Hip Pain After Lumbar and Piriformis Injections

Marc Darrow, MD, JD

Question:

“I have had pain mostly in my right hip since January 2020 and want it to go away without pain medication or an operation. Can you offer any solutions? I have had multiple MRIs of the hip and spine and the consensus is that the pain is stemming from the L4/L5 joint and/or L5/S1 joint. I have had 2 cortisone injections in the right piriformis and 5 in the spine, including 2 under anesthesia.”

This history raises an important question: What structure is producing the pain, and what did the previous treatments tell us?

For someone hoping to avoid long-term pain medication and an operation, we would begin with a focused reassessment and a treatment plan tied to a specific diagnosis.

Is the pain in the hip joint, around the hip, or referred from the back?

Patients use “hip pain” to describe discomfort in the groin, outer hip, buttock, or the area where the lower back meets the pelvis. These locations can involve different structures.

Lumbar radicular pain arises from a spinal nerve root and can extend into the leg. Radiculopathy involves nerve-root dysfunction, which may produce changes in strength, sensation, or reflexes. Referred pain from spinal joints or other tissues can also be felt away from its source without the same neurological findings.

A 2025 review describes how hip disorders, gluteal tendon problems, muscular pain, and other conditions can resemble or coexist with lumbosacral radiculopathy. A lumbar abnormality and a painful hip-region condition can both be present. (1)

These are clues for evaluation, not rules that establish a diagnosis. A separate 2025 review emphasizes that several musculoskeletal conditions mimic radiculopathy and that examination findings and imaging can be nonspecific. (2)

Our article on sciatica, radicular pain, and referred pain explains these distinctions further.

What does “L4–L5 or L5–S1” actually identify?

L4–L5 and L5–S1 are spinal levels. Each includes a disc, paired facet joints, nearby ligaments, and relationships with nerve roots. Saying that pain comes from a level leaves several questions unanswered.

Is the concern a disc pressing on a nerve? A painful facet joint? Foraminal narrowing? Predominantly back pain referred toward the buttock? The treatment target differs in each situation.

Multiple MRIs may document anatomy carefully, but the number of scans does not establish which finding causes symptoms. A systematic review found that degenerative spinal findings are common in people without pain and become more frequent with age. Such findings need clinical interpretation rather than automatic dismissal or automatic treatment. (3)

What did the seven injections accomplish?

The history reports two piriformis injections and five spinal injections. It does not say whether they provided no relief, brief relief, or substantial improvement that later wore off.

We may reconstruct that treatment history before proposing another procedure:

• What was injected, and into which structure?
• Was the spinal procedure epidural, transforaminal, a facet injection, or something else?
• Did familiar hip-area pain improve immediately, later, or not at all?
• How long did relief last, and did walking, sitting, or sleep improve?
• Was the response documented separately from the effects of sedation or other medication?

An injection performed “under anesthesia” does not identify its target. Obtaining the procedure notes is more useful than assuming all five injections tested the same diagnosis.

A short-lived response may be informative, but it is not perfect proof of the pain source. No response can also have several explanations. The next decision should reflect the procedure performed and its measured benefit.

Why cortisone may help temporarily without settling the problem

A 2025 American Academy of Neurology systematic review included 90 randomized trials of epidural steroids. For cervical and lumbar radiculopathies, epidural injections probably improved short-term pain and disability; evidence was insufficient to determine whether they reduced long-term pain. These findings concern epidural injections and cannot automatically be applied to piriformis or facet procedures. (4)

This helps explain why some patients experience a useful period of relief without a permanent solution. It does not mean steroids always fail or that repeated pain proves ligament damage.

When prior injections have not produced meaningful, sustained functional benefit, the clinician and patient should reconsider the rationale for repeating them. The appropriate alternative depends on the diagnosis.

Could the piriformis diagnosis be incomplete?

The piriformis is one of several muscles deep in the buttock. The sciatic nerve passes close to it, but buttock pain alone does not establish compression by that muscle.

A reassessment may examine the deep gluteal region, hip movement, hamstring attachments, lumbar neurological findings, and surrounding tissues. Piriformis-related symptoms and spinal disease may coexist. A piriformis injection that did not provide lasting relief does not, by itself, exclude every deep gluteal problem. (2)

Our piriformis syndrome article discusses this region. For an individual patient, suspected tendon-attachment pain, muscular pain, and actual nerve entrapment deserve separate consideration.

Reassess the outer hip and SI region

Gluteal tendon disorders can cause pain over the outer hip. SI-region pain can overlap with lumbar and hip symptoms. These possibilities should be considered when examination findings support them, even if a lumbar MRI is abnormal. (1)

Targeted ultrasound may help evaluate superficial tendons, while electrodiagnostic testing can sometimes clarify suspected nerve dysfunction. Neither is automatically required. A diagnostic local-anesthetic injection may be useful for a defined question, but it should not become another procedure without an interpretation plan.

See our discussions of hip tendonitis and reassessing suspected sacroiliac joint pain.

Can treatment proceed without long-term pain medication?

For many nonurgent musculoskeletal conditions, a plan can emphasize rehabilitation, education, activity adjustments, and measurable functional goals. It must be tailored to the identified problem.

For example, a randomized trial in gluteal tendinopathy found that education about load management plus targeted exercise produced better global improvement than corticosteroid injection at 52 weeks. This was a study of gluteal tendinopathy, not lumbar nerve compression, but it illustrates why diagnosis-specific rehabilitation matters. (5)

The fact that someone has already tried physical therapy does not tell us whether the program addressed the current diagnosis, was tolerable, or progressed appropriately. A reassessment should examine those details rather than simply prescribe “more PT.”

Useful goals might include sitting through a meal, sleeping with fewer interruptions, walking farther, or returning to a valued activity. Progress should be reviewed against those goals.

PRP injections?

Platelet-rich plasma is prepared from a patient’s blood. Evidence depends on the diagnosis and injection location. An epidural injection near a nerve, an injection into a disc, and treatment of a gluteal tendon are different procedures.

A 2025 review of seven studies involving 416 patients compared PRP and corticosteroid injections for lumbar radicular pain. Steroids produced greater early functional improvement at four weeks, while most other comparisons showed no significant differences. The authors called for larger studies with standardized preparations and longer follow-up. (6)

For outer hip pain, a 2025 placebo-controlled trial analyzed 79 patients with refractory greater trochanteric pain syndrome. It found no significant benefit of the tested PRP protocol over placebo. This finding should be part of the discussion rather than assuming that an injection described as regenerative is necessarily superior. (7)

An October 2026 review of 11 trials involving 623 patients with chronic discogenic low back pain found no significant pooled differences in pain or function between PRP and comparison treatments. Evidence certainty was very low and preparation methods varied substantially. This is evidence about discogenic back pain, not proof of effectiveness for this patient’s hip-area symptoms. (8)

PRP can therefore be discussed for selected indications with a clear explanation of uncertainty, cost, alternatives, and the intended target. It should not be promised as a way to eliminate pain or avoid an operation.

What about bone marrow or other cell-based injections?

Bone marrow concentrate contains a mixture of cells and other components. It is not interchangeable with PRP or laboratory-expanded cell products.

A 2025 double-blind trial randomized 63 patients with presumed discogenic low back pain to an intradiscal bone marrow concentrate injection or a sham procedure. It found no significant between-group differences in the primary pain outcome or specified functional improvement outcomes through 12 months. Limitations included inadequate characterization of the injected cells. (9)

That trial does not answer every question about every injection site, but it prevents a confident claim that marrow injections reliably repair a painful lumbar disc. Likewise, evidence about a disc injection cannot establish treatment benefit for piriformis pain, hip tendon pain, or nerve compression.

Our back-pain injection article provides additional background. For this patient, treatment selection should follow clarification of the pain source.

Does persistent pain mean surgery is the next step?

Duration alone does not establish a surgical indication. The decision depends on the diagnosis, neurological findings, disability, response to appropriate care, and expected benefit of a specific operation.

Progressive weakness or foot drop deserves prompt evaluation. New loss of bladder or bowel control, saddle numbness, or rapidly worsening neurological symptoms requires emergency assessment. These findings should not wait for an elective regenerative treatment consultation.

Without those urgent features, a careful second assessment can help determine whether there are reasonable nonsurgical options and whether any proposed operation addresses the symptoms the patient most wants improved.

References

1. Bateman EA, Fortin CD, Guo M. Musculoskeletal mimics of lumbosacral radiculopathy. Muscle & Nerve. 2025;71(5):816–832. doi:10.1002/mus.28106.
2. Jorgensen SP, Chiodo AE. Musculoskeletal mimics for lumbosacral radiculopathy. Part 2: Specific disorders. Muscle & Nerve. 2025;71(1):22–28. doi:10.1002/mus.28279.
3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015;36(4):811–816. doi:10.3174/ajnr.A4173.
4. Armon C, Narayanaswami P, Potrebic S, et al. Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2025;104(5):e213361. doi:10.1212/WNL.0000000000213361.
5. Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. doi:10.1136/bmj.k1662.
6. Wang X, Zhang Y. Therapeutic interventions of platelet-rich plasma versus corticosteroid injections for lumbar radicular pain: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025;20(1):306. doi:10.1186/s13018-025-05725-z.
7. Atchia I, Ali M, Oderuth E, Holleyman R, Malviya A. Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomized Controlled Trial. Journal of Bone and Joint Surgery American Volume. 2025;107(5):444–451. doi:10.2106/JBJS.24.00763.
8. Madrazo-Ibarra A, de la Huerta-Meza D, Gutierrez-Naranjo JM, Kirschner JS. Preparation methods and clinical outcomes of platelet-rich plasma for chronic discogenic low back pain: A systematic review and meta-analysis of randomized controlled trials. PM&R. Published online October 9, 2026. doi:10.1002/pmrj.70216.
9. Levi D, Tyszko S, Horn S, Pham N, Levin J. Bone marrow concentrate intradiscal injection for chronic discogenic low back pain: A double-blind randomized sham-controlled trial. Interventional Pain Medicine. 2025;4(3):100611. doi:10.1016/j.inpm.2025.100611.