A 65-year-old former collegiate athlete came to Venn Chiropractic and Wellness Center with severe pain affecting his left hip, gluteal region, and upper leg. At times, he also felt discomfort into the groin.
But one detail made the case less straightforward than it initially appeared:
He had no low back pain.
While walking, he would occasionally experience a sudden burst of pain accompanied by the sensation that his leg would briefly give out or stop working normally. The episode would settle almost as quickly as it appeared, but a lower level of pain remained throughout the day. His symptoms were also particularly bothersome at night.
By the time he arrived at our office, he had already pursued several different approaches to the problem.
His primary care physician had referred him to physical therapy, but his symptoms persisted. He later underwent a surgical evaluation and reported being told that his left hip was severely degenerative and that he needed a hip replacement. He had also been working with pain management but reported receiving very little relief.
He was understandably skeptical about seeing a chiropractor. In fact, he readily admitted that the main reason he scheduled the appointment was because his wife encouraged him to come.
From his perspective, the situation seemed fairly simple: his hip hurt, an evaluation had identified significant hip degeneration, and his lower back didn’t hurt at all.
Why would we look anywhere else?
The X-Rays Confirmed a Significant Hip Problem—But That Wasn’t the End of the Evaluation
Because of his history, symptoms, and examination findings, Dr. Jason Venn decided that digital X-rays were appropriate.
The images confirmed something important:
His left hip did have severe degenerative changes.
That finding wasn’t dismissed. His hip range of motion was also clearly reduced on the affected side, providing additional evidence that a genuine hip problem was present.
However, the lumbar X-rays provided additional information. There were degenerative changes in the lumbar spine, although they were not severe. Dr. Venn also identified posterior translation and altered positioning involving the L5 vertebral level.
Now there were abnormalities in two different areas that potentially deserved consideration.
The question was no longer whether the patient had hip degeneration. He clearly did.
The more important question was:
Did the severity of the hip X-ray findings fully explain the symptoms that had brought him into the office?
The Symptom Pattern Raised Questions About the Hip Being the Only Source
Several details from the history and examination led Dr. Venn to investigate possible lumbar and nerve involvement rather than assuming that the degenerative hip was responsible for every symptom.
The patient experienced substantial discomfort when transitioning from sitting to standing, but he often felt somewhat better after he had been moving for a while. His severe episodes could appear suddenly while walking and then settle rapidly. He also reported significant symptoms at night and discomfort through the gluteal region and upper leg.
None of those findings, by itself, can determine where pain originates. Hip osteoarthritis can produce stiffness after rest, groin or thigh pain, restricted motion, and symptoms that vary with activity. Likewise, pain at night is not specific to a nerve problem.
But taken together with the episodic leg symptoms and the lumbar findings, the presentation gave Dr. Venn reason to consider whether the lumbar spine and nerve structures could be contributing to what the patient was experiencing.
This distinction was especially important because having an abnormal X-ray does not automatically establish which structure is producing a patient’s current symptoms.
In this case, there was no question that the hip was structurally degenerative. The clinical challenge was determining how much of his current pain and leg dysfunction could reasonably be attributed to the hip—and whether another problem was occurring at the same time.
What Dr. Venn Believed Was Contributing to the Symptoms
After comparing the history, examination findings, hip findings, and lumbar X-rays, Dr. Venn’s working clinical impression was that the patient’s severe hip and upper-leg symptoms were not being explained by the degenerative hip alone.
The lumbar findings also needed to be considered.
Dr. Venn identified altered positioning at the L5 level along with degenerative disc changes. Based on the overall clinical picture, Dr. Venn believed that the lumbar findings and possible nerve irritation were contributing significantly to the symptoms the patient was experiencing.
That distinction affected the treatment plan.
The goal was not to treat the severe hip degeneration as though it could simply be adjusted away. In fact, the restricted hip motion remained an important finding throughout the case.
Instead, Dr. Venn developed a conservative treatment plan directed at the lumbar and mechanical findings that appeared to correlate with the patient’s current symptoms.
Treatment Began With Gonstead Chiropractic and Spinal Decompression
The initial plan incorporated specific Gonstead chiropractic care and spinal decompression.
The two treatments were used for different reasons.
Gonstead analysis was used to determine where a specific chiropractic adjustment was appropriate based on the examination and spinal findings. Spinal decompression was then used as a separate intervention for the lumbar disc and nerve-related component of the case.
On the first visit, the patient received his chiropractic adjustment and immediately reported feeling somewhat better when he got up from the table.
He then received spinal decompression.
After getting off the decompression table, he again reported that he could feel a difference in his symptoms.
An immediate response does not establish the source of someone’s pain by itself. However, in this case, the patient’s early response was additional information that supported Dr. Venn’s working clinical impression and the decision to continue monitoring his response to lumbar-focused conservative care.
Why Chiropractic and Decompression Were Used Together
The chiropractic adjustment and spinal decompression were not used as interchangeable treatments. Each had a different purpose within the patient’s care plan.
The Gonstead approach allowed Dr. Venn to use the patient’s examination and X-ray findings to identify the specific areas of the lumbar spine he believed required correction. Rather than broadly manipulating the lower back, the goal was to make a precise adjustment based on the mechanical findings identified during the evaluation.
Spinal decompression addressed a different part of the clinical picture.
Unlike conventional traction, which primarily applies a pulling force to the spine, spinal decompression uses controlled cycles of distraction and relaxation. Dr. Venn often describes this as creating a gentle pumping effect within the affected spinal area.
As the decompression table alternates through these controlled phases, the goal is to repeatedly reduce and release mechanical pressure rather than simply holding the spine under a continuous stretch. This pumping action is intended to create changing pressure within and around the spinal discs while reducing mechanical stress on irritated structures.
In this patient’s case, decompression was incorporated because Dr. Venn believed the lumbar disc and nerve-related findings were contributing to his symptoms. The chiropractic adjustment addressed the specific mechanical findings identified during the examination, while decompression provided a different mechanical approach to the disc and surrounding structures.
Rehabilitation was intentionally added later, once the patient’s severe pain had substantially improved. At that point, the emphasis could begin shifting toward mobility, strength, and helping him return to normal activity.
The First Week Produced an Important Change
The patient initially received care approximately three times per week.
By the end of the first week, he reported that his pain was approximately 90% improved. The sudden episodes involving severe pain and the sensation that his leg might give out were also occurring less frequently.
That rapid improvement was clinically significant, but treatment did not stop simply because the pain level had dropped.
Dr. Venn continued to monitor the patient’s symptoms, function, and response to care. The objective was to determine whether the improvement would continue and whether the patient could return to normal activity without the severe symptoms that had originally brought him into the office.
By Week Three, the Pain Had Resolved
By approximately the third week of care, the patient reported being pain-free.
What remained was different from the original complaint.
He still had tightness and restricted motion in the left hip. Given the severe degenerative changes visible in that joint, this was not unexpected. The structural degeneration seen on his X-rays had not disappeared simply because his pain had improved.
At this stage, spinal rehabilitation was added to the treatment plan, with strengthening and mobility exercises used as the patient’s symptoms and function allowed.
His hip mobility subsequently improved, although it never became completely normal. The underlying degenerative changes in the hip were still present.
That difference between symptom improvement and structural change is one of the most important lessons from this case.
The patient’s severe pain resolved even though the degenerative hip did not suddenly become a normal hip.
What Happened Over the Next Five Months?
The early improvement continued as the patient’s treatment progressed.
Over approximately five months, care shifted from controlling the symptoms that initially brought him into the office toward improving mobility, strength, and function. As he became more comfortable and capable, his rehabilitation progressed with the goal of helping him return to the active lifestyle that had always been important to him.
By the end of this period, he was doing very well and had returned to normal activities without the severe hip and upper-leg pain or the episodes in which his leg felt as though it might suddenly give out.
He ultimately did not proceed with the hip replacement that had previously been recommended.
That outcome does not mean his hip degeneration disappeared or that someone with severe hip osteoarthritis never needs joint replacement. His X-rays still showed substantial degenerative changes, and some limitation in hip range of motion remained.
Instead, his response raised an important point: a significant structural abnormality can be real without necessarily accounting for every symptom a patient is experiencing at a particular time.
Today, the patient is no longer receiving the intensive treatment schedule used during the initial phase of care. He contacts the office as needed when he feels he would benefit from additional care.
What Made This Case Unusual?
Several features made this case particularly instructive.
He Had Severe Hip Pain but No Low Back Pain
One of the patient’s biggest reasons for doubting that chiropractic care could help was simple: his lower back didn’t hurt.
But the location where a person feels pain does not always identify its source.
Lumbar nerve irritation can produce symptoms away from the lower back, including symptoms extending into the buttock or leg. That is one reason an evaluation of severe hip or leg symptoms may sometimes include areas beyond the location where the patient feels the pain.
The Hip X-Ray Really Was Abnormal
This wasn’t a case in which imaging showed a healthy hip that had simply been mistaken for the source of the problem.
The left hip was significantly degenerative, and its range of motion was restricted.
That made the case more complicated—and more useful.
Dr. Venn had to consider whether the hip findings adequately explained the patient’s current symptom pattern or whether the lumbar findings and possible nerve involvement also needed to be considered.
The Patient’s Symptoms Changed Before His Hip Structure Did
Within the first week, the patient reported approximately 90% improvement. By around the third week, he reported being pain-free.
His severe hip degeneration obviously had not disappeared in three weeks.
He continued to have some restriction in hip mobility even after his pain resolved.
That doesn’t prove that the hip contributed nothing to his symptoms. Rather, the difference between his persistent structural findings and changing symptoms became another useful piece of the clinical picture.
His Response Was Monitored Over Time
The first treatment produced an encouraging response, but one good day was not treated as proof of a diagnosis or a successful outcome.
The more meaningful information came from what happened afterward: the pain continued to decrease, the episodes of the leg giving way became less frequent and then resolved, function improved, rehabilitation was introduced, and he ultimately returned to his normal active lifestyle.
Why Hip and Leg Pain Deserve a Careful Evaluation
Hip and upper-leg pain can have more than one potential source.
The hip joint itself may be involved. The lumbar spine or nerve structures may contribute. Muscles and other surrounding tissues can produce symptoms as well. And sometimes more than one abnormality exists at the same time.
This patient’s case illustrates why identifying an abnormality on an X-ray is only part of the evaluation.
His severe hip degeneration mattered. So did his restricted hip motion. But so did the lumbar findings, symptom behavior, examination, and subsequent response to treatment.
The goal is not to ignore an abnormal image or assume every symptom comes from the spine.
It is to ask a more useful question:
Which findings best explain what this particular patient is experiencing right now?
Clinical Takeaway: The Most Obvious Finding Isn’t Always the Whole Story
This case did not demonstrate that severe hip degeneration is unimportant. In fact, the patient’s X-rays and restricted range of motion showed that his left hip had a significant structural problem.
What made the case valuable was that the hip findings did not necessarily explain the entire clinical picture.
Despite having no low back pain, the patient had additional lumbar findings and a symptom pattern that led Dr. Venn to consider whether lumbar nerve involvement could be contributing to the severe hip and upper-leg symptoms.
After beginning lumbar-focused conservative care, the patient’s symptoms changed substantially while the underlying hip degeneration remained.
That distinction matters.
X-rays and other imaging can identify important structural abnormalities, but imaging findings still need to be considered alongside the patient’s history, examination, neurological findings when relevant, and symptom pattern.
Sometimes the most dramatic finding on an image is clinically important but may not be the only factor contributing to what the patient is experiencing.
Case Summary
Patient: 65-year-old male, former collegiate athlete
Primary complaint: Severe left hip, gluteal, and upper-leg pain with occasional groin pain
Low back pain: None
Additional symptom: Sudden episodes of severe pain accompanied by the sensation that the leg would briefly give out
Previous care: Primary care evaluation, physical therapy, surgical evaluation with a reported recommendation for hip replacement, and pain management
Imaging: Severe degenerative changes of the left hip; degenerative changes in the lumbar spine with posterior translation and altered positioning involving L5
Clinical consideration: Dr. Venn believed the lumbar findings and possible nerve irritation were contributing significantly to the patient’s presenting symptoms despite the genuine structural hip disease.
Treatment: Gonstead chiropractic care and spinal decompression, followed by strengthening and mobility rehabilitation beginning around the third week
Early response: Patient reported some improvement immediately after the first visit and approximately 90% improvement in pain with fewer giving-way episodes after about one week
Week three: Patient reported being pain-free; residual hip tightness and restricted range of motion remained
Longer-term outcome: Continued improvement during approximately five months of care, returned to normal active life, and did not proceed with the previously recommended hip replacement. Some hip range-of-motion restriction remained consistent with the underlying degeneration.
Current status: No longer on the initial treatment schedule and contacts the office for care as needed
Frequently Asked Questions
Can a Lower Back Problem Cause Hip or Leg Pain Without Back Pain?
Yes. Symptoms involving the lumbar spine or spinal nerves can sometimes be felt in the buttock, hip region, or leg even when a person does not report significant lower back pain.
That was one of the important features of this case. The patient initially questioned why his lumbar spine would even be evaluated because his back did not hurt. His primary complaints were severe pain around the left hip, gluteal region, and upper leg, along with episodes in which the leg felt as though it might suddenly give out.
The location of pain is important, but it does not always identify its source by itself.
Can Hip Arthritis and a Lumbar Spine Problem Exist at the Same Time?
Yes. More than one structural or mechanical problem can be present at the same time.
In this patient’s case, X-rays showed severe degenerative changes in the left hip as well as findings in the lumbar spine. His restricted hip range of motion also supported the presence of a genuine hip problem.
The clinical question was not whether his hip was degenerative. It clearly was. The question was whether the hip findings explained the entire pattern of symptoms he was experiencing.
Does Severe Hip Degeneration on an X-Ray Mean the Hip Is Causing All of the Pain?
Not necessarily.
Imaging can identify structural changes, but those findings still need to be considered alongside the patient’s history, examination, symptom pattern, and other clinical findings.
This patient’s hip remained severely degenerative even after his presenting pain resolved. He also continued to have some limitation in hip range of motion.
His outcome does not prove that the hip contributed nothing to his symptoms. It illustrates why a significant imaging finding should be interpreted as part of the complete clinical picture rather than automatically assumed to explain every symptom.
How Can a Chiropractor Determine Whether Hip or Leg Pain May Involve the Lumbar Spine?
The evaluation begins with more than simply asking where it hurts.
Dr. Venn considers the history of the problem, where symptoms are experienced, what makes them better or worse, movement and functional limitations, spinal and orthopedic findings, neurological findings when relevant, and imaging when appropriate.
Those pieces are then compared to determine which findings appear most clinically relevant and whether conservative chiropractic care is appropriate.
Sometimes the evaluation suggests that the lumbar spine may be contributing. In other situations, the hip itself or another condition may require a different approach or further evaluation.
Can Chiropractic Care Reverse Severe Hip Degeneration?
No. Chiropractic treatment does not reverse severe degenerative changes in a hip joint.
That distinction is particularly important in this case.
Although the patient’s severe pain resolved and his hip mobility improved, the structural degeneration visible on his X-rays did not disappear. Some restriction in hip range of motion remained.
The purpose of his treatment was not to regenerate the degenerative hip. Care was directed toward the mechanical and possible nerve-related findings that Dr. Venn believed were contributing significantly to his presenting symptoms.
Why Was Spinal Decompression Used in This Case?
Spinal decompression was used because Dr. Venn believed the patient’s lumbar disc and possible nerve-related findings were contributing to the clinical picture.
Decompression was not being used to treat the degenerative hip itself.
It was incorporated as part of the lumbar-focused treatment plan, using controlled cycles of distraction and relaxation to create a pumping effect rather than simply applying a continuous pulling force like conventional traction.
Whether decompression is appropriate depends on the individual patient’s findings. The fact that it was used in this case does not mean that everyone with hip or leg pain is a candidate for spinal decompression.
Why Was Rehabilitation Added Later?
The patient’s initial presentation involved severe pain and unpredictable episodes in which the leg felt as though it might give out.
By approximately the third week, he reported being pain-free, although tightness and restricted hip motion remained. Rehabilitation was then added to place greater emphasis on strength and mobility as his symptoms allowed.
The timing and progression of rehabilitation can vary depending on the individual patient’s condition and response to care.
Does This Case Mean Someone Who Has Been Told They Need a Hip Replacement Should See a Chiropractor Instead?
No. This case should not be interpreted to mean that chiropractic care is a substitute for hip replacement when joint replacement is medically appropriate.
This patient had severe hip degeneration, and that structural condition remained present after his pain improved. His case was unusual because the complete clinical picture led Dr. Venn to consider whether lumbar findings and possible nerve irritation were also contributing to the symptoms for which the patient was seeking care.
The patient ultimately did not proceed with the hip replacement that had previously been recommended, but that was his individual outcome.
Someone considering hip replacement should discuss the risks, benefits, alternatives, and expected outcomes with the appropriate healthcare professionals based on their own diagnosis and circumstances.
Severe Hip or Leg Pain With No Back Pain?
Pain in the hip, buttock, groin, or upper leg does not always tell you which structure is responsible for the symptoms.
A careful evaluation can help determine whether the hip itself appears to be the primary source, whether the lumbar spine or nerve structures may be contributing, or whether multiple findings need to be considered together.
At Venn Chiropractic and Wellness Center in Frisco, Dr. Jason Venn evaluates the patient’s history, examination findings, neurological findings when relevant, and imaging when appropriate before determining whether conservative care makes sense.
The purpose is not to make every hip or leg problem a chiropractic problem. It is to better understand what may be contributing to the symptoms before deciding what to treat.
Not Sure Whether Your Hip or Leg Pain Could Be Coming From Your Back?
An evaluation can help determine whether your symptoms appear to involve the hip, lumbar spine, nerve structures, or a combination of factors—and whether chiropractic care, spinal decompression, rehabilitation, additional testing, or another approach may be appropriate.
This case study describes one patient’s individual experience and response to care. Results vary, and similar symptoms can have different causes. This information is educational and is not intended to diagnose a condition or predict how another patient will respond to treatment.