Imagine a situation where you wake up with hip pain. It hurts and limits your ability to perform your daily activities. At first, you wait for it to go away. You’re an active person and minor aches and pains aren’t uncommon. After several weeks you see your doctor and are prescribed physical therapy. The therapist gives you hip strengthening exercises and stretches. They help a little but the pain is still there, it’s frustrating.

In many cases the hip, or the ‘victim’, isn’t the true cause of the pain. In the example above, the true cause of pain isn’t the hip but the lower back. Problems with the low back commonly transfer pain into the hip and leg, even when no low back pain is present. In a situation like this, treating the hip may help a little but it isn’t going to resolve the underlying problem. That’s because the true cause of the pain is not being addressed.

Our bodies are incredibly complex and capable of masking dysfunction for a long time. Weakness and compensations can hide behind stronger muscle groups until the problem is too big to ignore. Pain, weakness and dysfunction often come on so slowly that they are easy to ignore at first. The low back is just one example. Pain anywhere in the body can be related to dysfunction somewhere else, and even when one area is the primary cause, body regions surrounding and even distant to the injured part are more often than not related to the primary injury.

A physical therapist trained in orthopedic manual therapy can recognize these patterns and identify the ‘silent cause’. This is a crucial part of treatment to resolve symptoms and prevent them from returning. In the case described above, treatment may consist of some hip strengthening, because glute weakness often accompanies low back pain. Strengthening of the core and identification of faulty movement patterns is also equally important.

It may seem strange at first to work on the back when the hip is what hurts, but a good physical therapist will explain what you are doing and why. By identifying the ‘silent cause’ an individual can work towards true recovery.