Hip pain has dozens of possible causes, and the single most useful clue for narrowing them down is where exactly you feel it. Pain on the outer side of the hip, deep in the groin, or in the buttock each point toward different structures. Your age, activity level, and what makes the pain better or worse fill in the rest of the picture.
Where You Feel It Matters Most
The hip is a deep ball-and-socket joint surrounded by layers of muscle, tendon, and fluid-filled sacs called bursae. Because so many structures sit close together, and because the hip shares nerve pathways with the lower back and pelvis, pain can show up in surprising places. A problem inside the joint itself typically registers as groin pain. A problem with the tendons or bursae on the outside of the hip creates lateral (side) pain. And buttock pain often traces back to either the sciatic nerve or the sacroiliac joint at the base of the spine.
A simple way to start sorting this out at home: lie on your back and place your ankle on the opposite knee so your leg forms a figure-4 shape, then gently let the bent knee fall outward. This is a version of what clinicians call the FABER test. If it reproduces groin pain, it suggests something inside the hip joint like arthritis, a labral tear, or impingement. If it reproduces pain in the buttock or the back of the pelvis, sacroiliac joint dysfunction is more likely. If you can barely get into the position at all, that restricted range of motion is itself a meaningful finding worth mentioning to a provider.
Outer Hip Pain
The most common cause of pain on the outside of the hip is greater trochanteric pain syndrome, a term that covers irritation of the bursae, tendons, or both around the bony bump you can feel on the side of your upper thigh. For years this was simply called hip bursitis, but imaging studies have shown that the bursa itself is inflamed in only a fraction of cases. More often, the gluteal tendons that attach near the same spot are overloaded or partially torn.
The hallmark symptom is tenderness right over that bony prominence, especially when you press on it. Pain typically worsens when you lie on the affected side at night, climb stairs, or stand on one leg. It can radiate down the outer thigh, though it shouldn’t travel below the knee or into the foot. You may also notice that your hip feels weak, particularly when walking or trying to balance.
Repetitive loading is the usual trigger. Runners, walkers who suddenly increase their mileage, and people who stand for long periods on hard surfaces are all at higher risk. A tight iliotibial band (the fibrous strip running from hip to knee along the outside of the thigh) can add friction to the area and keep symptoms going.
Exercise-based rehab is the strongest long-term treatment. A systematic review of randomized controlled trials found that targeted exercise slightly but meaningfully reduces pain and improves physical function over time, and that it outperforms corticosteroid injections for sustained improvement. Injections can offer short-term relief, but they don’t change the underlying tendon problem. Strengthening the gluteal muscles, particularly the gluteus medius, is usually the core of a rehab program.
Groin and Front-of-Hip Pain
Pain that settles into the groin crease or the front of the hip usually points to something happening inside or around the joint itself. The three most common culprits are osteoarthritis, labral tears, and femoroacetabular impingement (FAI).
Hip Osteoarthritis
Osteoarthritis is a gradual wearing down of the cartilage that cushions the ball-and-socket joint. It’s most common after age 50 but can develop earlier if you’ve had a previous injury or a structural abnormality. The classic pattern is a deep, aching groin pain that gets worse with activity and improves with rest. Morning stiffness is typical but usually lasts less than 30 minutes. As the condition progresses, you may notice a grating or crunching sensation when you move the hip, and eventually pain can appear even when you’re sitting still.
One of the earliest measurable signs is a loss of internal rotation. If you sit on the edge of a chair, let your lower leg swing outward (which rotates the thigh bone inward), and notice that one side moves noticeably less than the other or causes pain, that’s a red flag. Clinical guidelines use internal rotation below 15 degrees combined with limited flexion as a key diagnostic marker.
Labral Tears
The labrum is a ring of tough cartilage lining the rim of the hip socket. When it tears, you typically feel a deep ache in the groin that comes on gradually, worsened by prolonged sitting or standing. Clicking, catching, or a sensation that the hip is locking or giving way are common complaints. Pain can also radiate to the buttock, outer hip, or even the inner knee.
Labral tears are surprisingly common. They’re estimated to be present in about 66% of people with mechanical hip pain, and imaging studies have found them in roughly 39% of people who have no symptoms at all. This means a torn labrum on an MRI doesn’t automatically explain your pain, which is why clinical context matters.
Femoroacetabular Impingement
FAI is a structural mismatch between the ball and socket. In some people, extra bone develops on the top of the thigh bone (cam type), the rim of the socket (pincer type), or both. This extra bone causes the joint to pinch during certain movements, particularly when you bring the knee up toward the chest and rotate inward. Over time, that repeated pinching can damage the labrum and cartilage.
FAI is a leading cause of hip pain in active adults in their 20s, 30s, and 40s. It produces a dull, aching groin pain that starts gradually and worsens with activities involving deep hip flexion: squatting, sitting in low chairs, cycling, or pivoting in sports. If your pain fits this pattern and you’re younger than typical osteoarthritis age, FAI is worth discussing with your provider.
Buttock and Posterior Hip Pain
Pain that centers in the buttock can come from the hip joint itself, but it’s more often traced to the sacroiliac joint, the piriformis muscle, or the sciatic nerve.
Piriformis syndrome occurs when the piriformis, a small muscle deep in the buttock, compresses the sciatic nerve as it passes nearby. This produces pain, numbness, or tingling in the buttock that can travel down the back of the leg. It feels a lot like sciatica caused by a herniated disc in the lower back, but the pain originates in one specific spot in the buttock rather than in the spine. Sciatica from a disc problem tends to involve the lower back as well and may affect a broader area of the leg.
Sacroiliac joint dysfunction is another common source. The SI joints sit at the base of the spine where it connects to the pelvis, and when they become inflamed or move abnormally, the result is a deep ache in the buttock and posterior hip that can be hard to pinpoint. It often worsens with prolonged sitting, standing on one leg, or transitioning from sitting to standing.
When the Problem Isn’t the Hip at All
The lower back and hip share nerve pathways so closely that a problem in one can masquerade as pain in the other. A herniated disc or degenerative changes at L4-L5 in the lumbar spine can produce what feels like hip pain, particularly in the groin, outer thigh, or buttock. People often compensate for a back problem by changing how they walk or sit, which loads the hip differently and can create a secondary pain source on top of the original one.
A useful distinction: true hip joint pain almost always worsens when you rotate or flex the hip, while referred pain from the spine tends to change with back movements like bending forward, arching backward, or twisting. If your “hip pain” gets worse when you arch your lower back or bend to one side but doesn’t change much when you move the hip through its range, the spine deserves a closer look.
Sorting Out Your Next Step
Start by noting three things: exactly where the pain is (groin, outer hip, buttock, or some combination), what makes it worse (lying on your side, sitting, walking, climbing stairs, specific movements), and how it started (suddenly after an injury, gradually over weeks, or without any clear trigger). These details do more to narrow the diagnosis than any single test.
For pain that’s been present less than two weeks without a traumatic injury, a trial of rest, ice, and gentle stretching is reasonable. Outer hip pain often responds to sleeping with a pillow between the knees and avoiding lying on the sore side. Groin pain from suspected impingement or arthritis tends to improve temporarily by avoiding deep squats, low chairs, and activities that force the hip into extreme positions.
Pain that persists beyond a few weeks, wakes you at night, causes visible limping, or involves clicking and locking sensations is worth getting evaluated. An X-ray can reveal arthritis or bone abnormalities, while an MRI provides a better look at soft tissue structures like the labrum and tendons. In many cases, a focused physical exam alone can identify the pain generator and point toward the right treatment.