Hip aching usually comes from one of a handful of common causes: inflammation of the soft tissues around the joint, wear-and-tear arthritis, muscle tightness, or less often, a structural problem inside the joint itself. Your age, where exactly the pain sits, and what makes it worse are the best clues to figuring out which one applies to you.
Where the Pain Is Matters Most
Hip pain doesn’t always feel like it’s coming from the hip. The joint sits deep in the body, and different problems radiate to different spots. Pain on the outer side of your hip, running down the outside of your thigh (sometimes all the way to the knee), usually points to a soft tissue problem like bursitis or tendon irritation. Pain deep in the groin or inner thigh is more characteristic of arthritis or a problem inside the joint itself. Pain in the buttock that shoots down the back of the leg is often coming from the lower back or the sciatic nerve, not the hip joint at all.
Paying attention to this distinction can save you a lot of guesswork. If you press on the bony point on the outside of your hip and it’s tender, the issue is likely in the surrounding tissues. If the ache is deep, hard to pinpoint, and worse when you bend or rotate your leg, the joint itself is more likely involved.
Bursitis and Tendon Problems
The most common reason for aching on the side of the hip is inflammation of the bursae or tendons around the greater trochanter, the bony bump you can feel at the widest part of your hip. Nine small fluid-filled sacs (bursae) sit in that area, cushioning the tendons and muscles that slide over the bone. When one or more of those sacs becomes inflamed, the concentrated nerve supply in the area makes it disproportionately painful.
Closely related is gluteal tendinopathy, where the tendons of the muscles that stabilize your pelvis start to break down from repetitive loading. These two conditions overlap so much that clinicians often group them under the umbrella term “greater trochanteric pain syndrome” rather than trying to distinguish one from the other. Typical signs include:
- Pain when lying on the affected side at night
- Aching that flares with walking, climbing stairs, or sitting cross-legged
- Tenderness when you press on the outside of the hip
- A limp that develops gradually
This type of hip pain is especially common in women over 40 and in runners or people who suddenly increase their walking distance. The good news is that it responds well to conservative care. A regular routine of stretching the iliotibial band and strengthening the surrounding hip muscles typically improves symptoms within a few weeks, with most people feeling significantly better in six to ten weeks.
Osteoarthritis of the Hip
If you’re over 60 and your hip aches deep in the groin, stiffens up in the morning, and hurts more when you walk or go down stairs, osteoarthritis is the leading suspect. The cartilage that cushions the ball-and-socket joint gradually wears down, and the resulting friction and inflammation produce a deep, persistent ache.
Several patterns strongly suggest hip arthritis. Pain located in the inner thigh is one of the most telling. Posterior hip pain when you squat, groin pain when you move your leg sideways, weakness in the muscles that pull your leg outward, and reduced ability to rotate your leg inward all point toward arthritis. A family history of osteoarthritis or a personal history of knee arthritis also raises the likelihood.
On the flip side, certain features make arthritis less likely. If you’re under 60, if your morning stiffness clears in less than an hour, if walking doesn’t bother you, or if sitting doesn’t relieve the pain, the cause is probably something else. It’s worth noting that X-rays don’t always tell the full story. The correlation between what an X-ray shows and how much pain someone actually feels is surprisingly low, so imaging alone isn’t the best way to confirm or rule out hip arthritis.
Managing Hip Arthritis
The American Academy of Orthopaedic Surgeons rates anti-inflammatory medications (like ibuprofen or naproxen) as the strongest first-line recommendation for hip arthritis, supported by high-quality evidence for reducing pain and improving function. Physical therapy also has strong evidence behind it, particularly for mild to moderate cases. Corticosteroid injections into the joint can provide short-term relief, though they’re typically reserved for flare-ups rather than ongoing management.
One treatment that doesn’t hold up to scrutiny: hyaluronic acid injections into the hip. Despite being widely marketed, they perform no better than a placebo in clinical trials, and guidelines now recommend against them. Acetaminophen (Tylenol) may help modestly, but the evidence is much weaker than for anti-inflammatories.
Labral Tears
Inside the hip socket, a ring of cartilage called the labrum deepens the socket and helps seal the joint. When this cartilage tears, it can cause a deep ache in the groin along with distinctive mechanical symptoms: a clicking, catching, or popping sensation when you move your hip. The pain often worsens with activities that involve twisting or pivoting.
Labral tears are more common in younger, active adults and in people with subtle structural variations in their hip anatomy. They don’t always show up on a standard X-ray. An MRI, sometimes enhanced with contrast dye injected into the joint, is usually needed to confirm the diagnosis. Many labral tears respond to physical therapy focused on hip stability and movement patterns, though some require arthroscopic surgery if symptoms persist.
Muscle Tightness and Sedentary Habits
Not every aching hip has a dramatic diagnosis behind it. Prolonged sitting tightens the hip flexors, the group of muscles at the front of the hip that pull your thigh toward your torso. When these muscles shorten from hours of desk work or driving, they pull on the pelvis and create a dull, stiff ache that’s worst when you first stand up and gradually eases as you move.
Weak glute muscles compound the problem. The gluteus medius, the muscle on the side of your hip responsible for stabilizing your pelvis when you walk, tends to weaken with inactivity. When it can’t do its job, surrounding structures pick up the slack and become overloaded. This is one of the most common and most fixable patterns behind bilateral hip aching, the kind where both hips feel stiff and sore without any clear injury.
Hip Pain That Disrupts Sleep
Aching hips at night deserve their own attention because the pain often feels worse when you lie down, even if it’s manageable during the day. Side sleepers put direct pressure on the outer hip structures, which can aggravate bursitis or tendinopathy. Sleeping on your back with a pillow under your knees, or on your side with a pillow between your knees, helps align the pelvis and reduces stress on the joint overnight. These simple positional changes make a noticeable difference for many people.
If your hip pain wakes you consistently, is accompanied by night sweats, unexplained weight loss, or fever, or if the pain is severe and came on without any injury, those patterns warrant prompt medical evaluation. Pain that doesn’t respond to rest and basic anti-inflammatories over several weeks also deserves a closer look.
What Your Age Tells You
Age is one of the most useful filters for narrowing down hip pain. In your 20s and 30s, labral tears, hip flexor strains, and stress-related injuries from overtraining are the most common culprits. In your 40s and 50s, tendon problems and early arthritis start to dominate. After 60, osteoarthritis becomes the most likely explanation for persistent hip aching, especially if it’s gradually worsening over months or years. At any age, muscle imbalances from too much sitting remain the most underappreciated cause of hip discomfort, and often the easiest to fix with targeted stretching and strengthening.