Hip bone marrow edema presenting as low back pain: a case report

Area of Science:

• Orthopedics
• Radiology
• Physical Therapy

Background:

• Nonspecific low back pain (LBP) is commonly managed by physiotherapists.
• Direct access settings present challenges, with potential for serious underlying conditions mimicking LBP.

Observation:

• A case of Bone Marrow Edema Syndrome (BMES) of the hip presenting as mechanical LBP is described.
• Hip pain that initially improved with treatment but worsened with loading raised suspicion for a hip pathology.

Findings:

• Magnetic Resonance Imaging (MRI) confirmed hip BMES.
• This is the first reported case of hip BMES mimicking nonspecific LBP.

Implications:

• Physiotherapists must maintain a continuous differential diagnostic process, identifying red flags for further investigation.
• Accurate diagnosis requires integrating clinical reasoning, presentation, symptom behavior, and appropriate medical referral/imaging.