Hip aching usually comes from one of a handful of common conditions: arthritis wearing down the joint, inflammation in the fluid-filled sacs around the hip, strained muscles or tendons, or even a problem in the lower back that sends pain into the hip area. About 14% of adults over 60 report significant hip pain on most days, but hip aching isn’t limited to older adults. Younger, active people develop it too, often from different causes entirely.
The key to narrowing down your specific cause is paying attention to where exactly you feel the ache and what makes it worse.
Where You Feel It Matters
Hip pain isn’t one-size-fits-all, and the location of your ache is one of the strongest clues to what’s going on. Pain in the front of the hip, the outer side, and the back of the hip each point toward different problems.
Front of the hip or groin: This is the classic location for problems inside the joint itself, including osteoarthritis, labral tears, and hip impingement. Hip flexor strains also show up here, especially if you’ve been running, playing sports, or doing repetitive movements. In older adults, front-of-hip pain that gets worse with sitting or walking for long stretches often points toward arthritis.
Outer (lateral) hip: Pain along the outside of the hip, right over the bony bump you can feel when you press, is the hallmark of greater trochanteric pain syndrome. This is often called bursitis, though it can also involve the tendons of the buttock muscles. It’s more common in middle-aged women and people who are overweight. You’ll typically notice it when getting out of a chair, climbing stairs, or lying on that side at night.
Back of the hip or deep in the buttock: Posterior hip pain often originates from the lower back or the deep muscles of the buttock. Conditions like deep gluteal syndrome cause a burning, shooting pain that worsens with sitting, especially in a car. Pain that gets worse with long strides or running can signal impingement between two bones deep in the back of the hip.
Osteoarthritis: The Most Common Cause Over 50
If you’re middle-aged or older and your hip ache came on gradually over months or years, osteoarthritis is the most likely explanation. The cartilage that cushions the ball-and-socket joint slowly wears down, leaving bone closer to bone. The result is a deep, achy stiffness that tends to be worst after you’ve been sitting a while or at the end of a long day on your feet.
Early on, you might just notice that your hip feels stiff in the morning or that it takes a few steps to “loosen up.” As it progresses, you may lose range of motion. Turning your foot inward becomes harder, and bending the hip fully (like pulling your knee to your chest) starts to feel restricted. Some people develop a slight limp without realizing it. The ache typically builds over years, not days, and affects one hip more than the other.
Bursitis and Tendon Problems
The hip joint is surrounded by small fluid-filled sacs called bursae that reduce friction between bones, tendons, and muscles. When these sacs become inflamed, the result is a sharp or burning ache on the outside of the hip that can spread down the outer thigh.
Greater trochanteric pain syndrome is triggered by a range of everyday factors: overuse from exercise or prolonged standing, a sudden jump in activity level, being overweight, or even having one leg slightly longer than the other. Foot problems like plantar fasciitis or bunions can change the way you walk and put extra stress on the hip, eventually causing lateral hip pain. Muscle imbalances, particularly weakness in the buttock muscles, are another common contributor.
The pain is often worst at specific moments: getting out of bed, climbing stairs, or rolling onto the affected side while sleeping. Pressing directly on the outer hip bone usually reproduces the ache.
Hip Flexor Strain
If your hip ache started after exercise, a sudden movement, or a period of increased activity, a strained hip flexor is a strong possibility. The hip flexors are the muscles at the front of your hip that lift your knee toward your chest. They’re heavily used in running, soccer, hockey, martial arts, and football.
Strains happen when these muscles are overstretched or overworked. The most common risk factors are skipping a warm-up, lacking flexibility, or ramping up training too quickly. Even non-athletes can strain a hip flexor by bracing during a fall or spending long periods in a seated position that shortens the muscles over time. The ache is typically at the front of the hip or upper thigh, and it flares when you try to lift your leg or walk uphill.
Labral Tears and Hip Impingement
The hip socket has a ring of cartilage around its rim called the labrum. This ring deepens the socket and helps keep the ball of the thighbone stable. A labral tear, whether from an acute injury or gradual wear, causes a deep ache in the groin or front of the hip. Some people also feel a catching or locking sensation during certain movements.
Hip impingement (femoroacetabular impingement, or FAI) is a structural issue where extra bone on either the ball or the socket creates friction during movement. There are two patterns: one where extra bone extends from the socket rim, and another where the ball of the thighbone isn’t perfectly round. Many people have both. These bony irregularities can be present from birth or develop as bone spurs over time. The friction damages the labrum and cartilage, producing a gradual, worsening ache that’s most noticeable during activities that involve twisting, squatting, or rotating the hip. FAI and labral tears tend to affect younger, more active adults and are a leading cause of hip pain in people under 40.
When the Problem Isn’t Actually Your Hip
One of the trickiest aspects of hip pain is that it frequently originates somewhere else. The hip and lower spine share nerve pathways, so a problem in the lumbar spine can produce convincing hip pain. This overlap is common enough that doctors have a name for it: hip-spine syndrome.
Lumbar spinal stenosis, where the spinal canal narrows and presses on nerves, can cause pain that radiates down the leg and into the hip area. You might also notice numbness, tingling, or weakness in the leg. Distinguishing spinal referred pain from a true hip joint problem can be challenging even for doctors, which is why imaging and a thorough physical exam are often needed when the picture isn’t clear.
Abdominal and pelvic conditions can also refer pain to the hip. Urinary issues, bowel problems, or menstrual-cycle-related pain occasionally show up as what feels like an ache in the front or back of the hip.
Patterns That Signal Something More Serious
Most hip aching is from wear-and-tear conditions or soft tissue problems that improve with rest, activity modification, and strengthening. But certain patterns deserve prompt attention:
- Inability to bear weight after a fall, especially in older adults, can indicate a fracture. A fractured hip often causes the leg to appear shortened and rotated outward.
- Hip pain with fever may signal an infection in the joint, which requires urgent treatment.
- Night pain that wakes you and doesn’t improve with position changes can sometimes indicate avascular necrosis, a condition where blood supply to the bone is compromised. Risk factors include long-term steroid use, heavy alcohol use, smoking, and obesity.
- Sudden severe pain in a younger, very active person who has been overtraining, combined with pain while walking, may point to a stress fracture of the femoral neck.
What Typically Helps
For the most common causes of hip aching, initial management looks similar regardless of the specific diagnosis. Reducing activities that provoke the pain, applying ice or heat, and taking over-the-counter anti-inflammatory medication can ease symptoms in the short term. Strengthening the muscles around the hip, particularly the glutes and hip stabilizers, addresses the underlying mechanical problems that contribute to bursitis, tendonitis, and even early arthritis symptoms.
Physical therapy is one of the most effective interventions across nearly all causes of hip pain. A targeted program improves flexibility, corrects muscle imbalances, and teaches movement patterns that reduce stress on the joint. For bursitis and tendon-related pain, simply changing the aggravating activity, whether that’s sleeping position, exercise routine, or footwear, often provides noticeable relief within weeks.
When conservative measures aren’t enough, corticosteroid injections can reduce inflammation in and around the joint. For advanced osteoarthritis that no longer responds to other treatments, hip replacement surgery has a strong track record, with most people returning to full daily activities. For labral tears and impingement in younger patients, arthroscopic surgery to repair the labrum or reshape the bone is an option when physical therapy alone falls short.