Hip pain has dozens of possible causes, ranging from a strained muscle that heals in days to arthritis that develops over years. Where you feel the pain, how it started, and what makes it worse are the strongest clues to what’s going on. 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, so location is the first thing to pay attention to.
Front of the Hip
Pain at the front of your hip, especially in the groin crease, often comes from inside the joint itself. The most common causes include osteoarthritis, labral tears, femoroacetabular impingement (where extra bone growth causes the joint to pinch), stress fractures of the upper thighbone, and a condition called avascular necrosis where bone tissue dies from reduced blood supply. Tight or irritated hip flexor tendons can also produce pain here, particularly after prolonged sitting or activities that involve repeated leg lifting.
Osteoarthritis is by far the most common of these. It affects the majority of people older than 55, with an average onset age of 65. You’ll typically notice stiffness when you first start moving, a grinding or clicking sensation, limited range of motion, and pain that gradually worsens over months or years. X-rays can confirm the diagnosis by showing cartilage loss and bone changes.
Labral tears affect the ring of cartilage that lines your hip socket. They cause a distinctive clicking, catching, or locking sensation during movement. Three main things lead to them: direct trauma (like a car accident or contact sport), structural abnormalities you were born with (such as a shallow hip socket), and repetitive motions from sports like running, golf, or softball that wear the cartilage down over time. Many people with labral tears also have femoroacetabular impingement, where excess bone on the joint pinches and gradually damages the labrum.
Outer Hip Pain
Pain on the outside of the hip, near the bony point you can feel when you press your hand against your upper thigh, falls under what doctors call greater trochanteric pain syndrome. For years this was almost always blamed on bursitis, but imaging studies tell a different story. In one study of 877 patients with outer hip pain, only about 20% actually had bursitis. Nearly half had tendon degeneration in the gluteal muscles, and almost 29% had thickening of the iliotibial band, the thick strip of tissue running down the outside of your thigh.
This matters because bursitis and tendon problems respond to slightly different approaches. Both cause pain when lying on the affected side and when climbing stairs. But tendon problems tend to produce more tenderness slightly behind the bony point and hurt when you push your leg outward against resistance. Bursitis, by contrast, typically doesn’t flare with resisted movement. An ultrasound can distinguish between the two if the diagnosis is unclear.
Pain in the Buttock or Back of the Hip
Posterior hip pain has some of the trickiest causes because it frequently originates somewhere other than the hip itself. The lower back is one of the most common culprits. A pinched nerve root in the lumbar spine, often from a herniated disc, can send pain radiating into the buttock, hip, and down the leg. This is sciatica in its classic form, and the giveaway is that the pain follows a path rather than staying in one spot. Numbness, tingling, or weakness in the leg often accompany it.
Deep gluteal syndrome is another source of posterior hip pain. It happens when the sciatic nerve gets trapped by surrounding muscles, most commonly the piriformis. Sitting for long periods tends to make it worse, and the pain can mimic sciatica closely. Sacroiliac joint dysfunction, where the joint connecting your lower spine to your pelvis becomes inflamed or moves abnormally, also produces deep buttock pain that’s easy to mistake for a hip problem.
Hamstring injuries round out the list. A sudden tear during explosive movement causes immediate sharp pain near the sit bone. Chronic overuse, on the other hand, leads to a slower-building ache that worsens with activities involving hip extension, like sprinting or lunging.
Systemic and Inflammatory Causes
Not all hip pain is mechanical. Rheumatoid arthritis, an autoimmune condition, can attack the hip joint and cause pain, swelling, and stiffness that’s often worse in the morning. Unlike osteoarthritis, it typically affects both hips and comes with systemic symptoms like fatigue, low-grade fever, and loss of appetite. It can appear at any age.
Avascular necrosis deserves special attention because it can progress silently before causing serious joint damage. It occurs when blood flow to the ball of the hip joint is disrupted, causing the bone to weaken and eventually collapse. Two of the top risk factors are high-dose corticosteroid use (such as prednisone) and heavy alcohol consumption over several years. Corticosteroids may raise fat levels in the blood that reduce circulation to the bone, and alcohol causes similar fatty deposits in blood vessels. The risk worsens with repeated courses of steroids. Early-stage avascular necrosis often causes no symptoms at all, which is why people on long-term corticosteroids are sometimes screened for it.
When Hip Pain Needs Urgent Attention
Most hip pain develops gradually and can be evaluated at a routine appointment. But certain signs point to something that needs immediate care: a joint that looks deformed or out of place, a leg that appears shorter than the other, inability to move the hip or bear weight, intense sudden pain, rapid swelling, or fever and chills with skin color changes on the affected leg. These can signal a fracture, dislocation, or joint infection, all of which require prompt treatment to prevent lasting damage.
First Steps for Managing Hip Pain
For most non-emergency hip pain, the first line of treatment is targeted exercise. Strengthening the muscles around the hip, particularly the glutes, hamstrings, and outer thigh muscles, helps stabilize the joint and reduce pain. A structured program typically runs four to six weeks, with exercises performed two to three days per week. Equally important is flexibility work: stretching the muscles you strengthen helps restore range of motion and prevents further irritation.
A good routine starts with five to ten minutes of low-impact warmup like walking or stationary cycling, followed by stretches, then strengthening exercises, then stretches again to cool down. Key movements include hip abduction (lifting the leg outward while lying on your side), iliotibial band stretches, and gluteal strengthening. The important rule is that exercises should not cause pain. If a movement hurts, it’s either the wrong exercise or the intensity is too high.
After the initial recovery period, continuing these exercises two to three times a week serves as long-term maintenance. Many people with chronic hip conditions like osteoarthritis or tendon problems find that consistent strengthening keeps their pain manageable without medication or surgery for years.