Hip vs. Spine: Getting to the Root of Musculoskeletal Pain in Primary Care
At the American Academy of Physician Associates (AAPA) 2025 Conference & Expo meeting, Paul Coleman, DMSc, PA-C, DFAAPA of Thomas Jefferson University, outlined a critical clinical challenge: distinguishing between hip and spine pathologies. With low back pain topping global disability charts and overlapping symptoms clouding diagnoses, Coleman emphasizes the need for primary care providers to revisit anatomy, rethink presentation patterns, and focus on upstream care to guide patients toward the right treatment—before they ever reach a surgeon’s office.
Additional Resources:
- GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-e329. Published 2023 May 22. doi:10.1016/S2665-9913(23)00098-X
Consultant360: Can you describe the key themes of your presentation at the AAPA 2025 Conference & Expo meeting this year?
Paul A. Coleman, DMSc, PA-C, DFAAPA: My goal is to help general practitioners—whether in family practice, urgent care, or emergency medicine—differentiate between hip and spine pathologies. To do that, you need a solid understanding of anatomy, both normal and abnormal. This knowledge helps in identifying whether a patient's symptoms are due to spinal or hip pathology, how those symptoms present, and how to treat them appropriately.
Consultant360: Why is this topic relevant right now?
Dr Coleman: It’s easy to confuse the two. The spine and hip share overlapping innervation, which means the pain patterns overlap as well. Patients often struggle to describe their symptoms clearly, and even we, as clinicians, sometimes forget or misinterpret the anatomical relationships. The purpose of this session is to help providers in primary care quickly differentiate based on patient complaints and clinical presentation so they can offer the best care.
According to the World Health Organization, osteoarthritis ranks 12th globally for years lived with disability. Low back pain, however, ranks number one. Though hip arthritis represents only a small percentage of overall arthritis cases, these conditions together cause significant disability. Currently, over 500 million people live with low back pain globally, and that number is projected to increase to 800 million by 2050.
This isn’t just about pain—these conditions impact patients' lives, jobs, families, and mental health. Furthermore, even specialists often disagree on whether to address spinal or hip pathology first. A 2019 study showed that even top surgeons from the Spine and Hip Societies couldn't always agree. So, it’s even more important for primary care providers to be equipped to direct patients effectively from the outset.
Consultant360: That leads into the next question: what are the most important takeaways for clinicians?
Dr Coleman: Clinicians need to understand anatomy—nerve distributions, bone relationships, and biomechanics. For example, how the hip interacts with the pelvis, and how the pelvis interacts with the spine. With this knowledge and an understanding of how various pathologies present, clinicians can direct patients to the most appropriate care.
Consultant360: You’ve mentioned that a major gap in knowledge is anatomical understanding and differentiation. Are there any other knowledge gaps or future areas of research you'd highlight?
Dr Coleman: There isn’t necessarily a lot of new research needed—we already know that the hip and spine overlap and that many cases can be managed conservatively. Most of these conditions don't require surgery. Anti-inflammatories, physical therapy—both formal and informal—and patient education can be very effective.
The real gap is not in research but in practical understanding. Do clinicians understand the anatomy? Can they recognize how a pathology will present? If we can get this right at the primary care level, we not only take the best care of patients but also prevent more serious problems down the line.
Think of it this way: if we're always reacting downstream—constantly managing the influx of back and hip pain patients—we're missing the root cause. I tell my students: stop worrying about the smoke when the house is on fire. Address the fire. If we train providers to distinguish between the fire and the smoke, we can prevent more damage and provide better care.
Reference
Coleman P. My Hip Hurts...I Mean My Back Hurts...Something Hurts! Presented at the American Academy of Physician Associates (AAPA) 2025. https://aapa2025.eventscribe.net/searchGlobal.asp. Accessed May 12, 2025.