain was the only pattern linked with relief. No source we read supports the idea that the pelvis is 'out of place' and needs putting back.

Sources 22, 37, 38

How much pain is OK while you exercise?

Up to about 5 out of 10, settled within an hour, no worse that night or the next morning; leg symptoms that spread mean a smaller movementEmerging evidence

During the exercise, pain up to about 5 out of 10 is acceptable. It should settle within an hour or so, and your back and hip should be no worse that night or the next morning. If they are, do less next time (fewer repetitions, a smaller range, a lighter load), not nothing. NHS inform's back and hip exercise pages use the same 0 to 10 scale and the same next-morning check, and NICE warns that joint pain may rise when you start exercising for arthritis, while exercise still helps.

Leg symptoms are the exception: stop or shrink any movement that sends pain, pins and needles or numbness further down your leg. Outer hip pain shouldn't increase during or after the lying hip press; if it does, press more gently, as the move page says. With spinal stenosis, walking can bring on leg symptoms that ease when you sit, so walk in shorter bouts or cycle (our suggestion).

In pregnancy, pelvic girdle pain means keep active but avoid what makes it worse; the NHS suggests keeping your knees together getting in and out of a car and avoiding long spells sitting or standing. The 5 out of 10 figure matches the site's back and hip guides and hasn't been tested as a rule; in trials of long-lasting muscle and joint pain, exercise that allowed some pain did no worse than pain-free exercise.

Sources 39, 40, 24, 41, 19

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle: keep moving, sit less, and find what eases it

About the first 2 weeks. Keep up your normal activities and short walks, avoid long spells sitting or lying, and start gentle movement for the back and the hip, as the NHS advises. With a known cause, its own guide comes first: sciatica, SI joint pain, hip arthritis, hip bursitis, spinal stenosis or pelvic girdle pain.

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

5 to 10 min, several times a day · As in our back pain guide (editorial); walking outdoors counts the same

Harder: Treadmill jogging

Hip windshield wipers demonstrated on the 3D figure

3D demoHip windshield wipersBeginner · No equipment

2 or 3 at a time, little and often, building to sets of 8, up to 2 sets of 15 · NHS inform's knee rolls with its pacing, as our buttock pain guide uses them (the move page's own dose is editorial)

Easier: Supine heel slide · Harder: 90/90 switch

Single knee-to-chest stretch demonstrated on the 3D figure

3D demoSingle knee-to-chest stretchBeginner · No equipment

Hold 20 to 30 s, 2 to 4 times each side · The move page's dose (editorial). Only if it eases your pain; leave it out if bending forward sends pain down a leg, and ease off for a pinch at the front of the hip, as the move page says

Harder: 90/90 hip lift-off

Supine isometric hip abduction (belt press) demonstrated on the 3D figure

3D demoSupine isometric hip abduction (belt press)Beginner · A band

3 to 5 holds of 5 to 10 s, twice a day, at a light effort · The move page's dose, the LEAP trial programme's starting dose. Only if the outside of the hip hurts; the Leicestershire leaflet holds for 10 s, 5 times, once or twice a day

Harder: Lateral band walk

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

5 to 10 slow reps, once or twice a day · The Leicestershire outer hip leaflet's first-level bridge

Easier: Pelvic tilt into bridge · Harder: Single-leg glute bridge

Seated sciatic nerve slider (nerve glide) demonstrated on the 3D figure

3D demoSeated sciatic nerve slider (nerve glide)Beginner · A bench or box

10 slow reps, 2 to 3 times a day · The move page's dose, one NHS musculoskeletal service's. Only with pain or tingling down the leg; try it for 2 weeks and keep it only if it eases the leg

Easier: Lying sciatic nerve slider (nerve glide)

Move on when: You can walk for 10 to 15 minutes and get in and out of bed and the car without catching pain, and the pain is easing (editorial, as in our deadlift guide).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build: hips and trunk, one side at a time

About weeks 2 to 6: 2 or 3 days a week, with walks most days. Build strength around the pelvis and trunk, comparing the two sides, so that stairs and getting up from a chair get easier.

Sit to stand from a chair demonstrated on the 3D figure

3D demoSit to stand from a chairBeginner · A bench or box

5 to 10, once or twice a day, building to 3 sets of 8 to 10 from a lower seat · The start is the Leicestershire leaflet's chair squat; the build is as in our back pain and hip pain guides (editorial)

Easier: Sit to stand, pushing on the thighs · Harder: Bodyweight squat

Staggered-stance bridge (offset bridge) demonstrated on the 3D figure

3D demoStaggered-stance bridge (offset bridge)Beginner · No equipment

5 slow reps each side once a day, building to 2 sets of 5 to 10 at a somewhat hard effort · The move page's dose, from the LEAP trial programme

Easier: Pelvic tilt into bridge · Harder: Single-leg glute bridge

3D demoBird dogBeginner · No equipment

2 to 3 sets of 6 to 8 each side, with 3 to 5 s holds · As in our back pain guide (editorial)

Easier: Bird dog, one limb at a time · Harder: Bear crawl

Knee side plank demonstrated on the 3D figure

3D demoKnee side plankBeginner · No equipment

3 holds of 15 to 20 s each side · As in our back pain guide (editorial); compare the two sides

Harder: Side plank

Low step-up demonstrated on the 3D figure

3D demoLow step-upBeginner · A step

2 to 3 sets of 8 each side, holding a rail · As in our SI joint pain guide (editorial)

Harder: Step-up

Standing band hip extension demonstrated on the 3D figure

3D demoStanding band hip extensionBeginner · A band + An anchor point

2 to 3 sets of 8 to 12 each side, stopping with 2 or 3 reps in reserve · The move page's dose (editorial). Stop the leg where your low back starts to arch, as the move page says

Harder: Back extension on a 45-degree bench

Move on when: These pass the pain rule, a 20 to 30 minute walk is comfortable, and stairs are easier (editorial).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Strengthen, then walking, stairs, lifting and sport

From about week 6, ongoing: single-leg strength, loaded hinging and carrying, while walking, stairs, the car, sitting and lifting come back by the written steps below.

Dumbbell goblet squat demonstrated on the 3D figure

3D demoDumbbell goblet squatIntermediate · A dumbbell

3 sets of 8 to 10, to a box or chair at first · As in our back pain and hip pain guides (editorial)

Easier: Bodyweight squat · Harder: Barbell front squat

Split squat demonstrated on the 3D figure

3D demoSplit squatIntermediate · No equipment

3 sets of 6 to 10 each side · As in our hip pain guide (editorial). Skip it, or keep the stance narrow, with pelvic girdle pain in pregnancy, as the move page says

Easier: Bodyweight squat · Harder: Reverse lunge

Single-leg Romanian deadlift demonstrated on the 3D figure

3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell

2 to 3 sets of 6 to 8 each side · Editorial. Learn it with your fingertips on a wall or rail, as the move page says

Easier: Dumbbell Romanian deadlift

Side plank demonstrated on the 3D figure

3D demoSide plankIntermediate · No equipment

3 holds of 20 to 30 s each side · As in our back pain guide (editorial)

Easier: Knee side plank · Harder: Side plank with leg lift

Suitcase carry demonstrated on the 3D figure

3D demoSuitcase carryIntermediate · A dumbbell + A kettlebell

3 walks of 20 to 30 m each side · As in our back pain guide (editorial). If you can't stay level, the weight is too heavy, as the move page says

Easier: Farmer's carry · Harder: Overhead carry (waiter's walk)

Recumbent exercise bike demonstrated on the 3D figure

3D demoRecumbent exercise bikeBeginner · Cardio machine

10 to 20 minutes at a moderate effort, building towards 30 · The move page's dose (editorial). A good alternative to walking with spinal stenosis, because sitting and bending forward ease the symptoms

Harder: Stationary cycling

Move on when: Our suggestion: walks building towards 30 minutes most days, stairs, the car and your usual lifting are back within the pain rule. Keep two strength sessions a week once the pain has settled; for hip arthritis, NICE makes exercise the long-term core treatment.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Sitting, standing and the car (written steps)

Our 3D figure can't show these. Each step names its source or is our suggestion.

1. Avoid low chairs and sofas, which put extra pressure on the hip, or raise the seat with a cushion (the NHS and NHS inform).
2. Get up and move every so often: more than 5 hours' sitting a day went with back pain coming back.
3. With outer hip pain, don't cross your legs, and don't stand with your weight on one hip pushed out to the side (an NHS trust leaflet); share your weight between both legs (our suggestion).
4. To get into a car, sit on the seat first with your back to the car, then swing both legs in together, and reverse it to get out (our suggestion). In pregnancy, keep your knees together getting in and out, as the NHS says.

Sources 42, 43, 7, 36, 19

Walking and stairs (written steps)

These come from the NHS and NHS inform, except where a step is our suggestion.

1. Keep moving without overdoing it, in comfortable, shock-absorbing shoes with a soft sole (the NHS). Shorter walks more often, building up gradually, suit most people (our suggestion).
2. A walking stick may help, held in the hand opposite the sore hip (NHS inform).
3. On stairs, use a handrail, and lead with the good leg going up and the sore leg coming down (NHS inform).
4. With spinal stenosis, symptoms ease when you sit or bend forward, so a bike, walking poles or leaning on a trolley can stretch how far you go (our suggestion).

Sources 42, 43, 11

Sleep, carrying, ice and heat (written steps)

These come from an NHS trust leaflet and the NHS, except where a step is our suggestion.

1. With outer hip pain, if lying on the painful side hurts, lie on the other side with a pillow between your knees, and a pillow behind your back to stop you rolling onto the painful side (the NHS trust leaflet).
2. Don't carry anything heavy while the hip is sore (the NHS); with back pain, keep loads close and split them between both hands (our suggestion).
3. An ice pack wrapped in a towel for up to 20 minutes every 2 to 3 hours can ease a sore hip, and heat packs can help sciatica (the NHS).

Sources 7, 42, 27

Medicines, injections and surgery

For back pain, NICE suggests an anti-inflammatory at the lowest dose for the shortest time, not paracetamol on its own, and no routine opioids or spinal injections. For sciatica that is severe and not improving, a specialist may offer an injection, a procedure that seals off the nerves sending pain signals (radiofrequency denervation) or decompression surgery. For outer hip pain, a steroid injection helped at 8 weeks, but less than education and exercise. For hip pain, the NHS lists steroid injections and, when other treatments haven't helped, a hip replacement, and replacing an arthritic hip often eased back pain that came with it. Inflammatory back pain needs a rheumatologist, NICE says.

Sources 23, 27, 28, 42, 21, 12

Positions to swap, and why

Habit or position	Why it matters	Instead
Long spells sitting or lying down	The NHS says don't sit or lie down for long periods, as moving isn't harmful and can help you get better faster; more than 5 hours' sitting a day went with back pain coming back.	Get up and move regularly, with short walks.Try: Treadmill walking
Low chairs and sofas	The NHS says low chairs can put extra pressure on your hips.	A higher, firm chair, or a cushion to raise the seat.Try: Sit to stand from a chair
Crossing your legs, or standing with one hip pushed out	An NHS trust leaflet's advice for outer hip pain.	Feet flat, with your weight shared between both legs.
Lying on the painful hip	An NHS trust leaflet's advice for outer hip pain.	The other side, with a pillow between your knees and one behind your back.
Taking stairs with either leg first	NHS inform's advice for hip arthritis.	Good leg first going up, sore leg first coming down, with a rail.Try: Low step-up
Getting into a car one leg at a time	Our suggestion: NHS inform lists getting out of a car among the tasks hip arthritis makes hard, and the NHS suggests keeping your knees together in pregnancy.	Sit first, then swing both legs in together.
Long walks on a bad day, or stopping walking altogether	Our suggestion; with spinal stenosis, sitting and bending forward ease the symptoms.	Shorter walks more often, or a bike.Try: Recumbent exercise bike
Carrying heavy shopping on one side	The NHS says don't carry anything heavy while your hip is sore.	Split the load, use a trolley or a rucksack, and practise carrying in the last stage.Try: Suitcase carry
Side-lying leg lifts while the outside of the hip hurts	Its move page warns that the position can aggravate outer hip pain.	The lying band press and staggered bridges, as in the LEAP trial.Try: Supine isometric hip abduction (belt press)
Hard hamstring or piriformis stretches that send pain down the leg	Leg symptoms that spread mean a smaller movement, as the back pain rule says.	Gentle nerve sliders, and only if they ease the leg.Try: Seated sciatic nerve slider (nerve glide)
Waiting for a scan before you start moving	NICE advises against routine imaging for back pain and diagnoses hip arthritis without it from 45.	Start the first stage now, and see a GP for the warning signs.Try: Hip windshield wipers

Routines to follow

Lower back stretch routine

Seven gentle stretches and mobility moves for a stiff lower back, done lying and kneeling.

12 minBeginner7 movesA wall

Pilates for back pain (gentle routine)

A gentle 15-minute Pilates-based routine for ongoing low back pain, built from neutral-spine moves with options for backs that dislike bending or arching.

15 minBeginner10 movesNo equipment

Pilates for hip pain: a 20-minute class that spares the hip

A 20-minute Pilates class for hip pain: bridges, outer-hip holds, standing leg work and balance, without deep bends, crossed legs or lying on the sore side.

20 minBeginner14 movesA band, A wall

Glute workout at home

A 25-minute glute workout with bodyweight and a mini band: bridges, clamshells, band walks, kickbacks and lunges.

25 minBeginner9 movesA wall, A band

Hip mobility routine

A 15-minute hip opener: 90/90 switches, windshield wipers, CARs, Cossack squats, frog and pigeon.

15 minIntermediate8 movesA wall

Yoga for sciatica: a gentle sequence that lets your leg decide

A gentle 25-minute yoga sequence for sciatica: breathing, a nerve glide, poses chosen by how your leg responds, and standing strength, with no straight-leg folds.

25 minBeginner16 movesNo equipment

Hip and core control routine: even strength around the pelvis

A 25-minute routine for a pelvis that feels twisted or uneven: gentle holds, bridges, bird dogs, side planks and single-leg balance, the same on both sides.

25 minBeginner11 movesA band, Other / check instructions

Claudication walking workout: walk-rest-walk

The walk-rest-walk session for leg pain from narrowed arteries: walk until the pain is close to the most you can bear, rest until it goes, repeat to 30 minutes.

45 minBeginner8 movesA wall, Cardio machine

More moves for this area

Questions people ask

Is it my hip or my back?

Groin pain, a limp and a stiff hip that won't turn in point to the hip; pain in the low back above the buttock, tingling, and pain below the knee point to the back. The buttock is the commonest place for both, and both often hurt together, so a physiotherapist or GP examines both.

Why do my lower back and hip hurt on one side?

Commonly the SI joint (low on one side by the dimple, into the buttock), the outer hip tendons (the bony point on the outside of the hip), a trapped nerve (pain down the leg) or the hip joint (groin and buttock). Our lower back pain on one side guide covers one-sided pain that isn't from the hip, including the kidneys.

Why do my lower back and hip hurt when I walk?

Hip arthritis typically hurts in the groin, buttock or thigh when walking, with stiffness. If both buttocks and legs get heavy or tingly on walking and ease when you sit or bend forward, it may be spinal stenosis. An ache that comes on after a set distance and goes with a few minutes' rest can be narrowed arteries, which needs a GP.

Why do my lower back and hip hurt when I sit?

Long sitting stiffens the back and hip, and the NHS says low chairs put extra pressure on the hips. Deep buttock pain that is worse sitting can be deep gluteal syndrome. Use a higher chair, get up regularly and take short walks.

Why do my lower back and hip hurt at night?

Lying on the painful side commonly aggravates outer hip pain, so lie on the other side with a pillow between your knees. Back pain that wakes you in the second half of the night and eases when you get up and move can be inflammatory back pain, which needs a GP, and pain that is worse at night and doesn't ease with rest needs a GP too.

Can lower back and hip pain be cancer?

Rarely. Back pain is rarely caused by anything serious, but contact your GP or cancer team urgently if you have had cancer and get new back pain that is severe, getting steadily worse or worse at night. See a GP for back pain with weight loss you can't explain, and for bone pain that is constant or worse at night, especially with a lump, weight loss or a fever.

Why do women get lower back and hip pain?

The common causes are the same, and outer hip pain is commoner in women, especially aged 40 to 60. Pain in the lower tummy and back with painful periods can be endometriosis, and pelvic girdle pain affects up to 1 in 5 pregnant women. Tummy pain low down on one side with bleeding, if you could be pregnant, needs urgent advice. Our guides to lower back pain in women and hip pain in women cover each in more detail.

What are the best exercises for lower back and hip pain?

Exercise is the core treatment for back pain, hip arthritis and outer hip pain, and no single exercise has been shown to be best. Start with walking, knee rolls, bridges and a lying hip press, then sit-to-stands, staggered bridges and side planks, as the staged plan on this page sets out.

Could my back and hip pain be my kidneys?

Kidney pain is usually in the side or back under the ribs and comes with a high temperature, pain or burning when peeing, or feeling sick; it needs an urgent GP appointment or NHS 111. A kidney stone causes severe pain starting in the side or lower back that can spread to the groin.

I'm pregnant and my lower back and hips hurt. Is that normal?

Back and pelvic pain are common in pregnancy, and a physiotherapist can help. Keep active, keep your knees together getting in and out of a car, and avoid long spells sitting or standing. Contact your GP or midwife urgently for back pain in the second or third trimester, or with a fever, bleeding, pain when you pee or pain in your sides.

Do I need a scan for lower back and hip pain?

Usually not: NICE advises against routine imaging for back pain and diagnoses hip arthritis without it from 45. Scans help after a fall when a broken hip is possible, with warning signs, or when an injection or an operation is being planned.

When should I see a doctor?

Call 999 for numbness around the genitals or bottom or bladder or bowel changes, sudden, severe tummy or back pain, or not being able to stand or put weight on your leg after a fall. See a GP if hip pain hasn't improved after 2 weeks, back pain after a few weeks, or you have morning stiffness that lasts more than 30 minutes.

Related exercise guides

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.