Hip joint pain most often comes from osteoarthritis, soft tissue inflammation, or structural problems with the bones that form the joint. But because the hip is a deep ball-and-socket joint surrounded by muscles, tendons, bursae, and nerves, the list of possible causes is long, and where you feel the pain is one of the best clues to what’s actually going on.
Where You Feel It Matters
The hip joint sits deep in the groin, so true joint problems like arthritis and labral tears typically cause pain in the groin or the front of the thigh. Many people are surprised by this because they assume “hip pain” means pain on the outside of the hip or in the buttock. Pain on the outer side of the hip usually points to bursitis or tendon problems rather than the joint itself. Pain that radiates into the buttock or down the back of the leg often originates in the lower back, from conditions like sciatica or spinal stenosis, even though it feels like a hip problem.
Knowing this distinction can save you time and frustration. If your pain is deep in the groin, a hip joint issue is the most likely culprit. If it’s on the outside of the hip, especially when lying on that side, soft tissue inflammation is a better bet.
Osteoarthritis: The Most Common Cause
Osteoarthritis is the leading reason people develop chronic hip pain, particularly after age 50. The cartilage lining the ball-and-socket joint gradually wears down over years until it becomes frayed and rough. As the protective space between the bones shrinks, bone can eventually rub directly on bone. The body tries to compensate by growing extra bone at the edges of the joint, forming small spurs called osteophytes, which can further limit movement and increase pain.
Early osteoarthritis often shows up as stiffness in the morning or after sitting for a while, with a deep ache in the groin that worsens with activity like walking or climbing stairs. Over time the pain becomes more persistent, and range of motion decreases. You might notice it getting harder to put on socks, tie shoes, or get in and out of a car. Younger people can develop osteoarthritis too, especially after a hip injury or if they were born with structural abnormalities in the joint.
Bursitis and Tendon Problems
The hip has several fluid-filled sacs called bursae that cushion areas where tendons and muscles slide over bone. When these become inflamed, the result is bursitis, and the most common type affects the bursa on the outer, upper edge of the thighbone. This is called trochanteric bursitis, and it produces a sharp or burning pain on the outside of the hip that often worsens when you lie on that side at night, climb stairs, or stand up from a chair.
Repetitive motions are the usual trigger. Running, cycling, climbing stairs frequently, or standing for long periods can all irritate the bursa. A fall onto the hip, a direct bump, or even lying on one side for too long can set it off as well. Structural issues that change how force travels through the hip, like scoliosis, legs of different lengths, or bone spurs, increase the risk by putting uneven pressure on the bursa.
A second bursa, located near the groin (the iliopsoas bursa), can also become inflamed and produce pain in the front of the hip that mimics joint problems. Tendinitis in the hip flexors or the gluteal tendons causes similar symptoms and often coexists with bursitis.
Labral Tears
The labrum is a ring of tough cartilage that lines the rim of the hip socket, helping to hold the ball of the thighbone securely in place. Tears in this cartilage are a common cause of hip pain in younger, active adults. They produce a deep, catching or clicking sensation in the groin, sometimes with sharp pain during twisting or pivoting movements.
Labral tears can result from a single injury, like a sudden twist during sports, or from repetitive stress over time. They are also closely linked to structural hip problems (more on that below). Diagnosing them can be tricky because standard physical exam maneuvers have limited accuracy. The most commonly used test, in which a clinician flexes and rotates the hip inward, catches only about 43% of tears confirmed on imaging. MRI with a contrast dye injected into the joint is typically needed for a reliable diagnosis.
Hip Impingement
Femoroacetabular impingement, usually just called hip impingement, happens when the bones of the hip joint aren’t shaped quite right, causing them to grind against each other during movement. There are two patterns. In one, a bump on the edge of the ball (the femoral head) prevents it from rotating smoothly, grinding into the cartilage of the socket. In the other, the rim of the socket extends too far over the ball, pinching the labrum underneath it during movement. Many people have a combination of both.
This abnormal contact doesn’t always cause pain right away. Some people have these bone shapes and never develop symptoms. But over time, impingement can wear down the cartilage inside the socket and tear the labrum, eventually leading to early-onset osteoarthritis. The pain typically shows up as a dull ache in the groin that gets worse with prolonged sitting, deep squatting, or athletic activity.
Avascular Necrosis
Avascular necrosis occurs when blood supply to the ball of the thighbone is disrupted, causing the bone tissue to die and eventually collapse. It’s less common than arthritis or bursitis, but it’s serious and can progress quickly if untreated.
The biggest risk factors are long-term or high-dose corticosteroid use and heavy alcohol consumption. A meta-analysis found that the incidence of hip osteonecrosis was about 6.7% among patients treated with high cumulative corticosteroid doses. For every additional 10 mg per day of prednisone (or its equivalent), the rate of osteonecrosis increased by 3.6%, and doses above 20 mg per day carried a notably higher risk. Hip fractures or dislocations can also cut off blood flow and trigger the condition.
Early symptoms resemble other hip problems: a dull ache in the groin that worsens with weight-bearing. As the bone weakens and collapses, the pain intensifies and range of motion drops sharply. Early detection through MRI matters because treatment options are much better before the bone surface collapses.
Referred Pain From the Spine
Not all hip pain originates in the hip. The lower back and hip share overlapping nerve pathways, so problems in the lumbar spine frequently masquerade as hip pain. Sciatica, caused by a compressed nerve root in the lower back, can send shooting or aching pain into the buttock, outer hip, and down the leg. Spinal stenosis, a narrowing of the spinal canal, produces similar symptoms, especially with walking or standing.
A useful clue: if your pain changes with back movements (bending, arching, or twisting your spine) more than with hip movements (rotating or flexing your leg), the source is more likely your back. Many people have both hip and spine issues simultaneously, which can make sorting out the primary driver harder without imaging.
Less Common Causes Worth Knowing
Several other conditions can produce hip pain, though they’re less frequent:
- Stress fractures develop from repetitive loading, especially in runners or people with weakened bones from osteoporosis. They cause a deep, activity-related ache that worsens over days to weeks.
- Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis) affects the hip joint with swelling and stiffness that’s often worst in the morning and improves with movement, the opposite pattern of osteoarthritis.
- Hip flexor strains cause sharp front-of-hip pain during activities like sprinting, kicking, or sudden acceleration. They’re especially common in soccer and football players.
- Infections in the hip joint (septic arthritis) are rare but serious, typically producing sudden, severe pain with fever and an inability to bear weight.
What Treatment Looks Like
Treatment depends entirely on the cause. For osteoarthritis, the first approach is usually physical therapy to strengthen the muscles around the hip, weight management to reduce joint stress, and over-the-counter pain relief. Many people manage well with this combination for years. When the joint deteriorates to the point where daily activities become difficult, hip replacement becomes an option. Recovery from hip replacement is faster than most people expect: significant pain relief often occurs within the first two weeks, and most patients return to normal function within a few months.
Bursitis typically responds to rest, ice, physical therapy, and sometimes a corticosteroid injection into the inflamed bursa. Identifying and correcting the underlying trigger, whether that’s a training error, leg length difference, or workplace ergonomics, prevents recurrence. Labral tears and impingement may be managed conservatively with therapy and activity modification, or surgically through arthroscopy if symptoms persist.
For any hip pain that lasts more than a few weeks, worsens over time, or limits your ability to walk or sleep, getting an accurate diagnosis is the most important step. The causes overlap enough that treating the wrong one wastes time and can allow the real problem to progress.