Hip pain has dozens of possible causes, and the most useful clue is usually where you feel it. Pain in the front of the hip points to a different set of problems than pain on the outer side or deep in the buttock. Understanding the location, along with what makes it better or worse, narrows the list considerably.
What the Location of Your Pain Tells You
Pain in the front of the hip, near the groin crease, typically involves the joint itself. Osteoarthritis, labral tears, hip impingement, and stress fractures all tend to show up here. A hallmark sign that the joint is involved: the pain gets worse when you rotate your leg inward, and it sometimes refers down to the knee.
Pain on the outer side of the hip, right over the bony bump you can feel when you press, usually comes from the soft tissues surrounding the joint rather than the joint itself. This is called greater trochanteric pain syndrome, which includes bursitis, tendon problems in the muscles that stabilize your pelvis, and friction from the thick band of tissue that runs down the outside of your thigh.
Pain in the back of the hip or deep in the buttock opens up a wider list. It could be your lower back referring pain downward, your sacroiliac joint (where the spine meets the pelvis), a tight muscle compressing the sciatic nerve, or a hamstring tendon issue near the sitting bone. Back-related hip pain is especially common and easy to confuse with a true hip problem because the same nerves supply both areas.
Osteoarthritis: The Most Common Cause Over 50
If you’re over 50 and your hip has been gradually getting stiffer and more painful over months or years, osteoarthritis is the most likely explanation. The cartilage that cushions the ball-and-socket joint wears down, leading to friction, inflammation, and eventually bone-on-bone contact. You’ll typically feel it deep in the groin, and it tends to be worst when you first stand up after sitting. Walking becomes more uncomfortable over time, and you may notice you can’t spread your legs apart or rotate your hip the way you used to.
Bursitis and Outer Hip Pain
Greater trochanteric bursitis is one of the most common reasons people feel pain on the outside of the hip. A fluid-filled cushion (bursa) over the bony prominence on the side of the thigh becomes inflamed, often from repetitive activities like running, climbing stairs, or even just sleeping on that side. The signature symptom is point tenderness right over the outer hip bone. Pressing on it reproduces the pain exactly.
The pain often radiates down the outer thigh but shouldn’t travel all the way to the foot. If it does, that suggests a nerve issue rather than bursitis. Lying on the affected side at night is a classic trigger, and many people say it wakes them up. Walking, running, and weight-bearing activities make it worse, and some people describe a feeling of weakness in the leg even though the muscles are fine.
What’s now understood is that bursitis rarely exists alone. Most cases of outer hip pain also involve damage or irritation to the tendons of the muscles that stabilize your pelvis when you stand on one leg. This is why the condition is increasingly called greater trochanteric pain syndrome rather than just bursitis.
Hip Impingement
Hip impingement happens when the ball and socket of the hip joint don’t fit together smoothly. Extra bone growth on either the top of the thighbone (cam type), the rim of the hip socket (pincer type), or both (combined type) creates friction that pinches the soft tissue inside the joint during movement. It’s a structural problem, meaning the shape of your bones is slightly off.
The pain typically shows up during activities that require deep bending at the hip: squatting, lunging, jumping, or even sitting for long stretches. You might feel stiff and sore on one side, and the discomfort tends to be in the groin area. Over time, the repeated pinching can damage the ring of cartilage (labrum) that lines the socket, which is why impingement and labral tears often go together.
Labral Tears
The labrum is a ring of rubbery cartilage that deepens the hip socket and helps seal the joint. When it tears, you may feel a clicking or popping sensation when you move the hip, along with a catching or locking feeling. The pain is usually in the groin and may come on gradually from repetitive motion or suddenly from a twisting injury. Some labral tears cause surprisingly little pain, while others make it hard to walk comfortably.
When Your Back Is the Real Problem
A significant number of people with hip pain actually have a spine problem. The lumbar spine and the hip share nerve pathways, so a herniated disc, arthritis in the spine, or spinal stenosis (narrowing of the nerve channels) can all send pain into the hip, buttock, and leg. This is the mechanism behind sciatica, where a compressed nerve root in the lower back creates symptoms that radiate downward.
A useful clue: if the pain changes with your back position (bending forward, arching backward, or twisting your trunk) rather than with hip movements, the source is more likely spinal. Pain that shoots below the knee or causes tingling and numbness in the foot also points to a nerve being compressed in the back rather than a hip joint issue. Some people have both a hip problem and a spine problem at the same time, which makes sorting out the source harder.
Hip Pain During Pregnancy
Pregnancy-related hip pain is extremely common, especially in the second and third trimesters. Your body produces a hormone called relaxin that loosens the muscles, ligaments, and joints of the pelvis to prepare for delivery. This loosening is necessary, but it can make the pelvis unstable and painful. You may feel it across the front of the pubic bone, on one or both sides of the lower back, or in the inner thighs.
This condition is called pregnancy-related pelvic girdle pain. It tends to flare during specific movements: climbing stairs, getting out of a car, rolling over in bed, or standing on one leg. The increased flexibility from relaxin also makes you more prone to strains and sprains in the hip area. Pelvic support belts and targeted exercises often help, and the pain typically resolves after delivery as hormone levels return to normal.
Less Common but Serious Causes
Stress fractures of the femoral neck (the narrow part of the thighbone near the joint) can cause groin pain that worsens with activity. These are more common in runners, older adults with thinning bones, and military recruits. Avascular necrosis, where the blood supply to the head of the thighbone is disrupted, causes progressive joint destruction and deep, aching hip pain. Risk factors include long-term steroid use, heavy alcohol consumption, and certain blood disorders.
Deep gluteal syndrome, previously called piriformis syndrome, occurs when the sciatic nerve gets trapped by muscles deep in the buttock. It produces pain in the buttock that can radiate down the back of the leg, often worsened by prolonged sitting.
Signs That Need Immediate Attention
Most hip pain develops gradually and isn’t dangerous, but certain symptoms require prompt medical evaluation. A hip that looks misshapen or out of place, inability to move the leg or bear weight, intense pain after a fall or injury, sudden swelling, and fever or chills with skin color changes on the affected leg all warrant a trip to the emergency room. A hip that suddenly gives out in an older adult after a fall raises concern for a fracture, even if the pain seems manageable at first.
Narrowing Down Your Cause
Pay attention to three things: where exactly the pain is (groin, outer hip, buttock, or thigh), what makes it worse (sitting, walking, lying on your side, specific movements), and how it started (gradually over weeks, suddenly after an injury, or during a period of increased activity). Groin pain with stiffness in a person over 50 is most often arthritis. Outer hip pain that’s worst at night when you lie on it is most often bursitis or tendon irritation. Buttock pain that shoots down the leg is most often coming from the spine or a compressed nerve.
These patterns aren’t foolproof, but they give you a useful starting framework. An X-ray can quickly rule out arthritis and fractures, and an MRI can reveal soft tissue problems like labral tears and tendon damage when the diagnosis isn’t clear from a physical exam alone.