Hip pain is extremely common, especially as you get older. Among adults 60 and over, about 14% report significant hip pain on most days. The cause depends largely on where you feel it, how it started, and what makes it worse. Pain on the side of the hip, deep in the groin, and in the buttock each point to different problems, and understanding the pattern helps you figure out what’s going on.
Where You Feel It Matters
Hip pain isn’t one thing. The hip is a deep ball-and-socket joint surrounded by layers of tendons, muscles, and fluid-filled sacs, and pain can come from any of them. It can also come from somewhere else entirely, like your lower back. The location of your pain is the single most useful clue to its cause.
Pain in the groin or front of the hip usually points to a problem inside the joint itself. That includes osteoarthritis, labral tears (damage to the cartilage ring lining the socket), a condition called femoroacetabular impingement where extra bone causes pinching inside the joint, or stress fractures of the thighbone neck. Tendon problems in the hip flexors (the muscles that let you lift your knee) also cause pain here.
Pain on the outer side of the hip is most often from the tendons and soft tissues around a bony bump called the greater trochanter. This is broadly called greater trochanteric pain syndrome, and it covers bursitis (inflamed fluid sacs), tears or irritation of the gluteal tendons, and friction from the thick band of tissue running down the outside of your thigh.
Pain in the buttock or back of the hip is frequently referred from somewhere else. Your lower back, sacroiliac joint (where the spine meets the pelvis), or hamstring tendons are all common sources. Nerves from the lumbar spine pass directly through the hip region, which is why a disc problem or spinal arthritis can feel exactly like a hip problem.
Osteoarthritis: The Most Common Cause Over 50
Osteoarthritis is the leading cause of chronic hip pain in older adults. It develops when the cartilage cushioning the joint gradually wears down, leaving bone rubbing closer to bone. It occurs most often after age 50, though younger people with previous injuries or joint abnormalities can develop it too.
The hallmark is groin pain that can spread into the thigh, buttock, or knee. Mornings are typically the worst: stiffness that lasts 30 minutes or more after waking is a classic sign. The pain tends to flare with vigorous activity but also worsens after long periods of sitting. As it progresses, you may notice a grinding sensation during movement, reduced range of motion, and a limp. Some people notice their pain tracks with the weather, worsening on rainy days.
An X-ray can confirm the diagnosis by showing narrowing of the joint space, changes in the bone surface, and bone spurs. But the severity on an X-ray doesn’t always match how much pain you feel.
Outer Hip Pain: Tendons, Not Always Bursitis
If your hip hurts on the outside, especially when you lie on that side at night, you likely have greater trochanteric pain syndrome. For years, this was automatically called bursitis. It’s now understood that the gluteal tendons (the muscles that stabilize your pelvis when you walk) are the real culprit in many cases.
This pain often creeps in gradually without a clear injury, though a fall can trigger it. Typical complaints include pain when rising from a chair, with prolonged standing, and with hip rotation. Night pain is common, particularly when lying on the affected side. In more advanced cases involving a full-thickness tear of the gluteal tendon, you’ll notice weakness: difficulty keeping your pelvis level when standing on one leg, or a noticeable limp.
This condition is more common in women, runners, and people who have recently increased their walking or stair climbing. It often responds well to targeted strengthening exercises for the gluteal muscles, activity modification, and avoiding positions that compress the outer hip (like crossing your legs or standing with your weight shifted to one side).
Labral Tears and Joint Impingement
If you’re younger and active, with a deep ache in the groin that catches or clicks, a labral tear or femoroacetabular impingement (FAI) is a strong possibility. FAI happens when the bones of the hip joint aren’t perfectly shaped, causing them to pinch the soft tissue lining the socket during movement. Over time, that repeated pinching tears the labrum.
The signature symptom is a locking, clicking, or catching sensation in the hip, often with groin pain during deep squatting, pivoting, or prolonged sitting. A large randomized trial published in The BMJ found that arthroscopic surgery for FAI produced meaningfully better results than physical therapy alone at eight months, with patients scoring about 10 points higher on a daily activity scale. However, two other comparable trials had mixed results: one found no difference between surgery and physical therapy at two years (though 70% of the physical therapy group eventually crossed over to surgery), and another found surgery was better at 12 months but not cost-effective. The takeaway: physical therapy is a reasonable first step, but some people will ultimately need surgery.
When the Problem Isn’t Your Hip at All
One of the trickiest things about hip pain is that it frequently originates in the lower back. The femoral, sciatic, and obturator nerves all travel from the lumbar spine through the hip region, so a herniated disc or spinal stenosis can produce pain in the groin, buttock, thigh, or knee that feels indistinguishable from a true hip problem. This overlap is common enough that it has a name: hip-spine syndrome.
Clues that your back may be the source include pain that radiates below the knee, numbness or tingling in the leg, and pain that changes with spinal positions (bending forward or arching backward) rather than hip movements. A limp can occur with either hip or spine problems, so it’s not a reliable way to tell them apart. If initial hip treatment isn’t helping, the spine is the next place to investigate.
How Hip Pain Is Diagnosed
A physical exam that tests your range of motion, strength, and pain with specific movements narrows the possibilities quickly. When imaging is needed, a standard X-ray is the first step for most hip pain. It’s enough to identify arthritis, fractures, and bone abnormalities.
If the X-ray looks normal but a soft tissue injury is suspected (a tendon tear, labral tear, or muscle injury), MRI is the next appropriate study. For traumatic injuries where a fracture is suspected but the X-ray is negative, a CT scan is typically ordered first because it can be done quickly, with MRI reserved if the CT is also inconclusive.
Practical Ways to Reduce Hip Pain
Sleep position makes a surprising difference. If your hip hurts at night, sleeping on your back with a pillow under your knees, or on your side with a pillow between your knees, helps keep the hips aligned and reduces pressure on irritated structures. Avoid sleeping on the painful side if you have outer hip pain.
For most non-traumatic hip pain, the initial approach is the same regardless of the specific diagnosis: reduce activities that provoke the pain, use over-the-counter anti-inflammatory medication for short periods, and start targeted exercises. Strengthening the muscles around the hip, particularly the gluteals, is the single most effective conservative treatment across nearly all causes of hip pain. A physical therapist can identify which movements are contributing to the problem and build a program around your specific pattern.
Ice can help after activity if the area feels inflamed. Prolonged sitting aggravates most hip conditions, so if you work at a desk, standing or walking briefly every 30 to 45 minutes helps.
Signs That Need Prompt Attention
Most hip pain improves with time and self-care, but certain patterns require urgent evaluation. Severe pain after a fall or injury, inability to bear weight, or tingling and loss of feeling in the hip or leg after trauma all warrant emergency care.
You should seek same-day medical advice if you develop sudden severe hip pain without an injury, if your hip is swollen and feels hot, if the skin around your hip changes color, or if you have hip pain along with fever or feeling generally unwell. These can signal infection or inflammatory conditions that need rapid treatment.
Outside of emergencies, see a doctor if hip pain is disrupting your sleep or daily activities, if it’s getting progressively worse, if home treatment hasn’t improved it after two weeks, or if you have morning stiffness lasting more than 30 minutes.