Hip pain has dozens of possible causes, ranging from joint wear and tear to muscle problems to pain that actually originates in the lower back. Where you feel the pain, how it started, and your age all point toward different explanations. Most hip pain falls into a few common categories, and understanding those categories can help you figure out what’s going on and what to do about it.
Where You Feel It Matters
The hip is a deep ball-and-socket joint surrounded by muscles, tendons, and fluid-filled sacs called bursae. Pain from inside the joint itself typically shows up in the groin or front of the hip. Pain on the outside of the hip usually comes from soft tissues like tendons or bursae. Pain in the buttock or back of the hip can involve muscles, nerves, or even the lower spine. This location-based pattern is one of the most useful clues for narrowing down the cause.
A simple test you can try at home: if bringing your knee toward your chest and then rotating it inward reproduces a sharp, catching pain deep in the groin, the problem is more likely inside the joint itself. If pressing on the bony point on the outside of your hip recreates the pain, the problem is more likely in the surrounding soft tissue.
Osteoarthritis
In adults over 50, osteoarthritis is the single most common cause of hip pain that originates inside the joint. The cartilage lining the ball and socket wears down over time, and the bones gradually lose their smooth gliding surface. Pain typically starts in the groin or front of the thigh and can spread to the buttock or knee. You may notice stiffness first thing in the morning or after sitting for a while, a grinding sensation when you move the hip, and a gradually shrinking range of motion that makes it harder to bend down or walk comfortably.
Osteoarthritis develops slowly. Some people trace it back to an old injury, but most simply notice that the hip gets stiffer and more painful over months or years. Rainy or damp weather can make symptoms worse. As it progresses, you might develop a limp or find that the affected leg feels slightly shorter. X-rays can confirm the diagnosis by showing narrowing of the joint space and bony spurs around the socket.
Greater Trochanteric Pain Syndrome
If your pain is on the outside of the hip rather than in the groin, greater trochanteric pain syndrome is the most likely culprit. This condition used to be called trochanteric bursitis, but research has shown that actual bursa inflammation accounts for only about 20% of cases. The rest involve irritation or small tears in the gluteal tendons that attach near the bony prominence on the side of the hip.
This condition most commonly affects women between 40 and 60. There’s usually no specific injury that triggers it. The hallmark is pain that worsens with walking, climbing stairs, sitting for long periods, or lying on the affected side at night. If sleeping on that hip wakes you up, greater trochanteric pain syndrome is high on the list. Tenderness when you press on the outer hip bone is a reliable sign. Early treatment focuses on activity modification and gradual strengthening of the hip muscles, though hip-abduction exercises should be avoided in the early stages because they can worsen tendon irritation.
Hip Impingement in Younger Adults
Femoroacetabular impingement, or FAI, is one of the most common causes of hip pain in people under 40. It happens when the bones of the hip joint don’t fit together perfectly, creating abnormal contact between the ball and socket during movement. There are three types: extra bone on the top of the thighbone (cam type), extra bone growth in the socket (pincer type), or a combination of both.
FAI develops gradually, usually without a specific injury. Athletes are more likely to notice symptoms because they use their hips more intensely, but the underlying bone shape is something you’re born with or develop during growth. The pain tends to be in the groin and gets worse with activities that involve deep bending at the hip, like squatting or sitting in low chairs. Over time, the abnormal contact can damage the ring of cartilage (labrum) that lines the hip socket, leading to a labral tear.
Labral Tears
The labrum is a ring of tough cartilage that helps seal and stabilize the hip joint. When it tears, you typically feel pain in the front of the hip or groin, often with a clicking, popping, or catching sensation during movement. Labral tears are common in sports that involve twisting or pivoting, including dance, gymnastics, hockey, basketball, and soccer. They can also result from a fall, a car accident, or the gradual wearing effect of hip impingement or osteoarthritis.
The mechanical symptoms are what set labral tears apart from other causes. If your hip clicks or catches in certain positions and that clicking comes with pain, a labral tear is worth investigating. These tears don’t heal well on their own because the labrum has limited blood supply, so persistent symptoms often require imaging and sometimes surgical repair.
Pain That Comes From the Back
Not all hip pain actually starts in the hip. The nerves that supply sensation to the groin, thigh, and buttock all pass through the lower spine, which means a disc herniation or narrowed spinal canal can produce pain that feels exactly like a hip problem. This overlap is common enough that it has a clinical name: hip-spine syndrome.
A few features help distinguish spine-related pain from true hip pain. If the sensation is tingling, burning, or shock-like rather than a deep ache, that points toward a nerve problem originating in the back. If the pain travels in a line down your leg past the knee, or if you notice numbness or weakness in specific areas of the leg, spinal nerve involvement is more likely. You can also have both problems at once. Stiffness in the hip can change how you walk, placing extra stress on the lower spine, which then develops its own issues.
Deep Gluteal Syndrome and Piriformis Issues
Deep buttock pain that worsens with sitting and radiates down the back of the leg is characteristic of deep gluteal syndrome. This is an umbrella term for conditions where the sciatic nerve gets compressed by surrounding muscles, most commonly the piriformis. Unlike a disc herniation in the spine (which can cause similar symptoms), the compression happens in the buttock itself.
A quick self-check: sit in a chair and cross the affected leg over the other knee, then lean forward. If this stretch reproduces your buttock pain and the radiating leg symptoms, deep gluteal syndrome is a possibility. The condition often responds well to stretching and physical therapy targeting the deep hip rotator muscles.
Inflammatory Arthritis
Autoimmune forms of arthritis affect the hip differently than osteoarthritis. Rheumatoid arthritis causes the joint lining to thicken and swell, producing chemicals that actively destroy cartilage. It often affects both hips at the same time and can show up at any age, including early adulthood. Ankylosing spondylitis causes inflammation in the spine and large joints (including the hips), leading to stiffness and pain that’s typically worse in the morning and improves with activity.
The key distinction from osteoarthritis is timing and pattern. Inflammatory arthritis tends to cause prolonged morning stiffness lasting 30 minutes or more, affects younger people, and may come with other symptoms like fatigue, joint swelling in the hands or feet, or lower back pain that improves with movement rather than rest. Blood tests for inflammatory markers and imaging can help confirm the diagnosis.
Hip Fractures
Hip fractures are a serious concern, particularly for adults over 60 with osteoporosis. They usually cause sudden, severe pain after a fall and an immediate inability to bear weight. In some cases, especially with stress fractures, the pain develops more gradually over weeks before a complete break occurs.
The consequences of hip fractures go well beyond the bone itself. One-year mortality rates range from about 6.5% in women aged 60 to 69 up to nearly 20% in men aged 80 to 89. These high numbers reflect the overall health decline that can follow a major fracture: prolonged immobility, surgical complications, and loss of independence. Hip fractures become dramatically more common with age, representing about 10% of all fractures in women in their 60s but nearly 30% of fractures in women in their 80s.
Signs That Need Immediate Attention
Most hip pain develops gradually and can be evaluated at a routine appointment. But certain combinations of symptoms signal something more urgent:
- Severe pain after a fall or injury, especially if you can’t put weight on the leg
- Sudden, intense hip pain with no clear cause
- Numbness or tingling in the hip or leg after trauma
- A hip that’s swollen, hot to the touch, or has skin color changes
- Hip pain accompanied by fever, which can indicate an infected joint
A hot, swollen joint with fever is particularly time-sensitive because a joint infection (septic arthritis) can destroy cartilage within hours if untreated. Sudden inability to bear weight after a fall in an older adult should be treated as a possible fracture until proven otherwise.