Groin pain and back pain are connected through shared anatomy, and one can genuinely contribute to the other. The hip joint sits at a biomechanical crossroads between the pelvis, lumbar spine, and lower extremities, so problems that produce groin pain frequently alter the mechanics of the lower back as well. The relationship runs in both directions: spinal conditions can refer pain into the groin, and hip or groin problems can generate or worsen low back pain. The pathways linking them involve muscles, joints, nerves, and the way you walk when something hurts.
The Psoas Muscle Is the Physical Bridge
The most direct muscular link between your groin and your lower back is the psoas major, a deep muscle that originates along the sides of the lumbar vertebrae, runs through the pelvis, and inserts near the top of the thigh bone. It is the only muscle that directly connects your spine to your leg. When the psoas is tight, strained, or in spasm, it can pull on both ends at once, creating pain in the groin and the lower back simultaneously. A case report involving a professional hockey player illustrated this clearly: the athlete was diagnosed with a psoas and rectus femoris problem on one side, which had direct implications for lumbar spine stability.1PubMed Central. Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implications
Because the psoas attaches to every lumbar vertebra, tension or dysfunction in this muscle does not just tug on the hip. It compresses the lower spine, increases the curve of the lumbar lordosis, and can shift how forces distribute through the spinal segments during movement. People who sit for long stretches tend to develop a shortened psoas, and the resulting anterior pelvic tilt places additional mechanical load on the lumbar discs and facet joints. The groin ache and the backache in these cases share a single root cause, even though they feel like two separate problems.
The Sacroiliac Joint Creates Overlapping Pain
The sacroiliac joint, where the base of the spine meets the pelvis, is one of the most common sources of overlapping groin and back pain. Dysfunction of this joint is an underappreciated cause of mechanical low back pain, affecting roughly 15 to 30 percent of people with chronic, non-nerve-related back pain.2PubMed. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment The pain referral patterns from this joint are highly variable, which is part of why it gets missed so often.
A study examining patients with sacroiliac joint dysfunction found that nearly half of them reported groin pain alongside their back pain.3PubMed Central. Groin pain associated with sacroiliac joint dysfunction and lumbar disorders That is a strikingly high proportion and suggests that when someone has both groin pain and back pain, the sacroiliac joint deserves a close look. A typical presentation involves lateralizing low back pain that radiates into the buttock and often the groin, sometimes with a history of onset around childbirth or after trauma to the lower back.4PubMed Central. What’s Old Is New Again: The Sacroiliac Joint as a Cause of Lateralizing Low Back Pain People with sacroiliac problems are more likely to recall a specific event that started the pain, and the discomfort tends to sit on one side rather than across the whole lower back.2PubMed. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment
How a Groin Problem Changes Your Gait and Loads Your Spine
Even when there is no direct anatomical pathway linking your groin issue to your spine, an indirect one often develops through the way you move. When you have pain in the groin, hip, or upper thigh, your body instinctively adapts your walking pattern to reduce the load on the painful side. You might shorten your stride, shift your weight, or rotate your pelvis differently. These compensatory changes do not stay contained to the hip. They ripple upward through the pelvis and into the lumbar spine.
Research into the link between lower extremity joint problems and low back pain has identified altered gait as a key mechanism. Abnormal gait patterns interfere with normal spinal segment movement, which leads to postural distortions, imbalances in how muscles fire, and dysfunction in spinal joints.5Longdom Publishing (International Journal of Physical Medicine & Rehabilitation). Abnormal Gait: How Lower Extremity Joint Pathology Leads to Low Back Pain Even in cases where there is no pain or injury in the lower extremity itself, abnormal biomechanics can adversely affect the lower back. So it is not just that groin pain makes you limp, and the limp hurts your back. Even subtle mechanical changes in how the hip functions can cascade upward.
A systematic review looking at hip range of motion and nonspecific low back pain found that reduced internal rotation of the hip was the movement limitation most consistently associated with low back pain, though the authors cautioned that the quality of evidence was very low.6PubMed. Is there an association between hip range of motion and nonspecific low back pain? A systematic review The idea makes intuitive sense: if your hip cannot rotate normally, the lumbar spine has to pick up the slack during movements like twisting, bending, or even walking. Over time, that extra demand on the spine can produce pain of its own.
When the Back Is Actually Causing the Groin Pain
The connection runs in the other direction too, and it is worth understanding because it changes what you should do about it. Conditions in the lumbar spine can send pain into the groin through nerve pathways. The nerves that supply sensation to the groin region emerge from the upper lumbar spine, roughly at the L1 through L4 levels. When a disc herniation, spinal stenosis, or other spinal problem compresses or irritates those nerve roots, the resulting pain can show up in the groin rather than, or in addition to, the back.
The same study that documented groin pain in sacroiliac joint patients also looked at people with lumbar spinal stenosis and lumbar disc herniation. Among those with stenosis, about 7 percent reported groin pain, and the same was true for about 8 percent of those with disc herniations. The involved nerve roots varied, with L2, L3, L4, and L5 all represented.3PubMed Central. Groin pain associated with sacroiliac joint dysfunction and lumbar disorders These percentages are lower than the sacroiliac joint group, but they matter clinically because a person might go to a urologist or orthopedic surgeon for groin pain when the actual source is a disc problem in the lower back.
Nerve entrapment syndromes from the lumbar plexus are another pathway. In athletes, nerves running from the lumbar spine through the pelvis and into the groin can become trapped or compressed, producing groin pain that mimics a muscle strain or hernia. Diagnosis relies on matching the pattern of pain and any numbness to the distribution of the involved nerve, and confirming with a nerve block.7Current Sports Medicine Reports. Lumbar Plexus Nerve Entrapment Syndromes as a Cause of Groin Pain in Athletes These are uncommon but worth knowing about, because they are easy to miss and the treatment is very different from what you would do for a muscle tear.
Hip-Spine Syndrome and the Diagnostic Challenge
Clinicians use the term “hip-spine syndrome” to describe situations where hip pathology and spinal pathology coexist, making it difficult to figure out which one is the dominant pain generator. This is not a rare clinical puzzle. Studies on people with hip osteoarthritis show that about 40 percent also have documented low back pain, and untangling the two can be genuinely difficult because the symptoms overlap so much.8PubMed. Does Low Back Pain Improve Following Total Hip Arthroplasty?
One approach that has shown high diagnostic accuracy in hip-spine syndrome is the use of guided injections into the hip joint. By numbing the hip with an ultrasound- or fluoroscopic-guided injection and then reassessing what pain remains, clinicians can determine how much of the pain picture originates from the hip versus the spine. This technique has shown sensitivity above 93 percent and specificity around 95 percent for identifying the hip as a pain source.9PubMed. Hip-Spine Syndrome: The Diagnostic Utility of Guided Intra-articular Hip Injections If the back pain vanishes along with the hip pain after the injection, that is strong evidence the hip was driving both. If the back pain persists, the spine needs its own workup.
A thorough physical examination remains the starting point. Distinguishing between intra-articular hip problems and extra-articular contributors requires looking at the hip joint itself, the surrounding soft tissues, and the associated structures of the spine, pelvis, and lower extremities.10PubMed Central. Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 1, Physical Examination This is one of those areas of medicine where a generalist may refer you to the wrong specialist if the clinical picture is not carefully parsed.
When Athletes Have Both Problems at Once
Athletes are a particularly informative population for understanding the groin-back connection, because they put heavy demands on the hip-pelvis-spine complex and tend to develop problems in multiple structures simultaneously. Athletic pubalgia, sometimes called a sports hernia, involves weakness or tearing in the muscles and tendons of the lower abdominal wall and groin. It often coexists with intra-articular hip pathology such as labral tears or femoroacetabular impingement.
A case series looking at athletes diagnosed with both athletic pubalgia and hip joint pathology found that when both conditions were surgically addressed, 89 percent returned to unrestricted sporting activity with improved outcome scores.11PubMed Central. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series The key insight from this research is that treating just one of the two problems tends to produce incomplete relief. If a structural hip issue is driving abnormal mechanics that contribute to both groin symptoms and lumbar strain, addressing only the groin without fixing the hip leaves the mechanical chain broken.
Fixing the Hip Can Fix the Back
Some of the most persuasive evidence for the groin-to-back connection comes from treatment outcome studies. When people with severe hip osteoarthritis undergo total hip replacement, their back pain often improves dramatically, even though no one touched their spine.
One study tracked patients who had documented low back pain before hip replacement surgery. At one year after surgery, back pain had resolved in about 82 percent of them, and at two years, that number climbed to over 91 percent.8PubMed. Does Low Back Pain Improve Following Total Hip Arthroplasty? Their disability scores dropped from an average that indicated moderate disability to levels consistent with mild or minimal impairment. A separate study confirmed the pattern: both spinal and hip pain and function improved significantly after hip replacement, and the improvements were maintained at two-year follow-up.12Spine. Hip-Spine Syndrome: The Effect of Total Hip Replacement Surgery on Low Back Pain in Severe Osteoarthritis of the Hip
For patients who have both hip osteoarthritis and lumbar degenerative disease, hip replacement has been shown to relieve back pain while restoring hip function, in some cases avoiding the need for spinal surgery altogether.13PubMed Central. Relieved Low Back Pain after Total Hip Arthroplasty in Patients with Both Hip Osteoarthritis and Lumbar Degenerative Disease These findings do not mean that everyone with groin pain and back pain needs a hip replacement. But they demonstrate the mechanical reality: fix the hip, and the spine often stops complaining.
Non-Musculoskeletal Causes That Produce Both Symptoms
Not every case of simultaneous groin and back pain involves muscles, joints, or nerves. Internal organs can produce pain in both locations at once, and these causes can be urgent.
Kidney stones are a classic example. A stone moving through the ureter can cause acute pain in the low back, flank, or groin, and often all three at once as the stone travels downward.14PubMed Central. Urolithiasis presenting as right flank pain: a case report The pain from a kidney stone tends to be sudden, severe, and colicky, which usually distinguishes it from the chronic or movement-related pain of musculoskeletal problems. But not always. Some people with a stone lodged in the upper ureter describe a steady ache in the back and groin that they assume is a muscle pull.
Endometriosis is another condition that can create both groin-region pain and back pain through overlapping mechanisms. Women with endometriosis and chronic pelvic pain show higher rates of musculoskeletal dysfunction, lower pain thresholds, reduced range of motion in the lumbopelvic region, and increased disability associated with low back pain compared to women without the condition.15PubMed. Musculoskeletal evaluation of the lower pelvic complex in women with endometriosis: A case-control study Part of this relates to the way chronic pelvic pain remodels how the nervous system processes pain signals. Endometriosis can facilitate changes in neural networks that contribute to sensitization and the development of myofascial trigger points, meaning that even after the endometrial lesions are treated, pain from muscles and connective tissue can persist.16PubMed Central. Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction Aortic aneurysms, inguinal hernias, and infections of the urinary tract or reproductive organs are other internal causes worth mentioning, though they are typically accompanied by symptoms beyond just pain.
When the Source of Pain Is Not Where You Feel It
One of the trickiest aspects of the groin-back relationship is referred pain, where the brain misinterprets where a signal is coming from. A case report described a 37-year-old man who presented with dominant right-sided low back pain that had persisted for six to twelve months. He also had milder right hip pain, but his back was what brought him in. The diagnosis turned out to be bilateral osteonecrosis of the femoral heads, a condition of the hip bones. The hip pathology likely contributed to his back pain both through aberrant pain localization by the nervous system and through altered biomechanical loading of spinal structures.17PubMed Central. What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis
This kind of mismatch between where the problem is and where it hurts is not unusual in the hip-spine region. The pelvis is a dense intersection of bones, muscles, nerves, and organs, and the brain does not always sort out the signals cleanly. Someone might be convinced they have a back problem when the pain generator is the hip, or they might focus on groin symptoms while the real issue is a lumbar disc. This is why a clinician who evaluates the whole kinetic chain, from the lumbar spine through the pelvis and hip down to the lower extremity, tends to reach the right diagnosis more reliably than one who focuses narrowly on the area the patient points to.
An Evolutionary Design That Invites Problems
The vulnerability of the hip-spine junction is not a fluke. The human pelvis evolved under competing demands: it needed to support upright walking, allow for efficient running, and in women, permit childbirth. Habitual bipedal gait required what researchers describe as a “double extension,” meaning extension of both the hip joint and the lumbar spine. This arrangement demanded extensive muscular adaptations around the hip and spine that are unique among primates.18Journal of Hip Preservation Surgery. Evolution of the human hip. Part 2: muscling the double extension The psoas, the gluteal muscles, the hip rotators, and the spinal extensors all evolved together to maintain this upright posture, and they remain deeply interdependent. When any part of this system is injured, weakened, or inflamed, the consequences do not stay local. They spread along the same kinetic chain that evolved for walking and running upright, which is exactly why groin pain and back pain turn up together so often.