Hip pain is one of the most common joint complaints in adults, and it can come from dozens of different sources, some inside the hip joint itself and others surprisingly far away. About 14% of adults over 60 report significant hip pain on most days, but younger people deal with it too, especially athletes and people who sit for long hours. The cause depends a lot on your age, where exactly you feel the pain, and what makes it worse.
Osteoarthritis: The Most Common Cause
If you’re over 50 and your hip aches deep in the groin or front of the thigh, osteoarthritis is the most likely explanation. The cartilage that cushions the ball-and-socket joint gradually wears down over years, leaving bone surfaces closer together and increasingly irritated. The hallmark pattern is stiffness in the morning or after sitting that loosens up after a few minutes of movement, then pain that builds again with prolonged activity. Over time, you may notice less range of motion, difficulty putting on shoes or socks, and a dull ache that lingers even at rest.
Other forms of arthritis can affect the hip too. Rheumatoid arthritis tends to affect both hips symmetrically and often involves other joints in the hands or feet. Psoriatic arthritis may show up alongside skin plaques. These inflammatory types typically cause more morning stiffness lasting 30 minutes or longer, while osteoarthritis stiffness usually eases within 15 minutes.
Bursitis: Pain on the Outside of the Hip
If the pain is on the outer side of your hip rather than deep in the groin, bursitis is a strong possibility. The greater trochanter is the bony point you can feel on the outside of your upper thigh, and it’s covered by a small fluid-filled sac called a bursa that reduces friction. When that bursa gets irritated or inflamed, you feel pain on the outside of the hip, in the side of the upper thigh, or sometimes into the buttock.
Trochanteric bursitis has a distinctive pattern: it hurts when you lie on the affected side at night, gets worse when you stand up after sitting, and flares with activities like walking upstairs. It’s common in runners, people who suddenly increase their walking distance, and anyone with a leg-length difference or weak gluteal muscles. Unlike arthritis, the joint itself is healthy. The problem is the soft tissue around it.
Labral Tears and Hip Impingement
In younger, active adults, hip pain often traces back to a tear in the labrum, which is the ring of tough cartilage lining the rim of the hip socket. Labral tears frequently occur alongside a structural issue called femoroacetabular impingement, where extra bone growth on the ball or socket side of the joint creates abnormal contact during movement. This is especially common in athletes who do repetitive hip flexion, like soccer players, hockey players, dancers, and runners.
The telltale signs are a catching, clicking, or locking sensation in the hip, along with groin pain that worsens with twisting motions or prolonged sitting. You might feel a sharp pinch when you bring your knee up toward your chest and rotate it inward. The pain tends to be intermittent at first, showing up during or after specific activities, then gradually becoming more persistent.
Tendinitis and Muscle Strains
The hip is surrounded by some of the body’s largest and most powerful muscles, and the tendons connecting them to bone can become inflamed with overuse. Hip flexor tendinitis causes pain in the front of the hip that worsens when lifting your knee or walking uphill. It’s extremely common in people who sit most of the day and then exercise without adequate warm-up, because the hip flexors tighten from prolonged sitting and then get overloaded during activity.
Muscle strains, particularly of the hip flexors or groin muscles (adductors), cause more sudden pain during a specific movement. You’ll usually remember when it started. Strains typically improve with rest over days to weeks, while tendinitis tends to linger because it comes from repetitive stress rather than a single event.
When the Problem Isn’t the Hip at All
One of the trickiest aspects of hip pain is that it can originate in your lower back. Nerves exiting the lumbar spine travel through the hip region on their way to the legs, and when one of those nerves gets compressed by a herniated disc or narrowed spinal canal, the pain shows up in the hip, buttock, or thigh. Sciatica is the most well-known version: a compressed sciatic nerve sends pain radiating from the lower back through the buttock and down the leg.
The key difference is that referred pain from the spine often comes with numbness, tingling, or weakness in the leg. It may worsen with coughing, sneezing, or certain back positions rather than hip movements specifically. If your hip pain doesn’t change when you rotate or flex the hip joint but flares when you bend your spine, the source is likely your back.
The sacroiliac joint, where the base of your spine meets the pelvis, is another common source of pain that patients describe as “hip pain.” It typically causes pain in the buttock or back of the hip, often on one side, and can be triggered by standing on one leg, climbing stairs, or transitioning from sitting to standing.
How Location Helps Identify the Cause
Where you feel the pain is one of the most useful clues:
- Deep in the groin or front of the thigh: Usually a problem inside the hip joint itself, such as arthritis, a labral tear, or impingement.
- Outside of the hip: Most often bursitis or irritation of the tendons and muscles around the greater trochanter.
- Buttock or back of the hip: Frequently referred from the lower back, sacroiliac joint, or sciatic nerve.
- Front of the hip near the crease: Often hip flexor tendinitis or a muscle strain, especially if it worsens when lifting the knee.
What Makes It Worse Matters Too
Pay attention to timing and triggers. Pain that’s worst first thing in the morning and improves with gentle movement points toward arthritis or stiffness-related issues. Pain that builds throughout the day with activity suggests a mechanical problem like impingement or bursitis. Night pain that wakes you up, especially if you can’t find a comfortable position, warrants closer attention since it can indicate bursitis (if lying on that side) but also more serious conditions like a stress fracture or, rarely, bone pathology.
Pain after prolonged sitting that hits when you first stand up is characteristic of both bursitis and hip flexor tightness. Pain only during high-impact activity like running but not walking often points to a stress reaction or early labral tear.
Hip Pain After a Fall or Injury
Sudden hip pain following a fall, collision, or awkward movement narrows the possibilities significantly. Hip fractures are most common in older adults with weakened bones from osteoporosis. The classic sign is inability to bear weight on the leg, with severe pain in the groin. The leg may appear shortened or rotated outward. This requires emergency care.
In younger people, a traumatic hip dislocation is possible from high-energy impacts like car accidents or hard falls during sports. Sprains and strains are far more common after minor injuries and generally allow you to still walk, though with pain.
Signs That Need Urgent Attention
Most hip pain is gradual and manageable, but a few patterns signal something more serious. Septic arthritis, a joint infection, causes severe pain that comes on fast, along with swelling, warmth, skin color changes over the joint, and often fever. It becomes very difficult to move or use the hip at all. This is a medical emergency because untreated joint infections can cause permanent damage within days.
If you’ve had a hip replacement and develop new pain, swelling, or looseness in the joint months or years after surgery, that could indicate a prosthetic joint infection, which also needs prompt evaluation. And any hip pain accompanied by unexplained weight loss, night sweats, or pain that worsens at rest rather than with activity should be assessed to rule out less common causes like avascular necrosis, where bone tissue dies from loss of blood supply.
What a Doctor Looks For
A physical exam for hip pain typically involves specific positioning tests. One of the most common is the FABER test, where you lie on your back and place your ankle on the opposite knee in a figure-4 position while the examiner gently presses your bent knee toward the table. This stresses the hip joint, sacroiliac joint, and surrounding muscles simultaneously. Where you feel pain during this maneuver helps pinpoint whether the problem is in the joint, the sacroiliac region, or the surrounding soft tissue.
Imaging usually starts with X-rays, which show arthritis, fractures, and bone abnormalities clearly. MRI is used when soft tissue problems like labral tears, tendinitis, or early avascular necrosis are suspected. In cases where referred pain from the spine is likely, nerve conduction studies can measure whether a spinal nerve is being compressed.