Causes of lower back pain after hip replacement surgery

I compiled this information from various sources, because my father had a hip replacement operation, and suffered from lower back pain during convalescence. I posted it here just in case it could be useful to someone else, and it is with great pleasure that I have been able to add some of the reader comments (scroll down to the end).

Tiredness and lower back pain after hip replacement surgery

The surgery involves the cutting and manipulation not only of bone but also of soft tissues such as muscles, tendons, nerves, and the capsule that encloses the joint. Such an invasive procedure is tough on the body, and recovering from it takes time. It is normal to be tired; your normal energy levels will return day by day. Don’t be too aggressive in exercising. Your body is working to recover and heal from the surgery even while you are resting.
Lower back pain may be caused by asymmetry in the power of thigh, abdominal and back muscles. Before surgery you were walking asymmetrically (your body was trying to reduce pain by restricting certain movements) and so you will have unconsciously decreased the power of certain muscles, because you used them less on one side. In addition, it is likely that your leg length is now slightly different. This in itself can cause lower back pain. Gradually, as you become more mobile, you will equalize muscle strength and lessen the strain on the lower back.
Something else that happens in hip replacement surgery is that the iliopsoas muscle running from your pelvis to your thigh gets traumatized. This can cause a degree of pelvic tilt for many weeks after surgery, as the iliopsoas remains in a state of contraction, causing imbalance. You may have the sensation of one leg being longer than the other, and this can be caused by this sort of contraction.
In some movements, your low back may tend to bend inwards (arching) as you perform the movement, causing lower back pain. It may help to tighten your stomach muscles during the movement; this helps keep the spine straight.

Often, even two months after surgery, people have pain when getting up out of a chair. The process of alleviating this is lengthy, because your muscles are still compensating for the pain in your hip, even though the operation has removed the source of the pain. Your muscles have been conditioned to misbehave, and many of them have atrophied and weakened in the years before your operation. Your gluteus muscles are weaker, likewise your sartorius, hip adductors and abductors. Quads and hamstrings have to be stretched and strengthened.

Convalescence timescale:

Full recovery: 3-6 months.
Total rehabilitation: muscle re-education will only be complete after a year.
In the early months, some good days and some bad days is totally normal. You should notice a gradual improvement over time.
4-6 weeks after surgery: zimmer or crutches
Next 4-6 weeks: a stick
About 10 weeks after surgery: walking without assistance, almost normally.
About 3 months after surgery: most of the soft tissue wounds have healed
3-6 months after surgery: gradual relaxation of hip and leg muscles.


You’ve been given some exercises to perform during convalescence. Remember to bear in mind all the warnings about the movements to avoid!
Don’t overdo it! Avoid high-impact exercises. Take great care whenever you are moving around to avoid tripping. Be careful going up and down stairs.
Initially you will be doing safe range-of-motion activities and muscle strengthening exercises. Exercises should be performed every day. You should allow 15 minutes, two to three times a day to begin; progress to 30 minutes, two to three times a day by the end of six weeks.
Walking is always good. Try to “walk tall,” as straight-backed as possible.

Stretching exercises:

Before you start doing these, you should talk to a physical therapist at the hospital. You have to be advised on when you can start them, and exactly how to do them. They are for hamstrings, quadriceps, hip flexors, illiotibial band, adductors. Once a day or even several times a day. There are also exercises to strengthen the core abdominal muscles.
These exercises will reduce pelvic tilt, decrease back pain, enable you to walk without a limp, equalize hip-and-abdominal strength.


Iron and vitamin supplements could be useful. Drink plenty of fluids. Try to limit your intake of coffee and alcohol.

Reader comments:
Dear Henry Neuteboom, Thank you. I am recovering from a hip replacement (tripped over a rug). I live in France so the care is great. But I looked everywhere on Google for info on how to be patient with pain and what to do to get better. I only found forums where people exposed their woes. Then I stumbled (didn’t fall thank Zeus) on your blog piece about lower back pain after hip surgery and was completely satisfied by your cogent, clear explanations of what to do or not to do and how long it may take. It has inspired me. No boogie-ing till muscle and pelvis and leg length etc have been dealt with. I will share the link to your piece with my 5000 Facebook friends, many of whom have had this same surgery. Once again thanks and buona fortuna. P.S. For give my dabble into Italian. I am learning Italian with Duolingo. So far I know how to say: “The Tiger is is eating the chef.” Plan to go to Montepulciano in September for a 3 week immersion course. “Tiger eats chef” is more or less preparing me for that endeavor. Cheers, S.W.

Thank u so much for your blog on ‘lower back pain after hip replacement’ I found it very helpful since I had the op on 5/12/2016 I was progressing well with gentle exercises when all of a sudden I could not walk without great pain and my doctor prescribed ibuprofen and sent me to physio. Doctor did not explain my condition as well as your blog did. Thanks once again. C.

Hi Henry I found your article on back pain when I was searching for something to help me understand my own back pain after hip replacement surgery. Honestly, Henry, I have become so frustrated that I broke into tears thinking I may have back pain for the rest of my life. Your article helped me be hopeful that I just need to be patient and continue to strengthen my body. Then I started to look at your paintings and a wave of calm came over me and even some laughter. I like your art. Thank you. J.

I came across your article on lower back pain after THR and it helped me so much. I have made a very good recovery after my operation, but still have stiffness at the base of my spine. I was beginning to worry that all was not well,despite my three month x ray telling me otherwise, You explained very clearly the reasons for this, so thank you. J.

Thank you so very much for compiling that information into one place. Your article was well written, informative, far-reaching, and, well, quite calming. I appreciated your description of why the disruption of surgery itself, as well as years of a maladaptive gait due to hip pain, means that patience, appropriate physical therapy, exercise, and a healthy diet are keys to the fullest recovery. Best wishes, A.H.

Hello Mr. Henry, I had to write to you after reading your article on lower back pain after THR. My mum’s just undergone the surgery and we couldn’t figure out the reason for her back ache. Our doctors asked us to ignore it as being normal post surgery.
Have a few questions, if I could request your answers:
1) when can the patient start bending, for example to touch one’s toes?
2) for how long does the back pain linger?
3) does the lower back (around tail bone) also swell up at the time of pain? We thought the bed/ mattress was responsible (until we read your article)
4) by when can she start sitting in a car (with bucket seats)?
Once again, many many thanks for putting your article out there. It sure has helped open our eyes and I’m am certain it is useful to a ton of other people. Hoping your dad has recovered and is running around. Waiting to see my mom do the same. Best wishes, P.

I had both hips done 6 wks apart Apr then June 2 doing great but begin to have some back pain,but your article was very helpful.I’m athletic so want to get back on my feet time and patience.Once again thank you I will pass this on. S.

Hi I read your article about lower back pain after hip surgery. My friend is having the same problem. And i was hoping you can email me the exercises that your dad did and the frequency and duration. Hes in rehab now but still in pain. He does exercises on good days or when the pain medication starts working. It has been a month since he had the back problem. The first two weeks he did not do pt due to extreme pain. Please help. R.C.

I wanted to thank you for this information I have been searching for days on some answers and you provided me with a lot of relief on this. I had hip surgery 24 days ago and seem to be moving around good other then the lower back pain that seems to be the only thing that limits me and because of that pain I tend to get out of breath but also I’ve been sitting for 3 years too so I am a bit out of shape. I don’t take pain medicine any more but do you think taking Aleve could help? C.B.

Thanks for a great guide on recovery following hip surgery, it was great to find all my question answered on this one page. The waiting time on going back to see the Consultent these days is so long, there’s no one to ask. Great thanks! K.H.