Hip pain shows up in three distinct zones: the groin and front of the hip, the outer side of the hip, or the back of the buttock and pelvis. Where you feel the pain is one of the strongest clues to what’s causing it, because each location points to a different set of structures. About 14% of adults over 60 report significant hip pain on most days, and the location pattern holds remarkably consistent across causes.
The Three Zones of Hip Pain
Pain that seems like “hip pain” can originate from very different places. The hip joint itself sits deep in the groin, not where most people expect it. That bony prominence you can feel on the outside of your upper thigh is actually the top of your thighbone, not the joint. And pain felt in the buttock may come from structures in your lower back or pelvis rather than the hip at all.
Pain close to the surface, around the outside or back of the hip, typically involves muscles, tendons, or the fluid-filled sacs that cushion them. Pain felt deeper, in the groin or front of the thigh, more often comes from the joint itself: the bones, cartilage, or the ring of tissue that lines the socket. Pain in the lower back or buttock that seems hip-related may be referred from the spine or the sacroiliac joint, where your pelvis connects to your lower spine.
Groin and Front of the Hip
When the hip joint itself is the problem, you almost always feel it in the groin. People often cup their hand in a “C” shape around the front of their hip crease to show a doctor where it hurts. This deep, interior ache is the hallmark of issues inside the joint.
Osteoarthritis is the most common cause, especially after age 50. The cartilage that cushions the ball-and-socket joint gradually wears down, creating stiffness and a deep ache that worsens with activity. In earlier stages, the pain tends to flare after prolonged sitting, walking, or exercise, then eases with rest. As the cartilage damage progresses, the pain becomes more constant.
A labral tear, which is damage to the ring of cartilage lining the hip socket, also produces groin pain. It often comes with a catching or clicking sensation during movement. Hip impingement, where the bones of the joint don’t fit together smoothly, causes friction that damages the labrum and cartilage over time. Impingement pain typically shows up in the groin but can also radiate to the outer hip, deep buttock, and sacroiliac area. About half of people with impingement notice a gradual onset, while roughly a quarter develop symptoms suddenly without any specific injury.
Outer Hip Pain
Pain on the outside of the hip, right over that bony bump you can feel on your upper thigh, points to a condition called greater trochanteric pain syndrome. This used to be called hip bursitis, and while inflammation of the bursa can be involved, the more common culprit is irritation or small tears in the tendons of the gluteal muscles that attach at that spot.
Outer hip pain tends to be worse when lying on the affected side, climbing stairs, or standing for long periods. Common triggers include:
- Overuse or a sudden increase in activity, like starting a new walking or running program
- A fall or direct impact to the side of the hip
- Leg length differences, even small ones, that shift your gait
- Foot and ankle problems like bunions or plantar fasciitis that change how you walk
- Muscle imbalances, particularly weak hip abductor muscles
This type of pain is more common in women and in people who are overweight. It can also develop after hip or knee surgery as your body compensates during recovery.
Back of the Hip and Buttock
Pain in the back of the hip is the trickiest to pin down because several structures can send pain to the same area. True hip joint problems occasionally cause deep buttock pain, but the lumbar spine and the sacroiliac joint are more frequent sources.
Sacroiliac joint dysfunction produces pain below the bony ridge at the back of your pelvis, often extending to the side of the buttock. It tends to follow nerve pathways in the lower back, which is why it can feel almost identical to a disc problem or arthritis in the spine. The overlap is significant: disc herniations, spinal arthritis, and sacroiliac dysfunction can all create an aching or shooting sensation in the buttock and upper thigh. This is referred pain, meaning the problem is in one place but you feel it somewhere else.
Sciatica, where a nerve root in the lower back is compressed, is another common mimic. It typically sends a shooting or burning sensation down the back of the thigh, sometimes all the way to the foot. If your “hip pain” travels below the knee, the source is almost certainly the spine rather than the hip joint.
How Location Helps Narrow the Cause
A doctor’s first question will be exactly where you feel the pain, because that answer immediately narrows the list of possibilities. Groin pain points toward the joint. Outer hip pain points toward tendons and bursae. Buttock pain raises the question of whether the hip or the spine is responsible.
Physical tests help sort things out further. For suspected joint problems, a clinician will rotate your hip inward while it’s bent and angled across your body. Pain during this maneuver is a strong indicator that something inside the joint, like a labral tear or impingement, is the source. Reduced ability to rotate the hip inward is another consistent finding with impingement.
For outer hip pain, pressing on the bony prominence on the side of the thigh usually reproduces the discomfort. Resisted leg movements that engage the gluteal tendons will also trigger it. Posterior pain gets evaluated with tests that stress the sacroiliac joint and maneuvers that check for nerve involvement from the spine.
When Imaging Is Needed
A standard X-ray is the first step whenever hip pain needs imaging. It can reveal arthritis, bone spurs, fractures, and abnormal bone shapes associated with impingement. In many cases, an X-ray is enough to identify the cause and guide treatment.
MRI becomes useful when X-rays look normal but pain persists, or when a soft tissue injury like a labral tear is suspected. MRI can show cartilage damage, tendon tears, early bone changes, and inflammation that plain X-rays miss. It’s the most comprehensive single imaging tool for hip pain, though it costs more and isn’t always necessary as a first step.
Pain That Needs Immediate Attention
Most hip pain develops gradually and is safe to monitor for a few days. But sudden, severe pain in or around the hip accompanied by fever, significant swelling, warmth over the joint, or an inability to bear any weight at all can signal a joint infection. Septic arthritis damages cartilage rapidly and requires urgent treatment. The combination of a hot, swollen joint with fever is the pattern to watch for, particularly if the pain came on within hours rather than days or weeks.
A hip fracture, most common in older adults after a fall, also causes immediate inability to put weight on the leg. The affected leg may appear shorter or turned outward. This is another situation that needs emergency evaluation.