Hip pain has dozens of possible causes, and the most likely one depends on your age, activity level, and exactly where the pain shows up. The hip is a deep ball-and-socket joint surrounded by layers of muscle, tendon, and bursa, so pain you feel “in the hip” could originate from the joint itself, the soft tissues around it, or even your lower back. Here’s how to narrow it down.
Where You Feel It Matters
The location of your hip pain is the single most useful clue to its cause. Pain deep in the groin or front of the hip usually points to something inside the joint itself, like arthritis or a labral tear. Pain on the outer side of the hip, right over the bony bump you can feel when you press, typically comes from the tendons or fluid-filled sacs (bursae) that cushion the area. And pain that starts in the buttock and travels down the back of your thigh may not be a hip problem at all. It’s often referred from a compressed nerve in your lower back.
A useful self-check: if you can point to the pain with one finger on the outside of your hip, soft tissue inflammation is likely. If the pain is harder to pinpoint and feels deep inside the joint, especially in the groin, the problem is more likely within the joint capsule.
Osteoarthritis: The Most Common Cause Over 50
Osteoarthritis affects over 50% of adults aged 65 and older in the U.S., and hip osteoarthritis specifically has increased in prevalence by about 25% over the past three decades. It happens when the cartilage lining the joint wears down, allowing bone to rub against bone. The hallmark is stiffness first thing in the morning or after sitting for a long time, combined with a deep, aching groin pain that gets worse with activity.
Two physical signs are especially telling. Groin pain when your leg is passively moved inward or outward is highly specific for hip arthritis. So is pain in the back of the hip when you squat. If your hip also feels like it has lost range of motion, particularly when rotating your leg or pulling your knee toward your chest, arthritis is a strong possibility.
Greater Trochanteric Pain Syndrome
If your pain is on the outside of your hip, you may have heard the term “trochanteric bursitis.” That diagnosis is still commonly used, but imaging studies have shown the pain is more often caused by damage to the gluteal tendons (gluteus medius and minimus) than by inflammation of the bursa alone. The umbrella term for this is greater trochanteric pain syndrome, or GTPS.
GTPS pain is typically one-sided, directly over the bony prominence on the outer hip, and gets worse with prolonged sitting, stair climbing, high-impact exercise, or lying on the affected side at night. Crossing your legs or standing with your weight shifted to one hip can also flare it. Pain tends to increase when the leg moves inward across the body and eases when it moves outward. A straight leg raise usually doesn’t hurt, which helps distinguish it from a joint problem or nerve issue.
Labral Tears and Hip Impingement
The labrum is a ring of cartilage that lines the rim of the hip socket, creating a seal that keeps the ball of the femur stable. When it tears, the most consistent symptom is a clicking, catching, or locking sensation in the hip, often accompanied by sharp groin pain during certain movements like pivoting or deep squatting. Some people also feel the hip “giving way” unexpectedly.
Labral tears frequently go hand in hand with femoroacetabular impingement (FAI), a condition where the shape of the hip bones causes abnormal contact inside the joint. There are two types. In one, the ball of the femur has a bump that jams against the socket during movement (cam type, more common in young men). In the other, the socket extends too far over the ball, pinching the labrum (pincer type, more common in middle-aged women). Many people have both.
Hip shape abnormalities are surprisingly common, especially in athletes. A study of college football players found that 95% of pain-free hips showed at least one sign of impingement on imaging. Among elite soccer players, the figure was 72% for men and 50% for women. This means impingement on an X-ray doesn’t automatically explain your pain, but when it lines up with clicking, groin pain, and limited rotation, it’s a likely contributor.
When the Problem Is Your Back, Not Your Hip
The lower spine and hip share overlapping nerve pathways, which means a compressed nerve root in your lumbar spine can produce pain you’d swear is coming from your hip. This is one of the most commonly missed causes of hip pain.
A few patterns help tell the difference. Nerve-related pain tends to radiate: it may travel from the buttock down the back or side of the thigh, sometimes reaching the knee, calf, or foot. You might also notice numbness, tingling, or weakness in the leg. Hip joint pain, by contrast, is usually felt in the groin and doesn’t travel below the knee. If your pain changes with back position (bending, twisting, or arching) rather than with hip movement, your spine deserves a closer look.
Musculoskeletal causes of hip pain are also more likely to produce focal tenderness when you press on the sore spot. Nerve-related pain from the spine tends to be more diffuse and harder to reproduce with direct pressure.
Other Common Culprits
Several other conditions show up regularly:
- Muscle strains and gluteal tears. The hip flexor, groin muscles, and gluteal muscles can all be strained during exercise or sudden movement. Pain is usually sharp at onset, worsens with specific movements, and is tender to touch.
- Piriformis syndrome. The piriformis muscle deep in the buttock can tighten or spasm and irritate the sciatic nerve, producing buttock pain that radiates down the leg. It often mimics sciatica from a disc problem.
- Snapping hip. A tendon sliding over bone can produce an audible or palpable snap, usually at the front or side of the hip. It’s often painless but can become irritated with repetitive motion.
- Avascular necrosis. Loss of blood supply to the femoral head causes the bone to deteriorate. It’s associated with long-term steroid use, heavy alcohol use, and certain medical conditions. Pain is typically in the groin and worsens over weeks to months.
How Hip Pain Is Evaluated
Standard hip X-rays (front and side views) are the recommended first step for most hip pain. They can reveal arthritis, fractures, and bony shape abnormalities like impingement. If X-rays look normal but a soft tissue injury is suspected (torn tendon, labral tear, or muscle injury), MRI without contrast is the standard next step.
In cases where the source of pain is ambiguous, a diagnostic injection into the hip joint can clarify things with over 90% accuracy. If the injection temporarily eliminates your pain, the joint is the source. If it doesn’t, the pain is coming from somewhere else, likely the spine or surrounding soft tissues.
What Helps: Exercise and Rehabilitation
For most non-fracture hip pain, a structured exercise program is the first-line treatment. A systematic review in the British Journal of Sports Medicine found that physiotherapy-led programs improve pain and function in young and middle-aged adults with hip pain, including those with impingement. Programs that included targeted strengthening exercises and lasted at least three months showed the best results.
The most commonly studied approaches include hip and core strengthening, stretching and range-of-motion work, neuromuscular control exercises (training your muscles to fire at the right time during movement), and manual therapy. For GTPS specifically, strengthening the gluteal muscles is key, since weakness in these muscles is a primary driver of the condition.
For people with impingement or labral tears who don’t improve with rehabilitation, arthroscopic surgery is an option. At 8 to 12 months, surgery shows a small advantage over physiotherapy alone. But by 24 months, the difference between the two approaches is no longer statistically significant. This is why most guidelines recommend trying a full course of rehab before considering surgery.
Warning Signs That Need Urgent Attention
Most hip pain develops gradually and responds to rest, activity modification, and exercise. But certain patterns warrant prompt evaluation: sudden severe hip pain after a fall or injury (possible fracture), hip pain with fever or chills (possible joint infection), inability to bear weight on the leg, rapidly worsening pain with no clear trigger, or hip pain in someone with a history of cancer. These scenarios can involve fractures, infections, avascular necrosis, or other conditions where delayed treatment leads to worse outcomes.