Hip pain affects roughly 1 in 7 adults over age 60, and it’s even more common among women and people who aren’t physically active. The cause depends heavily on where exactly you feel the pain, whether it’s the outer side, the front and groin area, or deep in the buttock. Some hip pain actually starts in the lower back. Understanding the location and pattern of your pain is the fastest way to narrow down what’s going on.
Where You Feel It Matters
The hip is a complex joint surrounded by layers of muscle, tendon, and connective tissue, so “hip pain” can mean very different things depending on the exact spot. Pain on the outer side of the hip, near the bony bump you can feel when you press, points to a different set of problems than pain in the groin or deep in the buttock. Before reading through the common causes below, take a moment to notice: does it hurt when you lie on that side at night? When you climb stairs? When you sit for a long time? When you lift your leg? Those details help pinpoint the source.
Outer Hip Pain
Pain along the outside of the hip is one of the most common complaints, and it’s often lumped under the label “bursitis.” But research paints a more specific picture. In a study of 877 patients with outer hip pain, only about 20% actually had bursitis (fluid-filled inflammation of the cushioning sac near the bone). Nearly half, close to 50%, had tendon damage in the gluteal muscles that attach at the outer hip. Another 28% had a thickened band of tissue running from the hip down to the knee.
This matters because the treatment for each is different. If your outer hip aches when you walk, climb stairs, or lie on that side at night, gluteal tendon problems are statistically the most likely culprit. The tendons of the muscles that stabilize your pelvis when you stand on one leg attach right at that bony prominence, and they break down gradually with repetitive stress. True bursitis, where the fluid sac becomes inflamed, tends to cause more localized tenderness right over the bone. The two conditions overlap so much in location that even clinicians sometimes need an ultrasound to tell them apart. One useful clue: if pressing into the hip while pushing your leg outward against resistance reproduces the pain, that points more toward a tendon issue than bursitis.
Front Hip and Groin Pain
Pain in the front of the hip or groin area typically involves structures inside or very close to the hip joint itself. This is where you’ll feel it when lifting your leg, running, or squatting.
Joint Impingement
One of the most common causes in younger and middle-aged adults is a condition where the bones of the hip joint don’t fit together smoothly. Small bony bumps, either on the ball of the thighbone, the socket, or both, create abnormal contact when the hip moves through its range of motion. These bony irregularities usually develop during childhood growth and may not cause symptoms until years later. Athletic people often notice problems earlier because they push the joint through more demanding movements. Over time, the repeated pinching can damage the ring of cartilage that lines the hip socket, known as the labrum.
A torn labrum typically causes a deep, aching pain in the groin that gets worse with pivoting, twisting, or prolonged sitting. Some people feel a catching or clicking sensation. This type of damage doesn’t heal on its own because the labrum has poor blood supply, but many people manage symptoms successfully with targeted strengthening and activity modification before considering surgical repair.
Hip Flexor Problems
The muscles at the front of the hip that lift your thigh can become strained or inflamed, especially if you sit for long periods and then jump into exercise. Pain from tight or irritated hip flexors tends to be sharper when you first stand up after sitting and may ease as you move around.
Pain in the Buttock or Back of the Hip
Posterior hip pain, felt in the buttock or the back of the hip, has its own set of causes. If your pain worsens with prolonged sitting, one common source is the piriformis, a small muscle deep in the buttock that can tighten and irritate the nearby sciatic nerve. This creates a deep ache in the buttock that sometimes radiates down the back of the leg.
Pain near the bottom of the pelvis, right where you sit, often involves the bony prominences called the sit bones. The tendons of the hamstring muscles attach here, and they can become irritated from activities like running, cycling, or simply sitting on hard surfaces for too long. The sacroiliac joint, where the base of the spine meets the pelvis just above the buttocks, is another frequent source of posterior hip pain. It can produce a one-sided ache that feels deep and hard to pinpoint, often flaring with transitions like standing up from a chair or rolling over in bed.
When the Problem Is Actually Your Back
This is one of the trickiest aspects of hip pain. Problems in the lower spine, particularly narrowing of the spinal canal or disc issues affecting the nerves that travel to the leg, can produce pain that feels exactly like it’s coming from the hip. Because the nerves exiting the lower spine supply sensation to the hip, thigh, and leg, a pinched nerve at the spine can create pain, numbness, tingling, or weakness anywhere along that path.
The overlap is so significant that clinicians have a name for it: hip-spine syndrome. Some people have problems in both the hip joint and the lower back simultaneously, making it genuinely difficult to sort out what’s causing what. A few patterns can help you distinguish the two. Spine-related pain more often travels below the knee, may come with tingling or numbness, and tends to worsen with standing or walking and improve with sitting. True hip joint pain usually stays in the groin or outer hip, worsens with weight-bearing and rotation, and doesn’t produce numbness.
Osteoarthritis
If you’re over 50 and your hip pain has been gradually worsening over months or years, osteoarthritis is the most common explanation. The cartilage that cushions the joint wears down over time, leading to stiffness, reduced range of motion, and a deep ache in the groin or front of the thigh. Morning stiffness that lasts less than 30 minutes and improves with gentle movement is a hallmark. The pain tends to be worst after prolonged activity and better with rest, though as the condition progresses, it can ache even at rest or wake you at night.
Standard X-rays can show joint space narrowing and bone spurs in moderate to advanced arthritis, but they can miss early changes. MRI is more sensitive and accurate for detecting early cartilage loss and other soft tissue problems that X-rays miss entirely. If your X-ray looks normal but you still have persistent pain, an MRI can reveal what’s actually going on.
Who Gets Hip Pain More Often
Women report hip pain more frequently than men across all age groups. Among adults over 60, about 16% of white women and 19% of Mexican American women report significant hip pain on most days, compared to about 12% of men regardless of ethnicity. Physical inactivity is also a clear risk factor: roughly 18% of inactive older adults report hip pain, compared to about 13% of those who exercise regularly. Carrying extra body weight increases the load on the joint with every step, accelerating wear on cartilage and tendons.
Simple Changes That Can Help
How you sleep can make a surprising difference. If you’re a side sleeper, placing a firm pillow between your knees keeps your hips aligned and reduces pressure on the outer hip. If you sleep on your back, a pillow under your knees takes strain off both the hip joints and lower back. Avoid sleeping on the painful side if outer hip pain is your main issue.
For most non-traumatic hip pain, the initial approach is the same: reduce activities that aggravate the pain, apply ice for acute flare-ups, and begin gentle strengthening exercises that target the muscles around the hip. Strengthening the gluteal muscles is particularly important because weakness in these muscles is a factor in outer hip pain, front hip impingement, and even some forms of back-related hip pain. Walking on flat ground, swimming, and cycling are usually well tolerated while you work on recovery. If your pain hasn’t improved after a few weeks of consistent effort, or if it came on suddenly after a fall or injury, that’s when imaging and a more detailed evaluation become important.