Hip pain that feels severe usually points to one of a handful of common conditions, ranging from joint wear and inflammation to soft tissue problems or even nerve issues originating in your lower back. About 14% of adults over 60 report significant hip pain on most days, but it affects younger people too, especially those who are active or spend long hours sitting. Where exactly you feel the pain, and what makes it worse, are the biggest clues to what’s going on.
Where You Feel It Matters
The hip is a deep ball-and-socket joint surrounded by muscles, tendons, and fluid-filled sacs called bursae. Pain from the joint itself tends to show up in your groin or deep in the front of your hip. Pain on the outside of your hip, near that bony point you can feel when you press, usually comes from the surrounding soft tissues. And pain in the back of your hip or buttock may actually be coming from your lower back or the sacroiliac joint, not the hip joint at all.
This distinction is worth paying attention to because it narrows the list of likely causes considerably. Groin pain with stiffness points toward arthritis or a structural problem inside the joint. Lateral pain that flares when you lie on that side suggests bursitis or a tendon issue. Buttock pain that shoots down your leg is more likely a spine problem.
Osteoarthritis: The Most Common Cause
Osteoarthritis is the single most frequent reason for persistent, worsening hip pain. The cartilage lining the joint gradually breaks down over years, narrowing the space between bones. As that cushion disappears, the bones may grow small spurs along their edges, and the joint becomes stiffer and more painful with use.
The pattern is distinctive. Pain and stiffness are typically worst first thing in the morning or after you’ve been sitting for a while. Early on, the pain flares mainly with vigorous activity and settles with rest. Over time it starts showing up during lighter activities, at rest, and even at night. You may notice a grinding sensation during movement, reduced range of motion that makes it harder to bend or put on shoes, or a limp that develops gradually. Some people notice their pain worsens in damp or rainy weather.
X-rays can confirm the diagnosis by showing a narrowed joint space, bone spurs, and changes to the bone surface. If your pain has been building over months or years and follows this morning-stiffness pattern, osteoarthritis is high on the list.
Bursitis and Tendon Problems
Pain on the outer side of your hip is commonly called trochanteric bursitis, but research over the past decade has shown that the bursa itself is often not the main problem. In many cases, the real issue is damage to the tendons of the gluteal muscles that attach near that outer hip bone. The umbrella term for this group of conditions is “greater trochanteric pain syndrome.”
The onset is often gradual, without any obvious injury, though a fall or sudden increase in activity can trigger it. Classic symptoms include pain when rising from a chair, pain with prolonged standing, pain that wakes you when you roll onto the affected side at night, and discomfort with hip rotation. When the tendons are partially or fully torn, you may notice weakness when walking, particularly a side-to-side sway or a dip of the pelvis on the opposite side with each step.
This type of hip pain is especially common in women over 40 and in runners or walkers who have recently increased their mileage.
Structural Problems Inside the Joint
If you’re younger and active, severe hip pain may come from a structural mismatch in the joint called femoroacetabular impingement, or FAI. This happens when the bones of the hip aren’t shaped ideally, causing them to bump against each other during movement.
There are two main types. In one, the ball at the top of the thighbone is slightly too wide, so it shears against the rim of the socket during deep bending or rotation. In the other, the socket itself extends too far over the ball, crushing the soft rim of tissue (the labrum) that lines the socket’s edge. Both patterns can tear the labrum, which produces a sharp catching or clicking sensation in the groin, especially during twisting motions or deep squats.
Labral tears often cause a deep, hard-to-pinpoint ache in the groin that worsens with activity and feels better with rest. Sitting for long periods in a low chair can also provoke it. These problems tend to affect people in their 20s through 40s who play sports involving rotation, like soccer, hockey, or martial arts, though they can occur in anyone.
Inflammatory Arthritis
Rheumatoid arthritis and other inflammatory joint diseases can target the hips, though they less commonly start there. The key difference from osteoarthritis is the nature of the morning stiffness: inflammatory arthritis typically causes stiffness lasting 45 minutes or longer after waking, compared to the shorter-lived stiffness of osteoarthritis that loosens within 15 to 30 minutes. You may also have fatigue, low-grade fever, loss of appetite, or pain and swelling in other joints, particularly in the hands, wrists, or feet.
Inflammatory arthritis tends to affect both hips and progresses differently than wear-and-tear arthritis. If your hip pain came on relatively quickly, affects both sides, and is accompanied by these systemic symptoms, blood tests can help identify the underlying inflammatory process.
Pain That Comes From Somewhere Else
Not all hip pain originates in the hip. The lower back is a frequent source. A herniated disc or narrowing of the spinal canal can compress the sciatic nerve, sending pain down through the buttock and into the leg. This pain often has a shooting or electrical quality and may come with numbness or tingling.
Another overlooked cause is compression of the nerve that provides sensation to the outer thigh. This condition, called meralgia paresthetica, produces tingling, burning pain, or numbness on the outer thigh. It typically affects one side and gets worse with walking or standing. Tight clothing, weight gain, pregnancy, or prolonged standing can all trigger it. The pain is purely sensory, so you won’t have weakness, but the burning quality can be intense enough to be mistaken for a hip joint problem.
Hip pain can also be referred from the sacroiliac joint (where the spine meets the pelvis) or from a hernia in the groin. If your pain doesn’t follow the typical patterns above, the source may not be the hip itself.
What Helps and What to Expect
For most non-surgical hip conditions, the first line of treatment is a combination of activity modification, targeted exercise, and over-the-counter anti-inflammatory medication. Physical therapy focused on hip and core strengthening is the standard recommendation, particularly for osteoarthritis, bursitis, and tendon problems.
The evidence on physical therapy for hip osteoarthritis is worth understanding realistically. A randomized trial published in JAMA found that patients who completed 12 weeks of structured physical therapy improved their pain scores by about 18 points on a 100-point scale. That’s a meaningful reduction, but not a dramatic one, and the study found that a sham treatment group improved by a similar amount. This doesn’t mean exercise is useless. It does mean that staying active and engaged in your recovery matters, but physical therapy alone may not eliminate severe pain.
For bursitis and tendon issues, exercises that strengthen the gluteal muscles are particularly effective. Avoiding positions that compress the outer hip (like crossing your legs or sleeping on the painful side without a pillow between your knees) can make a noticeable difference within a few weeks.
How Hip Pain Gets Diagnosed
If your hip pain is severe or hasn’t improved after a few weeks of home management, imaging usually starts with a standard X-ray. This is enough to identify osteoarthritis, fractures, and some structural abnormalities. If the X-ray looks normal but you’re still in significant pain, an MRI is the next step, particularly when a tendon tear, labral tear, or stress fracture is suspected. Current radiology guidelines recommend MRI without contrast for evaluating soft tissue injuries around the hip after X-rays come back negative or unclear.
Your doctor will also assess your range of motion, gait, and strength. Specific physical exam maneuvers can help distinguish between problems inside the joint and problems in the surrounding tendons. For example, pain or weakness when you try to rotate your hip outward against resistance while lying down can indicate a gluteal tendon tear.