Hip pain has dozens of possible causes, and the single best clue to narrowing them down is where exactly 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. Age, activity level, and how the pain started all help fill in the picture. Here’s what the most common culprits look like and how to tell them apart.
Where You Feel It Matters Most
Hip pain tends to fall into three zones, and each one is linked to a distinct group of conditions.
Front of the hip or groin: This is where true joint problems usually show up. In younger adults, the most likely causes are a labral tear (damage to the ring of cartilage lining the hip socket) or a structural mismatch where extra bone on the hip causes pinching inside the joint. In people over 50, osteoarthritis is the leading cause. Hip flexor strains, stress fractures from overuse, and even problems originating in the abdomen (hernias, ovarian cysts, appendicitis) can also send pain to this area.
Outer (lateral) hip: Pain here is most often greater trochanteric pain syndrome, a condition involving irritation of the tendons, muscles, or fluid-filled cushions around the bony point on the outside of your hip. It used to be called bursitis, but the name changed because the problem usually involves more than just an inflamed bursa. Women and older adults are more commonly affected.
Back of the hip or deep buttock: Posterior hip pain is frequently referred from somewhere else, especially the lower back. Lumbar spine issues, sacroiliac joint dysfunction, sciatic nerve entrapment, and hamstring tendon problems are all common culprits. Because hip and spine disorders produce overlapping symptoms, even doctors sometimes find it challenging to determine whether pain is coming from the hip, the spine, or both.
Osteoarthritis: The Most Common Cause After 50
Osteoarthritis of the hip is a wear-and-tear condition where the cartilage cushioning the joint gradually breaks down. It occurs most often in people 50 and older, though it can develop earlier, especially after an injury or in people with a family history. The hallmark symptom is groin pain that spreads into the thigh, buttock, or knee. You may also notice stiffness first thing in the morning or after sitting for a while, a grinding sensation during movement, and a gradually shrinking range of motion that eventually causes a limp.
Pain from osteoarthritis typically flares with vigorous activity and eases with rest, at least in the earlier stages. Some people notice it worsens in rainy or damp weather. On X-rays, the joint space narrows visibly and bone spurs form around the edges of the joint.
Greater Trochanteric Pain Syndrome
If your pain is on the outside of the hip, greater trochanteric pain syndrome (GTPS) is the most likely explanation. It’s an umbrella term covering irritation of the gluteal tendons, bursitis, and friction from the thick band of tissue running down the outside of your thigh. Common triggers include overuse, a sudden increase in activity, being overweight, having one leg slightly longer than the other, or problems in the feet or knees that change how you walk.
The pain is often sharp at first, then settles into a persistent ache. You’ll typically notice it most when getting out of a chair or bed, walking up stairs, sitting for a long time, or lying on the affected side at night. Sleeping can become a real problem, since rolling onto that hip puts direct pressure on the irritated area.
Labral Tears and Joint Impingement
The labrum is a ring of tough cartilage that lines the rim of your hip socket, helping hold the ball of the thigh bone in place. It can tear from a sports injury, repetitive motion, or gradually from structural impingement, where extra bone growth causes the joint to pinch with certain movements. Over time, that repeated pinching wears through the labrum.
Labral tears cause pain in the hip or groin that worsens with long periods of standing, sitting, walking, or athletic activity. A clicking, catching, or locking sensation in the joint is a classic sign. You may also feel stiffness and notice your hip doesn’t move as freely as it used to. These tears are most common in younger, active adults and can be tricky to diagnose because the symptoms overlap with other hip conditions.
Tendon Problems Around the Hip
The gluteal tendons attach your buttock muscles to the outside of the hip bone, and when they break down, the result is gluteal tendinopathy. This condition causes chronic, deep hip pain that’s often severe. Unlike a short-term tendon inflammation (tendinitis), tendinopathy involves structural changes in the tendon tissue and rarely improves with rest alone.
Certain movements are particularly telling. Pain that flares when you sit cross-legged, stand on one leg (like pulling on pants), or climb stairs points toward gluteal tendinopathy. Physical therapy exercises that specifically load and strengthen the tendons are the most effective treatment. Simple rest, ice, and compression work better for tendinitis but tend to fall short when the tendon itself has started to deteriorate.
When the Problem Is Actually Your Back
One of the most common sources of hip pain isn’t the hip at all. Lumbar spinal stenosis, where the spinal canal narrows and compresses nerves, can send pain down through the buttock and leg along with numbness, tingling, or weakness. Sacroiliac joint dysfunction, piriformis syndrome (where a deep buttock muscle traps the sciatic nerve), and disc problems in the lower back all mimic hip pain convincingly.
This overlap is common enough that it has its own name: hip-spine syndrome, where both the hip joint and the spine contribute to pain simultaneously. If your hip pain came with back stiffness, shoots down your leg, or is accompanied by tingling or numbness, the source may be partly or entirely spinal.
First-Line Treatments That Work
For osteoarthritis and most non-traumatic hip pain, over-the-counter anti-inflammatory medications like ibuprofen or naproxen are the strongest first-line option for reducing pain and improving function. Acetaminophen (Tylenol) is a reasonable alternative when anti-inflammatories aren’t an option, though the evidence for it is weaker. Opioid painkillers are not recommended for managing hip osteoarthritis.
Physical therapy has high-quality evidence supporting its use for mild to moderate hip osteoarthritis, both for reducing pain and improving how well you can move. For tendon-related problems like gluteal tendinopathy and GTPS, targeted strengthening exercises are often the core of treatment. Corticosteroid injections into the joint can help with short-term pain relief, though the benefit tends to fade over weeks to months. Hyaluronic acid injections (sometimes marketed as joint lubrication) have been shown to work no better than a placebo for hip arthritis and are not recommended.
Sleep Position and Nighttime Pain
Hip pain that wakes you up or makes it hard to fall asleep is one of the most frustrating symptoms. Sleeping on your back tends to take the most pressure off the hip joints. Placing a small pillow under your knees or lower back further aligns the spine and reduces strain. If you’re a side sleeper and can’t switch, placing a firm pillow between your knees keeps your hips stacked and prevents the top leg from pulling on the outer hip. Avoid sleeping on the painful side if outer hip pain is the issue, since direct pressure on an irritated bursa or tendon will make it worse.
Signs That Need Prompt Attention
Most hip pain improves with time, activity modification, and basic treatment. But certain patterns warrant a same-day or urgent evaluation. If you can’t bear weight on the leg at all, that needs immediate assessment. Hip pain after a fall in someone with osteoporosis raises concern for a fracture. Pain accompanied by fever, unexplained weight loss, or a palpable lump near the hip should be evaluated quickly. And if you develop numbness in the groin area, weakness in the legs, or any loss of bladder or bowel control alongside hip or back pain, that combination suggests possible nerve compression that requires emergency care.