Hip problems usually announce themselves as pain in the groin, not where most people expect. About 63% of people with hip joint disease feel groin pain during movement, making it the single most common location. But hip issues can also cause pain on the outer thigh, in the buttock, or even down to the knee, which is why so many people don’t realize their hip is the source.
Where Hip Pain Actually Shows Up
Most people point to the side of their pelvis when asked where their “hip” is. But the hip joint itself sits deep in the groin, and that’s where true hip joint problems tend to hurt most. In a study of patients with confirmed hip disease, groin pain was the top complaint during activity, followed by buttock pain (37% of patients), pain near the bony bump on the outer hip (35%), and anterior knee pain (34%). A significant number of patients felt pain in the front or side of the thigh as well.
This pattern catches people off guard. Knee pain that’s actually coming from a deteriorating hip joint is surprisingly common. The nerves supplying the hip joint also serve the groin, inner thigh, front of the knee, and inner lower leg. So pain in any of those areas, especially pain that doesn’t improve with treatment aimed at the knee or thigh, could be a hip problem in disguise.
The Most Common Hip Conditions and How They Feel
Osteoarthritis
Hip osteoarthritis is the most frequent cause of chronic hip pain. It comes on gradually over months or years, though some people trace it back to a specific injury. The hallmark is stiffness, particularly in the morning or after sitting for a while, that loosens up with movement but returns after prolonged walking or standing. Over time, your range of motion shrinks. Rotating your leg inward or crossing your legs may become uncomfortable or impossible. Everyday tasks like bending to tie shoes, getting in and out of a car, or climbing stairs get progressively harder.
Greater Trochanteric Pain Syndrome (Hip Bursitis)
This is the classic “outer hip” pain. It affects women aged 40 to 60 most often and typically develops without any specific injury. The pain gets worse with walking, sitting for long stretches, or lying on the affected side at night. If you consistently wake up with pain on one side because you rolled onto that hip, bursitis is a likely culprit. Unlike osteoarthritis, bursitis doesn’t usually restrict your range of motion. The area over the outer hip bone feels tender when you press on it.
Labral Tears
The labrum is a ring of cartilage that lines the hip socket. Tears often happen during sports that involve twisting or pivoting, like soccer, hockey, basketball, dance, and gymnastics. The signature symptom is a catching, clicking, or popping sensation in the hip during certain movements. Pain is typically felt in the front of the hip or deep in the groin. Some people describe a feeling of the hip “locking” or “giving way.”
Femoroacetabular Impingement
This condition involves extra bone along the hip joint that causes the bones to grind against each other during movement. It develops gradually without a specific injury and is especially bothersome for people whose activities require deep bending at the hip or a wide range of motion. The pain is felt in the groin and worsens with prolonged sitting, squatting, or bringing the knee toward the chest.
Stress Fractures
Femoral neck stress fractures are linked to overuse, particularly in runners and military recruits. They’re more common in women. The pain worsens with weight-bearing activity and improves with rest. If you’ve recently increased your training volume or intensity and develop a deep ache in the groin or front of the hip that won’t go away, a stress fracture needs to be ruled out.
Simple Movements That Reveal Hip Problems
You can get a rough sense of your hip health by testing a few basic movements. None of these replace a proper exam, but they can help you decide whether your hip deserves attention.
- Internal rotation: Sit on a chair with your knee bent at 90 degrees. Keeping your thigh still, swing your foot outward (this rotates the hip inward). Normal range is 30 to 40 degrees. If this motion is painful or you can barely move your foot outward at all, that’s one of the strongest indicators of a hip joint issue. Pain with internal rotation picks up about 82% of hip arthritis cases.
- Hip flexion: Lie on your back and pull one knee toward your chest. A healthy hip allows 110 to 120 degrees of flexion. Significant restriction or sharp groin pain during this movement suggests something is wrong inside the joint.
- The shoe-and-sock test: Can you cross one ankle over the opposite knee to put on a sock or tie a shoe? This combined movement of flexion, rotation, and abduction is one of the first things to become difficult with hip arthritis or impingement. If it’s painful or you’ve started finding workarounds (like propping your foot on a step), your hip range of motion has likely decreased.
Hip Pain vs. Lower Back Pain
The hip and the lower back share nerve pathways, which means problems in one area can mimic the other. Distinguishing between them matters because the treatments are completely different.
Back-related pain tends to produce burning, electric, or shooting sensations that travel down the leg, sometimes below the knee. It often worsens with bending forward, twisting, or prolonged sitting. The pain may change with spinal position: leaning forward might relieve it, or leaning backward might make it worse.
Hip-related pain is more commonly described as a deep ache or throbbing sensation, concentrated in the groin or front of the thigh. It worsens with weight-bearing activities like walking and standing, and with movements that rotate or flex the hip. One practical clue: if the pain changes when you move your spine (bending, arching, twisting your trunk), the spine is more likely the source. If it changes when you move your hip (rotating your leg, stepping up onto something), the hip is more likely to blame.
When both the hip and the lower back show signs of disease on imaging, which happens frequently in people over 50, doctors sometimes use a guided injection of numbing medication into the hip joint. If the pain disappears temporarily, the hip is confirmed as the source.
How Hip Problems Are Diagnosed
The first step is almost always a standard X-ray of the hip and pelvis. X-rays can reveal osteoarthritis, fractures, bone spurs, and structural abnormalities. For chronic hip pain, guidelines from the American College of Radiology consider X-rays the appropriate initial imaging study.
If X-rays look normal or inconclusive but symptoms persist, MRI is the next step. An MRI without contrast can detect bursitis, tendon problems, and early bone changes that X-rays miss. For suspected labral tears or impingement, an MR arthrography (MRI done after injecting contrast dye into the joint) or a standard MRI are both considered appropriate. MR arthrography is particularly good at showing labral damage and cartilage loss.
Ultrasound is sometimes used for soft tissue problems around the hip, like tendon inflammation or bursitis, and can be done quickly in a clinic setting.
Warning Signs That Need Immediate Attention
Most hip pain develops slowly and can be evaluated at a routine appointment. But certain combinations of symptoms signal something more urgent. Severe hip pain after a fall, especially if you can’t walk or bear weight on the leg, could mean a fracture. An older adult who falls and then has a leg that looks shortened or rotated outward while lying flat almost certainly has a hip fracture.
Sudden severe hip pain without any injury, combined with swelling, warmth, skin color changes, or fever, could indicate an infection in the joint. This is a medical emergency because untreated joint infections can destroy cartilage within days. Tingling, numbness, or loss of sensation in the hip or leg after an injury also warrants immediate evaluation, as this can signal nerve damage or compression.