Pain that starts in the hip and travels down the leg is common but often difficult to diagnose. The hip joint is a complex meeting point of the pelvis, thigh bone, and major nerve pathways. Due to this intricate anatomy, a problem originating in the lower back or deep within the hip can easily cause discomfort that radiates down the right leg. This radiating pain, known as referred pain, makes pinpointing the exact source challenging, requiring an understanding of the different anatomical structures involved.
Pain Stemming from Nerve Compression
When pain radiates sharply down the leg, the source is frequently irritation or compression of the sciatic nerve. This nerve, the largest in the body, begins in the lower spine and travels through the buttock and down the back of the leg. This discomfort is often described as sharp, burning, or shooting, and is typically accompanied by numbness or tingling, known as paresthesia.
The most common cause of this pain is lumbar radiculopathy, often called sciatica. This condition occurs when a nerve root in the lower spine becomes irritated or compressed, frequently due to a herniated disc or narrowing of the spinal canal. The pain typically starts in the lower back or buttock and follows a specific path down the leg, sometimes reaching the foot. Symptoms often worsen with activities that increase pressure on the spine, such as coughing, sneezing, or prolonged sitting.
A different source of nerve pain, piriformis syndrome, closely mimics sciatica but does not originate in the spine. The piriformis is a small muscle located deep in the buttock, and the sciatic nerve runs near or through it. When this muscle spasms or becomes tight, it can compress the sciatic nerve, leading to pain in the buttock that may travel down the back of the leg.
Piriformis syndrome pain is often more localized to the buttock area, while true lumbar radiculopathy causes symptoms that extend lower down the leg. Pain from piriformis syndrome is frequently aggravated by prolonged sitting, running, or climbing stairs, as these movements engage the muscle.
Issues Within the Hip Joint and Bursa
Pain originating directly from the hip’s structure often presents as a deep ache or stiffness, distinct from nerve irritation. The hip is a ball-and-socket joint, and problems usually involve the cartilage, surrounding fluid sacs, or stabilizing soft tissues. This localized pain is often felt in the groin area, the true location of the hip joint, but it can also be felt in the buttock or the front of the thigh.
Osteoarthritis (OA) is a progressive condition where protective cartilage within the hip joint wears away, causing bone to rub against bone. This degeneration results in deep, aching pain and stiffness that is typically worse in the morning or after rest. The pain usually increases with weight-bearing activities, such as walking or standing, and can reduce the joint’s range of motion.
A common source of pain is trochanteric bursitis, which is inflammation of the bursa located over the greater trochanter (the bony point on the outer hip). This condition causes sharp, localized pain on the outside of the hip, which may radiate down the outer thigh. The pain is typically worse when lying on the affected side or during activities like standing up from a chair or climbing stairs.
A labral tear involves the ring of cartilage (the labrum) that lines the rim of the hip socket and helps seal the joint. A tear often results in pain felt in the groin area, along with a distinct mechanical sensation. Patients frequently report a clicking, popping, or catching feeling in the hip, sometimes accompanied by a sense of the joint locking up.
Soft Tissue Injuries and Muscular Strain
When hip and leg pain is primarily muscular or tendon-related, it often presents as a strain, pull, or localized tenderness resulting from acute injury or repetitive overuse. These soft tissue issues are distinct from joint disease and nerve compression, though they can coexist. The pain is usually aggravated by specific movements that engage the injured muscle or tendon.
A hip flexor strain, involving the iliopsoas muscle group, causes pain at the front of the hip and groin. Since these muscles lift the knee toward the chest, activities like sprinting, kicking, or climbing stairs can trigger sharp pain. The injury occurs when muscle fibers are overstretched or torn, and the area may feel tender or exhibit morning stiffness.
Pain felt deep in the buttock, particularly at the “sit bone” (ischial tuberosity), may indicate hamstring tendinopathy. This condition involves irritation of the hamstring tendons where they attach to the pelvis, often developing gradually from overuse in activities like running or cycling. The pain is commonly worsened by prolonged sitting on hard surfaces and by movements that stretch the hamstring.
Muscle imbalances and weakness, particularly in the core and gluteal muscles, can contribute to chronic pain patterns. When stabilizing muscles are weak, other muscles and tendons overcompensate, leading to chronic strain and poor movement mechanics. Addressing these underlying strength and flexibility deficits is often necessary to resolve chronic soft tissue pain.
When to Seek Medical Evaluation
While many forms of hip and leg pain resolve with rest and home care, certain symptoms require immediate professional evaluation due to the risk of serious complications. These “red flag” symptoms indicate a potentially severe issue, such as a rapidly progressing nerve injury or a spinal cord emergency.
Immediate medical attention is necessary if you experience a sudden, severe loss of strength or paralysis in one or both legs, making it difficult to walk or bear weight. The most urgent warning signs include new-onset loss of bladder or bowel control, or numbness in the “saddle area” (groin, buttocks, and inner thighs). These symptoms suggest Cauda Equina Syndrome, a rare but serious condition requiring emergency treatment to prevent permanent nerve damage.
A medical consultation is also warranted if the pain is accompanied by systemic signs like fever, chills, or unexplained weight loss, which may signal an underlying infection or inflammatory process. If the pain is persistent and does not improve after one or two weeks of conservative home management (rest and over-the-counter pain relievers), seek a professional diagnosis. Pain that significantly limits daily mobility or worsens rapidly should also prompt a visit to a healthcare provider.