Hip aching is one of the most common musculoskeletal complaints in adults, and the cause depends largely on where you feel it, how old you are, and what triggers it. About 14% of adults over 60 report significant hip pain on most days. The tricky part is that “hip pain” can mean very different things depending on whether it’s in your groin, the outer side of your thigh, or deep in your buttock, and each location points to a different problem.
Where You Feel It Matters Most
The hip is a complex area where bones, tendons, fluid-filled sacs, and major nerves all sit close together. Pain in the groin or front of the hip usually comes from the joint itself. Pain on the outer side of the hip or thigh typically involves the tendons and muscles that attach to the bony prominence you can feel on the outside of your upper leg. Deep buttock pain that may shoot down your leg often involves nerve compression rather than the hip joint at all.
This distinction is important because many people assume their hip joint is the problem when the pain is actually coming from soft tissue on the outside of the hip or even from the lower spine. Nerves that exit the lumbar spine travel through the hip area on their way down the leg, so a pinched nerve in your back can create pain you’d swear is coming from your hip. This overlap is common enough that doctors have a name for it: hip-spine syndrome.
Osteoarthritis: The Most Common Cause After 50
In older adults, osteoarthritis of the hip joint is the leading cause of that deep, achy groin pain. It develops gradually as the smooth cartilage coating the ends of your bones thins out over time. Gravity and decades of use take a toll on the joint surfaces, and as cartilage wears down, bone spurs can form at the joint edges. When cartilage wears away completely, bone grinds directly against bone, which is intensely painful.
You’ll typically notice osteoarthritis as stiffness in the morning that loosens up after a few minutes of movement, along with a dull ache that worsens with activity and improves with rest. Over time the pain becomes more persistent, and you may find it harder to tie your shoes, get in and out of a car, or walk long distances. An X-ray showing narrowed joint space and bone spurs is usually enough to confirm the diagnosis.
Current guidelines from the American Academy of Orthopaedic Surgeons recommend physical therapy as a first-line treatment for mild to moderate hip osteoarthritis. Anti-inflammatory medications consistently reduce pain and are recommended when safe for you to take, though no single type works better than others. Corticosteroid injections into the joint can improve pain and function for up to four months. Notably, hyaluronic acid injections (sometimes marketed as joint lubrication) have consistently shown no improvement over placebo and are not recommended.
Outer Hip Pain: Tendons, Not Just Bursitis
If your hip aches along the outer side of your thigh or upper leg, the most likely culprit is greater trochanteric pain syndrome. For years this was called “hip bursitis,” and you may still hear that term. But research has since shown that the pain in this area is more commonly caused by small, repetitive injuries to the gluteal tendons (the muscles in your buttock that attach to the outer hip bone) rather than inflammation of the bursa alone.
Greater trochanteric pain syndrome is especially common in women over 40 and in runners. The telltale signs include pain when lying on the affected side at night, pain when rising from a chair, discomfort with prolonged standing, and tenderness when you press on the bony point of your outer hip. The pain can radiate down the outside of your thigh toward the knee, which sometimes gets confused with sciatica.
In more severe cases, the gluteal tendons can partially or fully tear. When this happens, you may notice weakness when walking, particularly a limp or a feeling that your pelvis drops to one side with each step. Full-thickness tears cause noticeable difficulty with activities like climbing stairs or walking on uneven ground.
Labral Tears and Impingement in Younger Adults
If you’re under 45 and your hip aches deep in the groin, two closely related conditions are the most likely explanation: femoroacetabular impingement and labral tears.
The hip socket has a ring of cartilage around its rim called the labrum, which acts as a gasket to keep the ball of the thighbone seated properly. Impingement happens when extra bone growth on either the ball or the socket (or both) causes the two surfaces to pinch the labrum during movement, particularly when you bring your knee toward your chest or rotate your leg inward. Over time, this repeated pinching can tear the labrum.
Labral tears produce a distinctive set of symptoms: a clicking, catching, or locking sensation in the hip joint, along with a deep ache in the groin. They’re common in athletes who do repetitive hip movements, including dancers, gymnasts, hockey players, and soccer players. But they can also result from a single traumatic injury. The pain often comes on gradually, worsens with activity, and may be hard to pinpoint because it feels deep and vague rather than sharp and localized.
Deep Buttock Pain and Nerve Compression
When your “hip” aches deep in the buttock and possibly radiates down the back of your leg, the issue may be nerve-related rather than joint-related. Deep gluteal syndrome (which includes what used to be called piriformis syndrome) occurs when the sciatic nerve gets compressed by muscles in the buttock. The hallmark is deep buttock pain that gets worse with sitting.
Lower back problems can also masquerade as hip pain. The nerves that supply sensation to the groin, outer hip, and thigh all originate from the lumbar spine. Disc herniations or arthritis in the lower back can compress these nerves, sending pain into the hip area even though the hip joint itself is perfectly healthy. This is one reason hip pain that doesn’t respond to typical hip treatments sometimes turns out to be a spine problem.
What Makes Hip Aching Worse
Several everyday factors can amplify hip pain regardless of the underlying cause. Prolonged sitting, especially in low chairs or car seats, compresses the front of the hip joint and tightens the muscles around it. Sleeping on your side without a pillow between your knees puts sustained pressure on the outer hip structures. Repetitive activities like climbing stairs, running on hard surfaces, or carrying heavy loads on one side can aggravate both joint and tendon problems.
Weight plays a measurable role. Every pound of body weight translates to roughly three to six pounds of force across the hip joint during walking. Even modest weight loss can meaningfully reduce the load on an arthritic hip.
Muscle weakness, particularly in the glutes, is both a cause and a consequence of hip pain. When these muscles are weak, the hip joint and surrounding tendons absorb forces they aren’t designed to handle alone. Targeted strengthening of the gluteal muscles is a core component of treatment for nearly every type of hip pain.
Signs That Need Prompt Attention
Most hip aching is not an emergency, but certain symptoms warrant immediate medical evaluation: a hip that looks visibly deformed or out of place, inability to move your leg or bear weight, intense pain after an injury, sudden swelling, or fever and chills along with hip pain. A leg that suddenly appears shorter than the other can indicate a fracture or dislocation. Fever combined with hip pain raises concern for joint infection, which requires urgent treatment.