Hip pain has dozens of possible causes, and the most useful way to narrow them down is by where you feel it. Pain in the groin, on the outer side of the hip, and deep in the buttock each point to different structures and conditions. Some causes are as simple as an overworked tendon; others involve the joint itself wearing down or a problem in the spine sending pain signals to the hip area.
Pain Location Narrows the Cause
The hip is a deep ball-and-socket joint surrounded by layers of muscle, tendon, and bursa (fluid-filled cushions). Because so many structures overlap in a small area, the location of your pain is one of the strongest clues to what’s going on.
Groin or front of the hip: Pain here usually comes from inside the joint itself. Common culprits include osteoarthritis, labral tears, femoroacetabular impingement (FAI), stress fractures of the femoral neck, and avascular necrosis (loss of blood supply to the bone). Flexor tendon irritation, which sits outside the joint, can also cause anterior pain.
Outer (lateral) hip: Pain on the side of the hip, right over the bony prominence you can feel when you press, is most often grouped under greater trochanteric pain syndrome. This umbrella term covers bursitis, gluteus medius tendon damage or tears, and irritation of the iliotibial band.
Buttock or back of the hip: Posterior pain can come from the sacroiliac joint, the lumbar spine, the deep gluteal muscles, or the hamstring tendons where they attach near the sit bone. Deep gluteal syndrome, for instance, causes burning pain that shoots down the leg and worsens with sitting, especially in a car.
Osteoarthritis: The Most Common Joint Cause
Osteoarthritis is the leading cause of hip pain in adults over 50. The cartilage lining the ball and socket gradually wears thin, allowing bone to grind against bone. You’ll typically notice a deep ache in the groin or front of the thigh that gets worse with activity and better with rest. Over time, the hip stiffens, making it harder to put on shoes or get in and out of a car.
Hip osteoarthritis tends to progress slowly over years. Early on, activity modifications, physical therapy, and anti-inflammatory medications can keep pain manageable. When those stop working and the pain limits daily life, joint replacement becomes an option. Modern hip replacements have a roughly 95% survival rate at 10 years and 70 to 77% at the 20-year mark, with most patients scoring well on functional outcome measures after surgery.
Labral Tears and Impingement
The labrum is a ring of tough cartilage that lines the rim of the hip socket, helping to seal and stabilize the joint. When it tears, you may feel a catching or clicking sensation in the groin, along with stiffness and pain during twisting or pivoting movements. Labral tears happen three main ways: from a traumatic injury like a car accident or contact sport, from repetitive motions common in ballet, golf, swimming, and long-distance running, or from structural abnormalities in the hip that put extra stress on the labrum over time.
One of the most common structural problems linked to labral tears is femoroacetabular impingement, or FAI. This occurs when extra bone develops on the femoral head (called a cam deformity), on the acetabular rim (called a pincer lesion), or both. The mixed type, involving both cam and pincer changes, is the most common form in people who have symptoms. The abnormal bone shape causes the femur and socket to pinch against each other during movement, gradually damaging the labrum. FAI is a frequent finding in young, active adults who develop groin pain with deep squatting or prolonged sitting.
Greater Trochanteric Pain Syndrome
If your pain is on the outside of the hip, the most likely diagnosis falls under greater trochanteric pain syndrome (GTPS). For years, this was simply called “hip bursitis,” but research now shows that the bursa is only part of the picture. In many cases, the real problem is damage to the gluteus medius tendon, one of the key muscles that stabilizes the pelvis when you walk.
GTPS typically develops gradually. It hurts to lie on the affected side at night, to rise from a chair, to stand for long periods, and to rotate the hip. When the gluteus medius tendon tears completely, you may notice a limp or a drop in the pelvis on the opposite side when standing on one leg. This condition is especially common in women over 40 and in runners who ramp up mileage too quickly.
Spine Problems That Mimic Hip Pain
The nerves that supply the hip originate in the lower lumbar spine, which means a disc herniation, spinal stenosis, or degenerative disc disease can send pain directly into the hip, groin, buttock, or thigh without the hip joint being involved at all. This overlap is so common that clinicians sometimes call it “hip-spine syndrome.”
Research on patients with confirmed hip arthritis found that, in addition to groin pain, many also reported pain in the posterior pelvis, the full length of the leg, and even the foot. This wide distribution makes it tricky to tell whether the hip or the spine is the primary source. A key difference: spine-related hip pain often changes with back position (bending forward or arching backward) and may travel below the knee, while true hip joint pain usually stays in the groin and upper thigh and worsens with weight-bearing activities like walking.
Stress Fractures and Avascular Necrosis
A stress fracture of the femoral neck is a serious cause of groin pain that can develop in distance runners, military recruits, and anyone who rapidly increases impact activity. The pain builds gradually, worsens with weight bearing, and may not show up on a standard X-ray for weeks. An MRI catches it much earlier. Left untreated, a stress fracture can progress to a complete break, so it warrants prompt evaluation.
Avascular necrosis (also called osteonecrosis) happens when blood flow to the femoral head is disrupted and bone tissue dies. Risk factors include long-term corticosteroid use, heavy alcohol consumption, and certain blood disorders. Pain develops in the groin, and without treatment the femoral head can collapse, eventually requiring hip replacement.
Hip Fractures
Hip fractures are overwhelmingly a concern in older adults with weakened bones. Globally, the 2023 Global Burden of Disease study counted 24.3 million new hip fracture cases. Most result from a fall, though in severely osteoporotic bone, a fracture can happen with something as minor as twisting while standing. The hallmark is sudden, severe groin or hip pain with inability to bear weight, and it requires surgical repair.
Posterior Hip and Buttock Pain
Several conditions cause pain behind the hip. Deep gluteal syndrome produces burning, sciatica-like pain down the back of the leg, often aggravated by sitting. Ischiofemoral impingement causes deep buttock pain that worsens with long-stride activities like running or walking uphill. Proximal hamstring tendinopathy, common in sprinters and hurdlers, creates sit-bone pain that flares during hip extension exercises.
Sacroiliac joint dysfunction is another frequent source of posterior hip pain. It tends to affect one side and feels like a deep ache near the dimple of the lower back, radiating into the buttock. Unlike lumbar disc problems, sacroiliac pain rarely travels below the knee.
Hip Pain in Children and Teens
Two conditions unique to growing bones deserve mention. Legg-Calvé-Perthes disease affects younger children, typically between ages 4 and 10, when blood supply to the growing femoral head is temporarily disrupted, causing the bone to soften and flatten. Slipped capital femoral epiphysis (SCFE) strikes older children and adolescents, usually during growth spurts, when the growth plate at the top of the thighbone shifts out of position. Both conditions cause a limp and pain in the groin, thigh, or knee, and both can lead to impingement problems later in life if not treated early.
When Hip Pain Signals an Emergency
Most hip pain develops gradually and responds to rest, physical therapy, or activity changes. A few scenarios require urgent attention. Septic arthritis, a joint infection, causes severe pain that comes on fast, making it nearly impossible to move or bear weight on the affected leg. The joint may be swollen and warm, and you may have a fever. Joint infections can permanently damage cartilage within days, so rapid treatment matters. If you’ve had a hip replacement and develop new pain, swelling, or loosening of the joint months or years after surgery, a prosthetic joint infection is possible and also needs prompt evaluation.
Sudden hip pain after a fall, particularly in anyone over 65 or with known osteoporosis, should be treated as a possible fracture until proven otherwise. And any hip pain accompanied by unexplained weight loss, night pain that wakes you from sleep, or a history of cancer warrants imaging to rule out more serious causes.