Hip pain is discomfort in or around the hip joint, one of the largest weight-bearing joints in the body. About 14.3% of adults aged 60 and older report significant hip pain on most days, but it affects people of all ages for very different reasons. Where you feel the pain, how it started, and what makes it worse all point toward different underlying causes.
How the Hip Joint Works
The hip is a ball-and-socket joint. The ball is the rounded top of your thighbone (femur), and the socket is a cup-shaped hollow on the side of your pelvis called the acetabulum. A layer of cartilage lines both surfaces so the bones glide smoothly against each other. An additional ring of cartilage called the labrum sits around the rim of the socket, adding stability and cushioning.
Surrounding all of this are muscles, tendons, ligaments, and small fluid-filled sacs called bursae that reduce friction. Pain can originate from any of these structures, or it can be referred from somewhere else entirely, like the lower back. That’s why hip pain sometimes feels confusing: the spot where it hurts doesn’t always match the spot where the problem is.
What the Location of Your Pain Tells You
Front of the Hip or Groin
Pain felt deep in the groin or at the front of the hip typically comes from inside the joint itself. In younger adults, the most common culprits are labral tears and a structural mismatch called femoroacetabular impingement, where the ball and socket don’t fit together smoothly. In older adults, osteoarthritis is the leading cause. Hip flexor strains, stress fractures of the femoral neck (common in runners and athletes with energy imbalances), and hip fractures from falls or osteoporosis can all produce pain in this area as well. Avascular necrosis, a condition where bone tissue dies due to reduced blood supply, typically shows up in middle-aged to older adults as deep anterior hip pain.
Outside of the Hip
Lateral hip pain, the kind you feel on the outer side of your thigh and hip, is most often caused by greater trochanteric pain syndrome. This umbrella term covers irritation or tears of the tendons that attach to the bony prominence on the side of your hip, along with bursitis and friction from the thick band of tissue running down the outside of your thigh. The hallmark pattern is pain that gets worse when you walk, climb stairs, sit for long periods, or lie on the affected side at night.
Back of the Hip or Buttock
Posterior hip pain frequently isn’t coming from the hip joint at all. Lower back problems, including disc issues and spinal arthritis, commonly refer pain into the buttock and back of the hip. Deep gluteal syndrome involves the sciatic nerve getting compressed by muscles in the buttock, producing pain that can radiate down the leg. Sacroiliac joint dysfunction (where the pelvis meets the spine) is another common source. Pain centered right under the sit bone may point to a hamstring strain or tendon injury, especially in people who run or do explosive movements.
Osteoarthritis: The Most Common Cause in Older Adults
Osteoarthritis develops when the cartilage lining the hip joint wears down over time, eventually allowing bone-on-bone contact. It can also develop after an injury to the joint, even years later. The pain typically builds gradually. You may notice stiffness in the morning or after sitting, a grating sensation when you move, and increasing difficulty with everyday activities like putting on shoes or getting in and out of a car.
A physical exam looks for tenderness around the hip, how far you can move the joint, whether there’s a grating feeling during movement, and changes in the way you walk. X-rays can confirm the diagnosis by showing narrowed joint space, bone changes, and the formation of bone spurs. In many cases, these findings guide decisions about whether to try conservative treatment or consider surgery.
How Hip Pain Gets Diagnosed
Diagnosis starts with your description of the pain and a hands-on exam. Your doctor will move your hip in different directions, press on specific points, and watch you walk. Certain positions that reproduce your pain can narrow down the source. For suspected labral tears, for instance, bending the hip while rotating it inward is a highly sensitive test.
X-rays are the first imaging step for most hip pain, especially after a fall or injury. They’re good at revealing fractures, arthritis, and bone abnormalities. If the X-ray looks normal but a fracture is still suspected, a CT scan is typically the next step because it can be done quickly. MRI is the best tool for soft tissue problems: muscle tears, tendon injuries, ligament damage, labral tears, and early bone changes that don’t show on X-rays. It’s also used when a CT scan is inconclusive for fractures.
Symptoms That Need Immediate Attention
Most hip pain develops gradually and isn’t dangerous, but some patterns require urgent evaluation. Severe pain after a fall or injury, inability to bear weight on the leg, or any tingling or numbness in the hip or leg after trauma all warrant emergency care. You should also seek same-day evaluation if your hip is swollen and feels hot, the skin around the joint has changed color, or you have hip pain along with fever and feeling generally unwell. These can signal a fracture, dislocation, or joint infection.
Managing Hip Pain Without Surgery
For many causes of hip pain, especially osteoarthritis, bursitis, and mild soft tissue injuries, strengthening the muscles around the hip is one of the most effective things you can do. Stronger glutes, hip flexors, and core muscles take pressure off the joint and improve stability. Four exercises commonly recommended for hip problems can be done at home with no equipment:
- Bridging: Lie on your back with knees bent and feet flat. Push your hips toward the ceiling using your arms for support, hold a few seconds, then lower back down.
- Standing hip extension: Hold a chair for balance. Keeping one leg straight, lift it behind you, hold briefly, then return.
- Sideways hip lift: Stand with one hand on a chair. Lift the outside leg straight out to the side, hold, and lower it back down.
- Sit to stand: Stand in front of a chair. Slowly bend your knees until your bottom just touches the seat (without fully sitting), then stand back up. Arms out front can help with balance.
Beyond exercise, managing hip pain often involves a combination of approaches. Adjusting activities that aggravate the pain, maintaining a healthy weight to reduce joint stress, and using over-the-counter anti-inflammatory options during flare-ups all play a role. Physical therapy can be particularly valuable because a therapist can identify which specific muscles are weak or tight and build a targeted program. For conditions like greater trochanteric pain syndrome, simply avoiding sleeping on the affected side and crossing your legs can reduce daily irritation significantly.
When conservative measures aren’t enough, options range from corticosteroid injections to reduce inflammation to surgical interventions like arthroscopy for labral tears or joint replacement for advanced arthritis. The right path depends entirely on the underlying cause, which is why getting an accurate diagnosis matters more than treating the pain in isolation.