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Back and hip pain

Hip pain radiating down your leg: six causes, how to tell them apart and when it’s urgent

The ache starts around your hip, then runs down your thigh, sometimes all the way to your foot. That path is a useful clue. Where the pain goes, and how it feels, can point to the cause.

By the Nourish & Strong teamBuilt from 13 sources9 min read
A woman in a pink knit sweater and jeans climbs carpeted stairs, gripping the wooden handrail with one hand and pressing the other to her hip, wincing, with a laundry basket on the landing behind her

The short answer: hip pain that radiates down the leg often comes from sciatica, a pinched nerve in the lower back. Other common causes are piriformis syndrome, hip arthritis, hip bursitis, meralgia paresthetica and sacroiliac (SI) joint problems. Pain below the knee with numbness or tingling points to a nerve. Numbness around your genitals or bottom, or new bladder or bowel trouble, needs emergency care.

What causes hip pain that radiates down the leg?

Hip pain that radiates down the leg is usually caused by an irritated nerve, a worn hip joint or an inflamed area around the hip. A review in American Family Physician lists most of these among the causes of pain that spreads from the lower back. The table draws on the NHS, Cleveland Clinic and the American Academy of Orthopaedic Surgeons (AAOS).

CauseWhere you feel itWhat it feels likeOther clues
Sciatica (often from a slipped disc)Bottom and the back of one leg, often into the foot and toesSharp, burning or electric pain, with tingling, numbness or weaknessWorse when you move, sneeze or cough; leg pain is worse than back pain
Piriformis syndromeButtock, hip or upper leg, sometimes down the back of the legAching, burning, shooting, numbness or tinglingWorse after sitting a long time, walking, running or climbing stairs
Hip osteoarthritisGroin (most common) or thigh, spreading to the buttock or kneePain and stiffness that build slowly over timeStiff in the morning or after sitting; grinding, locking or a limp
Hip bursitis (trochanteric)Point of the hip, spreading down the outside of the thighSharp and intense at first, later a wider acheWorse at night lying on that side, getting up from a chair, or on stairs
Meralgia parestheticaFront and outer side of one upper thigh, sometimes to the outer kneeBurning, aching, tingling or numbness; skin may be tender to light touchNo muscle weakness; worse after long walks or standing; tight belts or clothing can trigger it
SI joint pain (sacroiliitis)Low back and buttock, spreading to the hip or thigh, sometimes below the kneeSudden sharp stabbing, or a constant dull acheWorse after sitting or standing still, or turning your hips; morning stiffness lasting over an hour

Cleveland Clinic calls sciatica one of the most common causes of leg pain seen in medical care. By contrast, piriformis syndrome causes only about 0.3% to 6% of lower back pain, and meralgia paresthetica affects 3 to 4 people out of every 10,000 each year.

How can you tell hip pain from sciatica?

You can often tell hip pain from sciatica by where it starts and whether you have nerve symptoms. Cleveland Clinic says hip problems usually cause groin pain, or pain when you put weight on the leg. Sciatica usually starts in the lower back and travels into the hip or down the leg, and numbness, tingling and weakness point more toward the nerve.

How far it travels helps too. The American Family Physician review says pain from spine muscles, ligaments, joints and discs can reach the thigh but rarely goes below the knee. Pain from the lowest nerve roots, which form the sciatic nerve, does. Clues worth noticing:

What you noticePoints more toward
Pain in the groin, worse when you put weight on the legThe hip joint, such as arthritis
Tender spot on the bony outer point of the hipBursitis
Pain below the knee, into the calf, foot or toesA nerve root in the lower back (sciatica)
Numbness, tingling or pins and needlesA nerve: sciatica, piriformis or meralgia paresthetica
Pain worse with coughing, sneezing or strainingA slipped disc
Burning on the front and side of the thigh only, with normal strengthMeralgia paresthetica

These are clues, not a diagnosis. The NHS advises against diagnosing hip pain yourself. If sciatica sounds like your pattern, our guide to what sciatica feels like maps the symptoms by nerve, and what your hip pain means covers pain that stays around the hip.

Can hip arthritis cause pain down the leg?

Yes, hip arthritis can cause pain down the leg, though it usually stops at the knee. The AAOS says the most common place to feel hip osteoarthritis is the groin, and that pain in the groin or thigh can spread to the buttock or the knee. It usually comes on slowly and worsens over time. Pain and stiffness are often worse in the morning or after sitting, and over time can turn up at rest or at night.

Why does hip pain radiate down the leg when sitting or walking?

Hip pain that radiates down the leg when sitting or walking often reflects which structure is under pressure. The American Family Physician review says leg pain from a slipped disc tends to get worse when sitting. Narrowing of the spine (spinal stenosis) tends to hurt more with standing and walking, and eases with rest or bending forward. Cleveland Clinic lists sitting for long periods, walking and stairs as triggers for piriformis syndrome.

The AAOS says bursitis pain is typically worse at night, lying on the affected hip. If nights are hardest, our guide to hip pain at night covers sleep positions that take the pressure off.

When is hip and leg pain an emergency?

Hip and leg pain is an emergency when it comes with signs that nerves to your bladder, bowel or both legs are being squeezed, or after a fall. The AAOS calls cauda equina syndrome, a squeeze on the bundle of nerve roots at the base of the spine, a surgical emergency. Go to the emergency department or call emergency services if you have:

  • Sciatica on both sides, or weakness or numbness in both legs that’s severe or getting worse.
  • Numbness around or under your genitals, or around your bottom. Doctors call this saddle numbness.
  • New bladder or bowel trouble, such as being unable to pee, or not noticing when you need to go.
  • Severe hip pain after a fall or injury, or you can’t walk or put weight on the leg.
  • Tingling or loss of feeling in your hip or leg after an injury.

Don’t drive yourself. Ask someone to take you, or call an ambulance.

Get an urgent same-day appointment if your hip is hot and swollen, or you have hip or back pain with a fever or feel shivery and unwell. The NHS links a hot, swollen hip with a high temperature to a joint infection. New weakness in your leg or foot needs prompt care too. Cleveland Clinic warns that a badly squeezed nerve can cause foot drop, making it hard to lift the front of your foot.

What helps hip pain that radiates down the leg?

What helps most is staying gently active and easing pressure on the sore spot. These steps come from the NHS, Cleveland Clinic and the AAOS:

  • Keep moving. For sciatica, the NHS says to carry on with normal activities and not sit or lie down for long periods. Moving may hurt, but it isn’t harmful and can help you recover faster.
  • Use heat or cold. The NHS suggests heat packs for sciatica, and a wrapped ice pack for up to 20 minutes, every 2 to 3 hours, for hip pain.
  • Break up long sits. Sitting makes disc and piriformis pain worse. Stand and walk for a minute or two often. Our guide to lower back pain from sitting has easy desk fixes.
  • Loosen your waistband. For meralgia paresthetica, Cleveland Clinic says most cases improve with loose clothing and avoiding tight belts.
  • Cut back on what flares it. The AAOS advises avoiding the activities that make bursitis worse, then stretching and strengthening the hip.
  • Start gentle exercises. Try these sciatica exercises, and stop any move that brings on pain.
  • Ask a pharmacist about pain relief, especially if you take other medicines.

When should you see a doctor for hip pain down the leg?

See a doctor if the pain hasn’t improved after a few weeks of home care, is getting worse, or is stopping your normal activities. The NHS says the same for hip pain that affects your sleep, keeps coming back, or leaves your hip stiff for more than 30 minutes after waking. Cleveland Clinic adds that piriformis pain after an injury, or lasting more than a few weeks, should be checked.

Your doctor will ask where the pain travels, then test your strength, feeling and reflexes. Scans usually aren’t needed straight away. The NHS says sciatica usually gets better in a few weeks to a few months. Here’s more on how long sciatica lasts.

Your next step

Today, trace the path of your pain with a finger, from where it starts to where it stops. Note whether it passes your knee and whether anything feels numb. Bring that to your doctor. If the trail starts in your lower back, a short daily routine is often the best place to begin.

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Quick questions

Is hip pain radiating down the leg sciatica?

Often, but not always. Sciatica usually starts in the lower back and runs through the buttock and down the back of the leg, often with tingling or numbness. Hip arthritis, bursitis, piriformis syndrome, meralgia paresthetica and SI joint problems can also send pain down the leg. Pain below the knee with numbness points more toward sciatica.

Does sciatica cause hip and leg pain?

Yes. Cleveland Clinic says sciatic pain usually starts in the lower back and may travel into your hip or down your leg. The NHS says symptoms usually affect your bottom and the back of one leg, often including the foot and toes. Back pain may be there too, but it’s usually milder than the leg pain.

Can hip arthritis cause pain down the leg?

Yes. The AAOS says hip osteoarthritis most often causes pain in the groin, and that groin or thigh pain can spread to the buttock or the knee. It tends to build slowly, with stiffness in the morning or after sitting. Arthritis rarely causes the numbness or tingling that a pinched nerve does.

What causes hip pain radiating down the leg to the knee?

Pain that stops around the knee often comes from the hip itself or nearby tissues. Hip arthritis can spread from the groin to the knee, bursitis runs down the outside of the thigh, and meralgia paresthetica can reach the outer knee. Pain that passes the knee into the calf or foot points more toward a nerve root in the back.

Why is hip pain radiating down the leg worse at night?

The AAOS says hip bursitis pain is typically worse at night, especially lying on the sore side. Hip arthritis can also start to hurt at rest and at night as it progresses, and MedlinePlus says sciatica can be worse at certain times of day, such as night. Sleeping on your back or other side, with a pillow between your knees, may help.

When is hip pain radiating down the leg an emergency?

Get emergency help if you have numbness around your genitals or bottom, new trouble peeing or controlling your bowels, sciatica in both legs, or weakness in both legs that’s severe or worsening. These can be signs of cauda equina syndrome. Severe pain after a fall, or being unable to put weight on the leg, also needs emergency care.

This article is general information, not medical advice. Hip and leg pain has many causes, and only a doctor who examines you can find yours. If you have numbness around your genitals or bottom, new bladder or bowel problems, or weakness in both legs, get emergency help straight away.

Sources