If Your Lower Back Pain is Here - PLEASE READ THIS
Key insights: 60-second read
- Your lower back pain might not be coming from your lower back - pain across the lower back, on top of the hip, or down the side of the hip often originates from the thoracic spine (base of the rib cage).
- Dermatomes explain referred pain - the T10-L1 nerve distribution maps directly to the area where people commonly feel this type of back and hip pain.
- Test before you treat - use a lacrosse ball or foam roller at the base of your rib cage to find restricted spots. If releasing them changes your lower back symptoms, you have identified the source.
- Look up the chain, not just at the pain - focusing only on where it hurts misses the bigger picture. You need to assess the areas that can refer pain to that location.
- Daily postural habits are often the root cause - prolonged sitting in poor positions creates the stiffness and dysfunction that eventually refers pain downward.
If your lower back pain feels like a band across your lower back, sits on top of your hip, or radiates down the side of your hip or into your glutes, you may be experiencing referred pain - pain that is coming from somewhere else entirely.
In my 20 years as a physiotherapist treating thousands of people with low back pain, this presentation is consistently misdiagnosed and misunderstood. Patients are told their hip is the problem. Perhaps they have a lower disc bulge or arthritis, or that their lower back is weak. They spend years stretching, strengthening, getting injections, even surgeries - all without relief, because we may have been looking in the wrong place.
This video and article will show you where the pain may actually coming from, how to test it for yourself, and what to do to make it go away - and stay away.
"This type of back pain is consistently misdiagnosed and misunderstood completely unnecessarily. My hope is that this video will give you a chance to change your perspective on what your symptoms may actually mean."
On this page
Why this pain is so often misdiagnosed
Here is the problem. When you tell a healthcare professional where your pain is, they naturally and intuitively narrow their focus to that area to look for clues. On the surface, that makes perfect sense. It is reasonable.
But if they do not also take a step back and look at the parts of the spine that can refer pain or control that region, they may never see the full picture. Even if there are local issues, they may never understand why that area became vulnerable in the first place.
The source of this type of back pain is most often the lower thoracic spine - the area at the base of your rib cage, a little higher and a little lower. When the joints or tissues in this region become stiff, tight, overloaded, or irritated, they can refer pain downward.
The key insight
"You genuinely do not have to have back pain in those areas. All you need is overloaded, irritated tissue to the point where it can express itself somewhere else."
Dermatomes: the road map of referred pain
Dermatomes are essentially leftover fetal connections that develop in the womb. They represent where each level of the spine can refer pain or sensation.
The T10, T11, T12, and L1 dermatomes map directly to the area across the lower back, on top of the hip, and down the side of the hip - exactly where so many people feel their pain.
If there is segmental spinal dysfunction at those levels - stiffness, tightness, restriction - it can "short circuit" and play havoc with the areas those nerves connect to. Your pain may be coming from several inches higher than you think.
"The T10, T11, T12, L1 distribution gives us a perfect road map to understand why a band of pain in that area may exist. The days of just looking at where your symptoms are should be over."
A real story: three hip replacements
I recently treated a patient who had the same hip replaced three times over 15 years. She had persistent lateral hip pain that no one could explain. Her hip was structurally "in good nick," but the pain remained debilitating.
No one had taken the time to look at the base of her rib cage. When I assessed that area, it was stiff, tight, and restricted. When we mobilised and freed it up, her hip pain immediately improved.
This is not an isolated case. This pattern is common, and it is consistently missed.
Test-retest: find the source
Before you do anything, you need to establish a baseline. Stand up, walk around, move in a way that you know reproduces your symptoms. Arch backwards, bend forwards, bend side to side. Get a clear sense of how your back feels.
Then we will perform a simple self-release technique and re-test. If your symptoms change, you have just proven that your lower back pain was coming from higher up in your back.
Release technique: lacrosse ball or foam roller
What you need: A lacrosse ball, tennis ball, or foam roller.
Step 1 - Find the restriction: Place the ball or roller at the base of your rib cage, right in the middle of your back. Let it roll off to one side. Compare right versus left. You are looking for which side feels stiffer, tighter, more restricted, or more dense. It may or may not be tender. We are chasing restriction, not tenderness.
Step 2 - Release: Once you have found the side that feels more restricted, lie down on the ball (or lean against it if standing). Let it press in gently. Stay for 30 seconds to 2 minutes. Take deep, full breaths to help your nervous system downregulate.
Step 3 - Move: Systematically move the ball up or down, or slightly wider, chasing any other spots that feel restricted. Remember: the joints of your spine are like piano keys. You need to put pressure down through the joint to affect it, not just roll over the top.
Step 4 - Re-test: Immediately stand up and repeat the movements that previously reproduced your symptoms. Has anything changed?
If you put the ball in a spot and felt your lower symptoms change (increase or decrease), you have likely found the area you need to work on.
The piano key analogy
"We're not here to roll around and give you a massage. We are trying to influence the joints of your spine. If you are rolling over the top, you are never really getting down into the joint to affect change."
Addressing the root cause: your daily posture
Now you have released the stiffness and your symptoms have improved. But if we do not address why this part of your spine became dysfunctional in the first place, it will be hard for this to go away permanently.
Clinically, it is not the active, interesting things that tend to cause this dysfunction. It is the passive, sedentary shapes - specifically, the positions you put your spine into most throughout the day. Sitting at a desk, driving, sitting on the couch.
If we know that this part of your back is linked to your symptoms, it is very likely that you have a shape, position, or posture that you consistently get into without realising it - unknowingly hinging through that part of your back.
What you can do:
- If you don't have to sit, don't sit. Stand, move, change positions frequently.
- If you must sit, be in the best position possible. Roll up a towel and put it behind your lower back for support.
- Adjust your chair or desk height to encourage a neutral spine position.
- Consider a standing desk or frequent movement breaks.
All the core strength, glute strength, stretches, and even surgeries will only ever be as good as your day-to-day shapes and postures allow them to be.
From my clinical experience: the most missed diagnosis
In 20 years of practice, this pattern of referred pain from the lower thoracic spine is the most consistently misdiagnosed and misunderstood condition I see. Patients are told they have a hip problem, a glute problem, a lower back muscle strain. They are sent for scans, injections, and sometimes even surgery - all because no one looked a few inches higher.
The patient who had three hip replacements is not an exaggeration. That is a real person who suffered for 15 years because no one thought to look at her thoracic spine.
If your pain fits the pattern described in this video - a band across the lower back, pain on top of the hip, or pain down the side of the hip - do this test. Grab a ball, find the restricted spots at the base of your rib cage, and see what happens to your symptoms.
You may find that the answer has been hiding in plain sight all along.
One key insight from this video
"Your lower back pain may not be coming from your lower back. Pain across the lower back, on top of the hip, or down the side of the hip often originates from the thoracic spine at the base of the rib cage (T10-L1). If you treat only where it hurts, you will miss the source. Use a lacrosse ball to find and release restrictions higher up, then address your daily sitting posture to prevent recurrence."
Frequently asked questions
How do I know if my pain is referred or coming from the lower back itself?
The test-retest method in this video is your answer. If you release stiff spots at the base of your rib cage and your lower back symptoms change (improve or worsen), your pain is likely referred from higher up. If nothing changes, your pain may be coming from the lower back itself or another source.
Can a ball or foam roller make my pain worse?
Yes, if used too aggressively. Start gently. You should not be in severe pain. If your symptoms increase dramatically, stop and consult a physiotherapist. The goal is to find restriction, not to cause more irritation. A small increase in referred symptoms during the release can actually be a good sign - it confirms the connection - but it should settle quickly.
How often should I do this release?
Daily is fine, especially if you are getting relief. Spend 2-5 minutes on the restricted areas. However, the release is a band-aid if you do not address the cause. You also need to work on your sitting posture and daily spinal loading habits to prevent the stiffness from returning.
What if I don't have a lacrosse ball or foam roller?
A tennis ball works well. A tightly rolled towel or a small hard ball (like a baseball) can also work. The key is having something firm enough to apply pressure to the spinal joints, not something too soft that just compresses.
Can this cause hip pain?
Yes. As mentioned in the video, I treated a patient who had three hip replacements because her lateral hip pain was being referred from her thoracic spine. Hip pain - especially on the side of the hip, not deep in the joint - is a very common referred pain pattern from T10-L1 dysfunction.
If you have been suffering from lower back or hip pain that no one has been able to explain, I urge you to try this simple test. Your pain may not be where you think it is.
The days of only looking where it hurts should be over. We must respect where symptoms are, but we must also look higher up the chain - to the areas that can refer pain downward.
And once you have found relief, do not stop there. Look at your daily habits. How do you sit? How do you load your spine throughout the day? Those are the keys to making this go away forever.
I see patients in Port Macquarie and via telehealth for comprehensive assessment of back pain, hip pain, and referred pain patterns. If you would like to understand what is really driving your symptoms, I am here to help.
- Grant
Living With Persistent Pain?
If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a more nervous-system-focused approach. Learn more about our back pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via telehealth.
Disclaimer: This information is for educational purposes and does not replace individualised medical advice. If you have back pain, hip pain, or any concerning symptoms, consult a qualified healthcare professional. This blog post summarises a YouTube video from Your Wellness Nerd; the original source should be consulted for full context. Individual responses to self-treatment vary.
