Hip pain affects roughly 1 in 7 adults over 60, and the cause depends heavily on where you feel it, how it started, and what makes it worse. The hip is a deep ball-and-socket joint surrounded by layers of muscle, tendon, and connective tissue, so pain in the “hip area” can come from the joint itself, the soft tissues around it, or even your lower back. Pinpointing the location of your pain is the single most useful step in narrowing down what’s going on.
Where You Feel It Matters
Hip pain generally falls into three zones: the front (groin area), the outside of the hip, or the back near the buttock. Each zone points toward a different set of causes. Pain originating inside the hip joint itself almost always shows up in the front, typically as a deep ache in the groin or inner thigh. If your pain is on the outer side of the hip, especially near the bony point you can feel when you press, the problem is more likely in the tendons or bursae surrounding the joint rather than inside it. And posterior pain, felt in the buttock or wrapping around behind the hip, often traces back to the lower spine, the sciatic nerve, or the hamstring tendons.
This isn’t a perfect rule. Hip osteoarthritis, for instance, usually starts as groin pain but can radiate into the thigh, buttock, or even the knee. Still, thinking about location first helps you and your doctor avoid chasing the wrong diagnosis.
Osteoarthritis: The Most Common Cause After 50
If you’re over 50 and noticing a gradual, worsening ache in your groin or thigh, osteoarthritis is the most likely explanation. The cartilage lining the hip socket wears down over time, leaving bone rubbing against bone. You might hear or feel grinding (called crepitus) when you move, notice stiffness first thing in the morning or after sitting for a while, and find that vigorous activity flares things up.
As the cartilage thins, the bones often respond by growing small spurs at the edges of the joint. On an X-ray, this shows up as a narrowed joint space and visible bony outgrowths. The progression is usually slow, over months to years, and symptoms tend to come and go before eventually becoming more persistent. Some people notice their hip aches more in cold or rainy weather.
Range of motion shrinks gradually. You may have trouble bending to tie your shoes, getting in and out of a car, or walking without a slight limp. These functional losses, not X-ray findings alone, are what ultimately guide treatment decisions.
Outer Hip Pain: Tendon and Bursa Problems
Pain on the outside of the hip is most often caused by a condition called greater trochanteric pain syndrome. This is an umbrella term that covers irritation or small tears in the tendons of the buttock muscles where they attach to the hip bone, inflammation of the fluid-filled cushions (bursae) in the same area, or friction from the thick band of tissue running down the outer thigh.
This type of pain is especially common in women and tends to flare when getting out of a chair or bed, walking up stairs, sitting for long stretches, or lying on the affected side at night. Risk factors include a sudden increase in activity, being overweight, having one leg slightly longer than the other, or compensating for foot problems like plantar fasciitis. Even recovery from hip or knee surgery can trigger it, because altered walking patterns place extra stress on the outer hip tendons.
Labral Tears and Impingement in Younger Adults
In younger, more active people, two closely related conditions account for a large share of hip pain: labral tears and femoroacetabular impingement. The labrum is a ring of tough cartilage that lines the rim of the hip socket, helping to seal and stabilize the joint. When it tears, you may feel a deep ache in the groin along with a clicking, catching, or locking sensation during certain movements.
Femoroacetabular impingement happens when the shape of the ball or socket causes the bones to pinch the labrum during movement, particularly during deep flexion, twisting, or squatting. Over time this repeated pinching can damage the labrum and, if left unaddressed, accelerate cartilage wear. The hallmark is groin pain that worsens with prolonged sitting, standing, walking, or athletic activity.
When the Pain Is Actually Coming From Your Back
One of the trickiest aspects of hip pain is that it frequently originates in the lumbar spine. A herniated disc or narrowing of the spinal canal can compress nerves that run through the hip and down the leg, producing pain that feels like it’s in the hip itself. Because the symptoms overlap so much, doctors sometimes struggle to determine whether the hip, the spine, or both are responsible.
A few clues can help sort this out. Spine-related pain tends to travel down the leg below the knee and may come with numbness, tingling, or weakness. True hip joint pain usually stays in the groin or thigh and worsens with weight-bearing activities like walking rather than with sitting or bending your back. Piriformis syndrome and other forms of deep gluteal syndrome, where muscles in the buttock compress the sciatic nerve, can produce similar radiating symptoms and are another common source of posterior hip pain.
Sacroiliac joint dysfunction, where the joint connecting your spine to your pelvis becomes inflamed or moves abnormally, is yet another cause of pain felt in the back of the hip or buttock.
Less Common but Serious Causes
A few conditions require prompt attention. Avascular necrosis occurs when blood flow to the head of the thighbone is disrupted, causing the bone to gradually die and collapse. It most commonly strikes middle-aged adults, and the pain centers on the groin, thigh, or buttock. Early on there may be no symptoms at all, but the pain typically builds from mild discomfort with weight-bearing to constant pain even at rest. The strongest risk factors are long-term use of high-dose corticosteroids (like prednisone), heavy alcohol use over several years, and a prior hip injury or dislocation. Certain medical conditions including sickle cell disease and lupus also raise risk.
Stress fractures of the femoral neck are another concern, particularly in runners or military recruits who dramatically increase training volume, and in older adults with osteoporosis. Hip fractures in older adults often follow a fall, but weakened bone can sometimes fracture with surprisingly little force.
Signs That Need Immediate Attention
Septic arthritis, an infection inside the joint, causes severe pain that comes on rapidly, along with swelling, warmth, skin color changes over the joint, and often fever. It can destroy cartilage quickly if untreated. Any sudden, intense hip pain paired with fever or an inability to bear weight warrants urgent evaluation. The same applies if you’ve had a hip replacement and develop new pain or a sense that the joint is loosening, even months or years after surgery.
Exercises That Help Most Hip Pain
For the majority of hip problems (osteoarthritis, tendinopathy, bursitis, mild impingement), a consistent exercise program targeting the muscles around the hip is one of the most effective treatments. The key muscle groups are the gluteal muscles in the buttock, the hip abductors on the outer thigh, the adductors on the inner thigh, the hamstrings, and the deep rotators like the piriformis. Strengthening these muscles takes load off the joint and stabilizes it during movement.
The American Academy of Orthopaedic Surgeons recommends a structured hip conditioning program lasting 4 to 6 weeks, done 2 to 3 days per week, starting with a 5 to 10 minute warm-up like walking or stationary cycling. Stretching before and after strengthening exercises helps maintain flexibility and reduce soreness. For strengthening moves like hip abduction (lifting the leg out to the side), start with a weight that allows 8 repetitions and build to 12 before adding weight in small increments. Stretches should be held for about 30 seconds per side.
After the initial recovery period, continuing these exercises as a maintenance routine protects the hip long-term. Consistency matters more than intensity.
When Surgery Becomes the Right Option
Hip replacement is considered when pain limits everyday activities like walking and bending, persists even at rest or at night, and hasn’t responded adequately to anti-inflammatory medications, physical therapy, or walking aids. The decision is based on how much the pain and stiffness affect your life, not on your age or what an X-ray looks like. Some people with significant joint damage on imaging function well without surgery, while others with moderate changes have pain severe enough to justify it.
For labral tears and impingement in younger patients, arthroscopic surgery to repair the labrum or reshape the bone is sometimes recommended when physical therapy hasn’t provided enough relief, particularly if mechanical symptoms like clicking and locking persist.