Hip pain most often comes from arthritis, bursitis, muscle or tendon strain, or an injury to the cartilage inside the joint. The cause depends a lot on your age, activity level, and where exactly the pain shows up. Some hip pain starts in the hip itself, while some originates in the lower back or pelvis and radiates into the hip area, which can make it tricky to pin down.
Osteoarthritis: The Most Common Cause
Osteoarthritis is the leading reason for chronic hip pain, especially in adults over 50. Your hip is a ball-and-socket joint where the top of the thighbone fits into a cup-shaped socket in the pelvis. Both surfaces are lined with smooth cartilage that lets the leg glide in every direction. Over years of use, that cartilage gradually wears down. When enough of it is gone, bone presses against bone with no cushioning, and that contact produces a deep, aching pain.
The pain typically starts as stiffness after sitting for a while or a dull ache after walking. Morning stiffness that lasts under an hour is characteristic. As the condition progresses, the joint space narrows further, small bone spurs form around the edges of the socket, and the joint may lose some of its range of motion. You might notice that rotating your leg inward becomes painful or limited. In advanced stages, the pain can persist even at rest.
Previous injuries speed this process up. A hip fracture, dislocation, or even repetitive high-impact activity earlier in life can set the stage for arthritis decades later.
Bursitis and Outer Hip Pain
If the pain is on the outer side of your hip, bursitis is a likely culprit. Small fluid-filled sacs called bursae sit around the hip joint to reduce friction between bones, tendons, and muscles. When a bursa becomes irritated and swells, the result is a sharp or burning pain on the outside of the hip and sometimes down the outer thigh.
The most recognizable sign of hip bursitis is pain when lying on the affected side at night. It also tends to flare with activity like walking, climbing stairs, or standing for long stretches. Sitting with your legs crossed or standing on the affected leg can provoke it. Even getting in and out of a car may hurt. This condition, sometimes called greater trochanteric pain syndrome, is more common in women and in people who have tight hip muscles or a habit of standing with their weight shifted to one side.
Labral Tears
The labrum is a ring of tough cartilage that lines the rim of the hip socket, helping to keep the ball of the thighbone seated properly. When it tears, you often feel a clicking or catching sensation during movement, along with pain in the groin or front of the hip. The joint may feel unstable, and bending, twisting, or squatting can make the pain worse.
Labral tears happen in a few ways. In some people, the ball and socket don’t fit together perfectly from birth, creating extra pressure on the labrum with every movement until it eventually gives way. Sports that involve repeated hip rotation, like hockey, soccer, or ballet, are common triggers. Falls and car accidents can tear the labrum in a single event. Osteoarthritis can also wear the labrum down over time, so a tear and arthritis sometimes show up together.
Muscle and Tendon Strain
Not all hip pain comes from inside the joint. The hip is surrounded by large muscle groups, including the hip flexors in front, the glutes in back, and the adductors along the inner thigh. Overworking any of these through exercise, heavy lifting, or even prolonged sitting can produce pain that feels like it’s coming from the hip joint itself.
Mild strains from overuse are the most common cause of temporary hip pain in younger adults. They typically improve within a few days to a couple of weeks with rest. Tendon inflammation from repetitive activity, like running or cycling, can take longer to settle and tends to come back if the movement pattern doesn’t change. Stress fractures from repeated impact on the bone are a more serious version of this same overuse pattern and cause pain that worsens with weight-bearing activity.
Pain That Starts Somewhere Else
The hip area sits at a crossroads of nerves from the lower spine and pelvis, so pain you feel in or around the hip sometimes originates elsewhere. A herniated disc in the lower back can send pain, numbness, or tingling down into the hip, buttock, and leg. Problems with the sacroiliac joint, where the base of the spine connects to the pelvis, can produce deep buttock pain that mimics hip joint pain. Lumbar facet syndrome, a type of age-related wear in the small joints of the spine, can also refer pain into the hip region, particularly with backward bending.
The key clue with referred pain is that moving the hip joint itself often doesn’t reproduce or change the pain. If your hip hurts more when you bend your back or twist your torso than when you rotate your leg, the source may be spinal rather than in the hip itself.
Avascular Necrosis
A less common but serious cause of hip pain is avascular necrosis, a condition where blood flow to the top of the thighbone is reduced or cut off. Without adequate blood supply, the bone tissue gradually dies and can eventually collapse, leading to severe arthritis.
In its early stages, avascular necrosis may cause no symptoms at all. As it progresses over months to years, you might notice pain only when putting weight on the hip. Eventually the pain can persist even while lying down. Several specific risk factors raise the likelihood of this condition: long-term use of high-dose corticosteroids (like prednisone), heavy alcohol use over several years, a previous hip fracture or dislocation, and certain medical conditions like sickle cell anemia or lupus. High cholesterol also plays a role, because fatty deposits can block the tiny blood vessels that feed the bone.
How Age and Activity Shape the Cause
Your age is one of the strongest clues to what’s behind hip pain. In younger, active adults, muscle strains, tendon inflammation, stress fractures, and labral tears account for most cases. These are typically tied to a specific activity or event, and the pain tends to be sharper and more localized.
In middle-aged and older adults, degenerative changes take over as the primary driver. Cartilage wears thinner, tendons lose elasticity, and bursae become more prone to irritation. The pain tends to come on gradually, worsen over weeks or months, and feel deeper and more diffuse. Osteoarthritis alone accounts for the majority of hip replacements, though surgery only enters the picture after conservative approaches like physical therapy, weight management, and activity modification have been thoroughly tried.
Where the Pain Shows Up Matters
Location is one of the most useful pieces of information for narrowing down the cause:
- Front of the hip or groin: Usually points to a problem inside the joint itself, such as osteoarthritis or a labral tear.
- Outer hip: Most often bursitis or irritation of the tendons that attach to the bony prominence on the side of the thighbone.
- Back of the hip or deep in the buttock: More likely referred pain from the lower spine or sacroiliac joint, or piriformis syndrome (tightness in a small muscle deep in the buttock).
- Inner thigh: Can indicate an adductor strain or, less commonly, a hip joint issue that refers pain medially.
Pain that comes with clicking, locking, or a feeling that the hip might give way suggests a mechanical problem like a labral tear or loose cartilage inside the joint. Pain that’s worst first thing in the morning and eases with gentle movement leans toward arthritis. Pain that worsens steadily through the day with activity and improves with rest points more toward bursitis, tendinitis, or overuse.