Constant hip pain affects roughly 1 in 10 adults, and that number climbs with age. The cause is rarely obvious without a proper evaluation, partly because “hip pain” can originate from the joint itself, the muscles and tendons surrounding it, or even the lower back. Understanding where your pain is located and what makes it worse narrows the possibilities considerably.
The Most Common Causes
A study of adults with chronic hip pain that had been missed or misdiagnosed by their primary care doctors found that the single most common culprit was femoroacetabular impingement, accounting for over 55% of cases. Hip dysplasia came in second at about 13%, followed by pain referred from the lumbar spine (9%), inflammatory arthritis (7%), and bursitis (3%). Osteoarthritis, while extremely common in older adults, was a smaller slice in this particular younger population. In people over 50, osteoarthritis becomes a far more frequent explanation.
This spread matters because it shows that persistent hip pain, especially in younger adults, is often structural rather than age-related wear and tear. Many people assume their pain is “just getting older” when a treatable mechanical problem is actually driving it.
Osteoarthritis: The Wear-and-Repair Problem
Osteoarthritis is sometimes called “degenerative joint disease,” but that label is misleading. What actually happens is a tug-of-war between breakdown and repair. As the cartilage cushioning your hip joint wears away, your body responds by forming new bone at the joint edges and remodeling the bone underneath. This repair process isn’t smooth or precise. It creates bone spurs, stiffens the surrounding ligaments, weakens nearby muscles, and can trigger inflammation in the joint lining. The final picture depends on which process, destruction or repair, is winning at any given time.
Hip osteoarthritis is the second most common form after knee osteoarthritis and affects women roughly twice as often as men. The pain typically starts as stiffness after sitting or first thing in the morning, then progresses to aching during activity. Over time, it can change the way you walk, which puts extra stress on your knees, back, and the opposite hip, sometimes creating pain in those areas too.
Impingement and Labral Tears
Femoroacetabular impingement, or FAI, happens when the bones of your hip joint don’t fit together smoothly. The ball at the top of your thighbone or the socket it sits in (or both) have slight irregularities in shape. These irregularities cause the bones to press against each other during certain movements, pinching the soft tissue in between.
The tissue that takes the most damage is the labrum, a ring of cartilage lining the rim of your hip socket. The labrum acts as a gasket, keeping the joint sealed and stable. Repeated pinching from impingement can eventually tear it. A torn labrum often produces a clicking or popping sensation when you move, along with a deep, catching pain in the groin or front of the hip. Some people notice it most when twisting, squatting, or sitting for long periods. FAI is the most common cause of labral tears.
Bursitis: Pain on the Outside of the Hip
If your pain is concentrated on the bony point at the outside of your hip rather than deep in the groin, bursitis is a likely explanation. The trochanteric bursa is a fluid-filled sac that sits over the prominent bone on the side of your hip, cushioning the tendons that slide over it. When this bursa becomes inflamed, the pain radiates along the outer thigh.
Bursitis has a distinctive pattern. It tends to be worse at night, especially when you lie on the affected side. Getting up from a chair after sitting for a while flares it. Prolonged walking, climbing stairs, and squatting all aggravate it. If your pain follows this pattern, that’s a strong clue. Bursitis can develop from overuse, a fall, or simply from muscle imbalances that change how the tendons track over the bone.
Pain That Isn’t Coming From Your Hip
About 9% of chronic hip pain cases in one study turned out to be referred pain from the lower back. Nerves exiting the lumbar spine travel through the hip region, and when a disc bulge, joint problem, or nerve compression irritates them, the brain interprets the signal as hip pain. This is one reason hip pain can be so frustrating to pin down. The hip feels like the problem, but treating it directly doesn’t help because the source is several inches higher.
A clue that your hip pain might be spinal in origin: it changes with your back position, worsens with prolonged sitting or standing, or comes with numbness, tingling, or pain that shoots down the leg. True hip joint pain, by contrast, is usually felt in the groin, front of the thigh, or deep in the buttock, and it worsens specifically with hip movement like rotating or flexing the leg.
How Location Helps Identify the Cause
Where exactly you feel the pain is one of the most useful diagnostic clues:
- Groin or front of the hip: Most likely the hip joint itself. Osteoarthritis, impingement, labral tears, and hip dysplasia all tend to produce pain here.
- Outside of the hip: Bursitis or tendon problems around the greater trochanter.
- Deep in the buttock: Can be the hip joint, but also piriformis syndrome or referred pain from the sacroiliac joint or lumbar spine.
- Radiating down the thigh or leg: More likely nerve involvement, often originating in the lower back.
What Happens During Evaluation
The first step is a physical exam where a clinician moves your hip through different positions to see which motions reproduce your pain. This alone can distinguish between joint problems, tendon issues, and referred pain in many cases.
For imaging, an X-ray of the pelvis and hip is the standard starting point. It can reveal osteoarthritis, impingement bone shapes, dysplasia, and other structural abnormalities. If X-rays look normal or don’t explain the symptoms, an MRI is typically the next step. MRI picks up soft tissue problems that X-rays miss: labral tears, early cartilage damage, tendon injuries, and stress fractures. Ultrasound is sometimes used as an alternative, particularly for evaluating bursitis and tendon problems on the outside of the hip.
Why It Matters to Get It Right
Chronic hip pain is frequently misdiagnosed or diagnosed late, particularly in younger adults and women. The study of misdiagnosed cases found that conditions like impingement and dysplasia were routinely missed on initial visits. This matters because untreated impingement continues to damage the labrum and cartilage over time, and untreated dysplasia accelerates joint wear. What starts as a correctable mechanical problem can progress to irreversible arthritis.
Hip osteoarthritis itself also has downstream effects. The pain and stiffness alter your gait, and that altered movement pattern redistributes forces to your knees, spine, and opposite hip. Persistent hip pain that goes unaddressed doesn’t just stay in the hip. It reshapes how your entire lower body moves and can create new problems in joints that were previously healthy.