Hip pain has dozens of possible causes, and the most likely one depends heavily on your age, activity level, and where exactly you feel the discomfort. In younger adults (roughly 16 to 50), the culprit is often a structural issue like impingement or a soft tissue tear. In older adults, osteoarthritis dominates. But the hip joint is also a common site for referred pain from the lower back, which means the source of your discomfort may not be in the hip at all.
Where You Feel the Pain Matters
The hip is a ball-and-socket joint buried deep under layers of muscle, tendon, and connective tissue, so “hip pain” can mean very different things depending on where you point. Pain in the groin or front of the hip usually signals a problem inside the joint itself: cartilage damage, a labral tear, or arthritis. Pain on the outer side of the hip, near that bony bump you can feel when you press, more commonly comes from the tendons and muscles that attach there. And pain that wraps around to the buttock or shoots down the leg often originates in the lower spine, even if your back feels fine.
This distinction is the single most useful thing to notice before you see a provider, because it narrows the list of likely causes dramatically.
Osteoarthritis: The Most Common Cause Over 50
Osteoarthritis happens when the cartilage lining the ball and socket gradually wears down. In early stages, the joint space narrows slightly and small bony spurs form along the edges. As it progresses, the cartilage thins further, small cysts develop in the bone, and the ball of the femur starts to lose its round shape. In advanced cases, the cartilage is mostly gone and bone grinds against bone.
The pain typically starts as stiffness after sitting or first thing in the morning, then progresses to a deep ache in the groin that worsens with walking, stairs, or getting in and out of a car. Many people notice they gradually lose range of motion: it becomes harder to put on shoes, cross your legs, or clip your toenails on that side. Osteoarthritis tends to come on slowly over months to years, not overnight, and it affects one hip more than the other in most cases.
Femoroacetabular Impingement
In younger adults, one of the most common structural causes of hip pain is femoroacetabular impingement, or FAI. This happens when extra bone grows either on the top of the thighbone (called cam morphology) or along the rim of the hip socket (pincer morphology), or both. The extra bone causes the two surfaces to collide during movement instead of gliding smoothly.
FAI pain typically gets worse during physical activities, especially squatting, lunging, and jumping. Sitting for a long time or lying on the affected side can also flare it up. Over time, the repeated collision damages the cartilage and the labrum (a ring of soft tissue that seals the socket), which is why impingement and labral tears frequently show up together.
Labral Tears and Clicking Sensations
The labrum acts like a gasket around the hip socket, deepening it and helping hold the ball in place. When it tears, the torn flap can get pinched between the ball and socket during movement. The hallmark symptoms are groin pain and mechanical sensations: clicking, catching, locking, or a feeling that the hip might give way. Of these, clicking is the most consistent symptom that points toward a labral tear rather than a muscle problem.
Labral tears are common in athletes and people with impingement, but they also happen from repetitive motions or a single awkward movement. The pain often comes and goes, worse with activity and better with rest, which leads many people to dismiss it for months before getting it checked.
Lateral Hip Pain: Tendons, Not Bursitis
If your pain is on the outside of the hip, you may have been told you have bursitis. That diagnosis is falling out of favor. Surgical, imaging, and tissue studies have shown that what was traditionally called trochanteric bursitis is actually tendon damage in the gluteal muscles that attach to the outer hip bone, with or without inflammation of the nearby bursa. The current term is greater trochanteric pain syndrome.
This condition is especially common in women over 40 and in runners. It hurts to lie on the affected side at night, to climb stairs, and to stand on one leg. The pain is localized to a specific tender spot on the outer hip, which helps distinguish it from problems inside the joint.
Referred Pain From the Lower Back
The nerves that supply the hip originate in the lower spine, which means a disc problem, pinched nerve, or arthritic spinal joint can send pain straight to the hip area. This pain can land in the groin, the outer hip, the buttock, or all three simultaneously. Patients with confirmed hip arthritis who received diagnostic injections into the hip joint reported pain not just in the groin but also in the back of the pelvis, down the leg, and even into the foot, illustrating how widely hip-region pain can radiate.
The overlap between spine and hip problems is so common that clinicians have a name for it: hip-spine syndrome. If your hip pain doesn’t follow a clear pattern, or if it came on around the same time as back stiffness, the spine is worth investigating as a source.
Avascular Necrosis: When Blood Supply Fails
Avascular necrosis (AVN) occurs when blood flow to the ball of the femur is cut off, causing the bone to die and eventually collapse. It progresses through stages: early on, X-rays look normal and only an MRI can detect the damage. By the final stage, the femoral head has flattened and the joint space has narrowed severely.
The major risk factors are long-term or high-dose corticosteroid use (such as prednisone for autoimmune conditions), heavy alcohol consumption, sickle cell disease, lupus, high cholesterol, radiation treatment, and repetitive trauma from occupational activities. AVN can also occur after a hip fracture that disrupts blood vessels. In some cases, no clear cause is found. The pain typically starts as a dull ache in the groin that worsens with weight-bearing, and it can progress rapidly over weeks to months, which distinguishes it from the slower timeline of osteoarthritis.
Muscle and Tendon Injuries
The hip is surrounded by some of the body’s largest and most powerful muscles, and strains are common. The hip flexors at the front can be strained from sprinting or kicking. The abductor muscles on the outer hip can tear from sudden lateral movements. The piriformis, a small muscle deep in the buttock, can tighten and compress the sciatic nerve, sending pain down the back of the leg.
Muscle injuries tend to come on suddenly during activity, hurt when you contract or stretch the specific muscle, and improve steadily over days to weeks with rest. That pattern helps separate them from joint problems, which tend to be more persistent and harder to pin to one specific movement.
Snapping Hip Syndrome
If your hip makes an audible or palpable snap when you walk, swing your leg, or stand up from a chair, you likely have a tendon sliding over a bony prominence. The two most common culprits are the iliotibial band snapping over the outer hip bone and the hip flexor tendon catching on the front of the pelvis. Snapping hip is usually painless at first and merely annoying, but over time the repeated friction can inflame the tendon or bursa and start to hurt.
Red Flags Worth Knowing
Most hip pain is mechanical and not dangerous, but certain patterns warrant prompt evaluation. Sudden, severe hip pain after a fall, especially in someone over 65 or with osteoporosis, suggests a fracture. Hip pain with fever, chills, or redness could indicate a joint infection, which can destroy cartilage within days if untreated. Unexplained hip pain alongside unintentional weight loss or a history of cancer raises the possibility of bone metastasis. And any hip pain that wakes you consistently at night, rather than simply being noticed when you roll onto that side, deserves a closer look.