The hip joint is a complex ball-and-socket structure designed for mobility and weight-bearing capacity. When discomfort arises, the location where the pain is felt is the first and most informative clue for diagnosis. True hip joint issues often manifest as pain deep within the groin. Conversely, problems in the surrounding muscles, tendons, or even the lower back can cause sensations in the buttock, thigh, or outer hip area.
Pain Felt in the Front of the Hip
Pain centralized in the front of the hip, specifically the groin area, strongly indicates an issue originating from the hip joint itself. The most common cause of deep, aching groin pain, particularly in adults over 50, is osteoarthritis (OA), where the protective cartilage wears down. This discomfort tends to worsen with activity and may cause stiffness after periods of rest, such as in the morning.
Pain in this anterior region can also stem from soft tissue structures, such as the iliopsoas muscle and tendon (the primary hip flexors). Overuse or strain of this tendon, known as iliopsoas tendinopathy, causes pain when the leg is lifted. A labral tear, involving the cartilage lining the hip socket, can also cause sharp groin pain, sometimes accompanied by a clicking or locking sensation.
Pain Felt on the Outer Side of the Hip
Discomfort felt directly over the bony prominence on the side of the upper thigh, known as the greater trochanter, is classified as lateral hip pain. This presentation is most commonly attributed to Greater Trochanteric Pain Syndrome (GTPS), often mistakenly called trochanteric bursitis. GTPS is an umbrella term primarily covering tendinopathy of the gluteus medius and gluteus minimus muscles, which attach to the greater trochanter.
Irritated or overloaded gluteal tendons cause a burning or aching sensation that may radiate down the side of the thigh. This pain is frequently aggravated by activities that compress the area, such as lying on the affected side at night or standing with weight shifted to one leg. GTPS is observed more frequently in females between 40 and 60 years of age.
Pain Felt in the Back of the Hip
Pain felt in the buttock area, or posterior hip, is often complex to diagnose because it frequently results from referred pain rather than a hip joint issue. The lumbar spine (lower back) and the sacroiliac (SI) joint are common sources of pain that travel to the buttock region. Degenerative disc disease or a herniated disc in the lower back can irritate nerve roots, causing lumbosacral radiculopathy, commonly known as sciatica.
Sciatica typically presents as a sharp, shooting, or burning pain that starts in the buttock and may travel down the back of the leg, sometimes accompanied by tingling or numbness. The sacroiliac joint, which connects the sacrum to the pelvis, can also cause pain that is localized to the buttock and sometimes radiates to the groin or thigh.
Another potential cause is Piriformis Syndrome, where the piriformis muscle in the deep buttock region spasms and irritates the nearby sciatic nerve. Piriformis syndrome causes a dull ache directly in the buttock that can mimic sciatica, often worsening after prolonged sitting or when climbing stairs. High hamstring tendinopathy is another possibility, which causes pain lower in the buttock, particularly when sitting directly on the attachment point of the tendon.
Identifying Serious Symptoms
While most hip pain relates to musculoskeletal strain or age-related wear, certain symptoms signal a potentially serious problem requiring prompt medical evaluation. The inability to bear weight on the affected leg is a significant warning sign, as this may indicate a fracture or severe structural compromise. Sudden, intense pain following a fall or major trauma should be evaluated immediately for a possible hip fracture or dislocation.
Systemic symptoms accompanying hip discomfort are also a serious concern. If the pain is accompanied by a fever, chills, or noticeable swelling and warmth in the joint area, this could be a sign of an infection, such as septic arthritis, which requires urgent treatment. Any pain coupled with a visible deformity of the hip or leg, or a significant loss of sensation or motor function in the leg, warrants immediate medical attention.