Hip pain is often confusing, as discomfort described as “hip pain” might actually originate in the lower back, thigh, or groin. Understanding the location of the pain provides the most valuable clue for determining the underlying problem. The location helps distinguish between issues originating from the joint itself and those involving the surrounding soft tissues.
Understanding the Anatomy of Hip Pain
The hip is a large, highly stable ball-and-socket joint where the head of the femur rotates within the acetabulum (pelvic socket). This structure is cushioned by articular cartilage and the labrum, which deepens the socket for stability. True hip joint pathology, known as intra-articular pain, is typically felt in a concentrated area. Pain originating from the joint itself is often perceived in the groin or the front of the hip due to shared nerve pathways.
Pain originating from structures outside the joint capsule, known as extra-articular pain, is commonly felt in the lateral (side) or posterior (back) hip areas. These surrounding structures include muscles, tendons, ligaments, and fluid-filled sacs called bursae. For example, inflammation near the greater trochanter (the bony bump on the side of the upper thigh) causes lateral pain. This distinction between joint pain and soft tissue pain is fundamental to accurate diagnosis.
Anterior and Groin Pain Locations
Pain felt deep in the groin or at the front of the hip is the most reliable indicator of a problem originating within the hip joint. Osteoarthritis, the most common cause in older adults, involves the wearing down of joint cartilage, leading to pain that worsens with activity and causes stiffness. This deep, aching pain often radiates down the front of the thigh.
A labral tear, damage to the cartilage ring surrounding the hip socket, is another common source of anterior pain. Patients often report sharp, activity-related pain, sometimes accompanied by a clicking or catching sensation. Hip flexor strains or tendinopathy (affecting the iliopsoas muscle) also cause anterior pain, especially during activities involving lifting the knee. Conditions like femoroacetabular impingement (FAI), where abnormal bone shapes cause friction, typically present with anterior pain when the hip is flexed and rotated.
Lateral Hip Pain Locations
Discomfort located over the outer, bony prominence of the hip (the greater trochanter) is classified as lateral hip pain. This location is rarely associated with the hip joint itself but rather with the soft tissues crossing this landmark. The most common diagnosis is Greater Trochanteric Pain Syndrome (GTPS). While bursitis can occur, the primary source of pain is frequently gluteal tendinopathy, involving irritation of the gluteus medius and minimus tendons.
This pain is often exacerbated by lying on the affected side, standing for long periods, or walking. Another condition causing lateral discomfort is Iliotibial (IT) band syndrome, where the thick band of fascia along the side of the thigh becomes inflamed. Lateral pain is generally considered a soft tissue issue, often linked to muscle weakness or overuse, and typically does not extend into the groin.
Posterior and Buttock Pain Locations
Pain felt deep in the buttock region presents a challenging diagnostic puzzle because this area is a junction for multiple structures. The pain rarely comes directly from the hip joint itself. A major source of discomfort is Sacroiliac (SI) joint dysfunction, where pain is focused near the dimples on the lower back. SI joint pain is often felt on one side and can radiate down the back of the leg.
Another significant cause is Deep Gluteal Syndrome (DGS), an umbrella term for nerve compression in the deep buttock space. Piriformis Syndrome, a component of DGS, occurs when the piriformis muscle irritates the sciatic nerve, causing buttock pain that can mimic sciatica. High hamstring pain, or proximal hamstring tendinopathy, is felt at the ischial tuberosity (the sitting bone) and is common in runners, causing pain when sitting or during deep hip flexion.
Many causes of posterior hip pain are actually referred from the lumbar spine, such as a herniated disc causing nerve root irritation. Pain originating from the spine will often travel below the knee. Conversely, pain limited to the buttock and upper thigh is more likely to be a local hip or pelvic issue.