Hip pain has dozens of possible causes, and the single best clue to narrowing them down is where exactly you feel it. Pain in the front of your hip points to a different set of problems than pain on the outer side or deep in the buttock. Your age, activity level, and how the pain started also matter. Here’s a practical walkthrough of the most likely explanations.
Where You Feel It Matters Most
Doctors sort hip pain into three zones: anterior (front of the hip or groin), lateral (outer hip), and posterior (back of the hip or deep in the buttock). Each zone maps to a different group of structures, so pinpointing your pain location is the fastest way to figure out what’s going on.
Front or groin pain typically involves the joint itself. The most common culprits are osteoarthritis, hip impingement, labral tears, and flexor tendon problems. Less commonly, a stress fracture in the femoral neck or a loss of blood supply to the bone (avascular necrosis) can produce deep groin aching.
Outer hip pain almost always comes from the soft tissues around the bony bump on the side of your thigh. This cluster of problems, collectively called greater trochanteric pain syndrome, includes bursitis, gluteal tendon disease, and iliotibial band friction. It’s the most common reason people say “my hip hurts when I lie on my side.”
Back-of-hip pain is the trickiest because it’s often referred from somewhere else. Your lower back, sacroiliac joint, or sciatic nerve can all send pain into the buttock and be mistaken for a hip problem. Hamstring tendon issues and a condition called deep gluteal syndrome, where the sciatic nerve gets trapped under the muscles, also live in this zone.
Osteoarthritis: The Most Common Cause Over 50
If you’re over 50 and your hip aches deep in the groin, stiffens up after sitting, and gradually limits how far you can move your leg, osteoarthritis is the leading suspect. The cartilage lining the joint wears down over time, and the bones respond by forming small spurs. You may notice a grating or crunching sensation when you move the hip, stiffness first thing in the morning that eases within 30 minutes, and pain that gets worse with activity and better with rest.
A standard X-ray is usually enough to confirm the diagnosis. It will show narrowing of the joint space, bone spur formation, and changes in the bone surface. Not everyone with arthritis on an X-ray has significant pain, though, and not everyone with significant pain has dramatic X-ray findings. The correlation is imperfect, which is why doctors weigh your symptoms alongside the images.
Mild to moderate hip arthritis responds well to strengthening exercises, weight management, and anti-inflammatory medication. When the pain becomes severe enough to interfere with sleep or daily activities, hip replacement is remarkably effective. A large review published in The Lancet found that 85% of hip replacements are still functioning well at 20 years.
Hip Impingement and Labral Tears
Hip impingement is the leading cause of hip pain in active adults under 50. It happens when extra bone growth on the thighbone, the hip socket, or both causes the joint to pinch during movement. There are two types: one involves a bump on the thighbone (cam type), and the other involves the socket rim extending too far over the ball (pincer type). Many people have a combination of both.
The pinching creates a characteristic sharp, catching pain in the groin when you bring your knee toward your chest, sit in low chairs, or twist. Over time, the repeated friction can tear the labrum, a ring of cartilage that lines the rim of the socket and helps seal the joint. Labral tears cause clicking, locking, or a feeling of the hip “giving way,” along with a deep ache that’s hard to localize.
An X-ray can reveal the bony abnormality, but the labral tear itself usually requires an MRI to see. Treatment ranges from physical therapy and activity modification to arthroscopic surgery that reshapes the bone and repairs the labrum, depending on severity.
Greater Trochanteric Pain Syndrome
For years, any pain on the outer hip was called “trochanteric bursitis,” but the picture is more nuanced. The bursa (a fluid-filled cushion over the bone) is sometimes inflamed, but more often the real problem is degeneration or tearing of the gluteus medius tendon, which attaches right at that spot. This distinction matters because the treatments differ.
The hallmark is lateral hip pain that comes on gradually, though a fall or sudden increase in walking can trigger it. You’ll typically notice it when rising from a chair, standing for a long time, climbing stairs, or lying on the affected side at night. If the tendon is partially or fully torn, you may also notice weakness when pushing your leg out to the side, or a limp that develops after walking a while.
Strengthening the hip abductor muscles is the cornerstone of treatment for both bursitis and tendon problems. Lying on your side and slowly lifting the top leg (hip abduction) is one of the most effective exercises, starting with body weight and gradually adding resistance. A program of two to three sessions per week, combined with avoiding prolonged standing on one leg and crossing your legs, resolves most cases within a few months.
When the Problem Is Actually Your Back
One of the most overlooked explanations for hip pain is that it’s not coming from the hip at all. A herniated disc or narrowed nerve channel in the lower spine can compress nerve roots and send pain into the buttock, outer hip, or even the groin. This is radiculopathy, and when it involves the sciatic nerve, it’s called sciatica.
A few clues suggest your back is the real source. The pain often travels below the knee or into the foot. It may come with numbness, tingling, or weakness in the leg. And changing your back position (bending forward or arching backward) tends to shift the pain more than moving the hip joint itself. Sacroiliac joint dysfunction, where the joint connecting the spine to the pelvis becomes irritated, is another common mimicker that produces deep buttock pain easily confused with hip pathology.
Age-Specific Causes Worth Knowing
Hip pain looks different at different stages of life. In teenagers and young adults, hip dysplasia, a condition where the socket is too shallow to properly cover the ball, is a significant and often delayed diagnosis. Adolescents with dysplasia tend to have more severe forms because the soft tissues around the joint fail earlier under the abnormal load. The pain is typically a deep ache in the groin that worsens with activity and may have been dismissed as “growing pains” for years.
In young athletes, stress fractures of the femoral neck and labral tears from repetitive motion top the list. In adults over 65, osteoarthritis dominates, but a sudden onset of severe hip pain after a fall should always raise concern for a fracture, especially in anyone with osteoporosis.
How Hip Pain Gets Diagnosed
The process starts with your description of the pain: where it is, when it started, what makes it worse, and what makes it better. A physical exam checks your range of motion, strength, gait, and whether specific positions reproduce your pain. These findings alone can narrow the diagnosis considerably.
X-rays are the standard first imaging test. They’re fast, inexpensive, and excellent at showing arthritis, fractures, bone spurs, and dysplasia. If the X-ray looks normal but the pain persists, an MRI provides a detailed look at the soft tissues: the labrum, tendons, cartilage, and surrounding muscles. In some cases, an MRI with contrast injected into the joint gives the clearest picture of labral tears.
What You Can Do at Home
For most non-traumatic hip pain, a period of targeted exercise is the first and most effective step. The goal is stabilizing the joint by strengthening the muscles around it, particularly the gluteal muscles on the outside and back of the hip.
Hip abduction exercises (lying on your side and lifting the top leg) build the gluteus medius, which is the primary stabilizer of the pelvis during walking. Start with 8 repetitions using just your body weight and work up to 12 before adding resistance in one-pound increments. Do these two to three days per week. Bridges, clamshells, and standing hip circles also help. Consistency over weeks matters more than intensity on any single day.
Ice can help after activity if the area is sore. Avoiding positions that provoke the pain, like crossing your legs or sitting in very low seats, reduces irritation while the area heals. If home exercises don’t improve things within four to six weeks, or if the pain is severe, waking you at night, or accompanied by a limp, it’s worth getting an evaluation to identify the specific cause and match it to the right treatment.