9Posterior hip pain (see Table 4) is the least common pain pattern, and it usually suggests a source outside the hip joint. Posterior pain is typically referred from such disorders of the lumbar spine as degenerative disc disease, facet arthropathy, and spinal stenosis. Posterior hip pain is also caused by disorders of the sacroiliac joint, hip extensor and external rotator muscles, or, rarely, aortoiliac vascular occlusive disease.

Table 4: Posterior Pain Presentation and Findings

Disorder

Presentation and exam findings

Posterior pain

Referred pain from lumbar spine

History of low back pain

Pain reproduced with isolated lumbar flexion or extension

Radicular symptoms or history consistent with spinal stenosis

Sacroiliac joint dysfunction

Controversial diagnosis

Posterior hip or buttocks pain usually in runners

Pelvic asymmetry found on exam

Hip extensor or rotator muscle strain

History of overuse or acute injury

Pain with resisted muscle testing

Tender over gluteal muscles

Margo et al (2003)