Hip pain has dozens of possible causes, but most cases trace back to a handful of common conditions: arthritis, bursitis, tendon problems, structural issues inside the joint, or pain referred from the lower back. Where exactly you feel the pain is one of the strongest clues to what’s going on. About one in five U.S. adults has some form of arthritis, and a quarter of those people rate their joint pain at 7 or higher out of 10, so if your hips hurt badly, you’re far from alone.
Where It Hurts Matters Most
Hip pain generally falls into three zones: the front (groin area), the outer side, or the back of the hip and buttock. Each location points toward a different set of problems, and paying attention to where the pain concentrates can help you and a provider narrow things down quickly.
Front of the hip or groin: Pain here usually originates inside the joint itself. Osteoarthritis, labral tears, and a structural problem called femoroacetabular impingement are the most common culprits. Flexor tendon strains from overuse or sudden movements also land in this zone. In older adults, hip fractures after a fall almost always produce sharp anterior pain.
Outer (lateral) hip: This is the classic spot for greater trochanteric pain syndrome, a catch-all term that includes bursitis, gluteus medius tendon problems, and iliotibial band friction. It’s more common in women, people who are overweight, and middle-aged adults. The hallmark is tenderness right over the bony prominence on the outside of your thigh, especially when you press on it or try to sleep on that side.
Back of the hip or buttock: Posterior hip pain often isn’t coming from the hip joint at all. Deep gluteal syndrome causes a deep ache in the buttock that worsens with sitting, particularly in a car, and can send burning pain shooting down the leg. Lumbar spine problems, sacroiliac joint dysfunction, and hamstring tendon issues all show up here too. If you also have low back pain or a history of spinal problems, the hip may simply be where your back pain is landing.
Osteoarthritis: The Most Common Cause
Osteoarthritis is the single most frequent reason for chronic hip pain in adults over 50. The cartilage lining the ball-and-socket joint gradually wears down, leaving bone surfaces that grind and produce inflammation. Pain typically builds slowly over months or years, feels worst after sitting for a long time or walking a distance, and may include stiffness first thing in the morning that loosens within 30 minutes or so.
The condition is progressive, but severity varies enormously. Some people manage well for years with exercise and weight management. Others reach a point where the joint is bone-on-bone, and an estimated one million knee and hip replacements are performed in the U.S. each year because of osteoarthritis alone.
Greater Trochanteric Pain Syndrome
If your pain is on the outside of your hip and flares when you lie on that side at night, greater trochanteric pain syndrome is a strong possibility. The greater trochanter is the widest, most prominent bony point at the top of your thighbone, and the tendons and fluid-filled sacs (bursae) around it can become irritated from repetitive motion, prolonged sitting, or no obvious trigger at all.
The pain tends to be worse with physical activity, going up stairs, and crossing your legs. It often wakes people up at night when they roll onto the affected side. This is one of the more treatable forms of hip pain: targeted strengthening of the gluteal muscles, activity modification, and sometimes a corticosteroid injection can bring significant relief within weeks.
Labral Tears and Joint Impingement
The labrum is a ring of tough cartilage that lines the rim of your hip socket, helping to seal the joint and cushion movement. A tear in the labrum can cause deep groin pain along with a clicking, popping, or catching sensation when you move your hip. Some people describe a feeling that the joint locks momentarily, then releases.
Labral tears often go hand in hand with femoroacetabular impingement, a condition where the bones of the hip aren’t perfectly shaped. In one form, a bump on the ball of the femur grinds against the cartilage inside the socket during movement. In another, the socket itself has extra bone along its rim that crushes the labrum. Both types prevent the joint from gliding smoothly and, over time, can accelerate cartilage breakdown toward osteoarthritis. This pattern is especially common in younger, athletic adults with gradual-onset groin pain that worsens with deep squatting, pivoting, or prolonged sitting.
When the Problem Is Actually Your Back
The nerves that supply sensation to the hip and thigh originate in the lower lumbar spine, and they run through or alongside muscles deep in the pelvis before reaching the hip region. A bulging disc, narrowed nerve channel, or irritated nerve root at the L4 or L5 level can produce pain that feels like it’s in the hip when the hip joint itself is perfectly healthy. The sciatic nerve, which passes behind the short rotator muscles near the hip, is a particularly common source of confusion: piriformis irritation or deep gluteal compression can mimic hip joint problems almost exactly.
A useful clue is whether the pain travels. True hip joint pain tends to stay localized to the groin, outer hip, or buttock. Referred pain from the spine often radiates down the thigh or below the knee, and may come with numbness, tingling, or a burning quality. People who have both existing arthritis and spinal issues sometimes end up in a cycle where the joint problem alters their gait, which strains the spine, which adds a second layer of pain on top of the first.
Why the Pain Feels Worse at Night
Many people notice their hip pain peaks when they’re trying to sleep. Side sleepers put direct pressure on the outer hip structures, compressing an already irritated bursa or tendon. Back sleepers can develop discomfort if the hip flexors tighten in a slightly extended position. A medium-firm mattress helps because it supports your body while conforming to its natural curves. Sleeping on your back with a pillow under your knees, or on your side with a pillow between your knees, keeps the hips aligned and takes pressure off the painful area. These are small changes, but they can make a noticeable difference within a few nights.
What Recovery Typically Looks Like
For most non-surgical hip conditions, a structured exercise program is the cornerstone of treatment. A typical physical therapy course runs four to six weeks, focusing on two goals: strengthening the muscles that stabilize the hip joint and restoring flexibility in the muscles around it. Stronger glutes, hip flexors, and core muscles take load off the joint and reduce pain. Most programs call for exercises two to three days per week, and the same routine can continue as long-term maintenance once the acute pain resolves.
Improvement timelines vary by condition. Bursitis and tendon irritation often respond within a few weeks of consistent strengthening and activity modification. Osteoarthritis pain can be managed long-term but tends to fluctuate with activity levels, weather, and body weight. Labral tears and impingement may require a longer course of rehab, and some eventually need surgical repair if conservative treatment plateaus. The key factor across all of these is consistency. Sporadic exercise rarely produces lasting relief, while steady, moderate effort usually does.
Red Flags Worth Noting
Most hip pain is mechanical and manageable, but certain patterns warrant prompt evaluation. A hip that suddenly can’t bear weight after a fall could indicate a fracture, especially in older adults with osteoporosis. A hot, swollen, red hip joint with fever may signal septic arthritis, which is a medical emergency. Hip pain accompanied by urinary or bowel changes, or pain that follows a cyclical pattern with menstruation, may be referred from organs in the pelvis rather than from the musculoskeletal system. And pain that wakes you from sleep, is unrelenting at rest, or comes with unexplained weight loss deserves investigation beyond standard musculoskeletal workup.