Hip aching has a wide range of causes, from muscle strain and bursitis to arthritis and even referred pain from your lower back. Where exactly you feel the pain is one of the strongest clues to what’s behind it. About 14% of adults over 60 report significant hip pain on most days, but hip aching isn’t limited to older adults. Younger people frequently develop it from overuse injuries, muscle imbalances, or joint problems.
Where You Feel It Matters
The hip is a deep ball-and-socket joint surrounded by layers of muscle, tendons, and fluid-filled sacs called bursae. Pain can originate from inside the joint itself, from the soft tissues around it, or from somewhere else entirely. Pinpointing the location narrows the possibilities significantly.
Front of the hip or groin: Pain here often comes from inside the joint. In younger adults, the most common culprits are a labral tear (damage to the ring of cartilage lining the hip socket) or structural impingement where the bones of the joint rub abnormally. In older adults, osteoarthritis is more likely. Hip flexor strains and stress fractures can also produce pain in this area.
Outside of the hip: Lateral pain is most commonly caused by greater trochanteric pain syndrome, a group of conditions affecting the bony prominence on the outside of your upper thigh. This includes inflammation of the bursa, tendon irritation, or tears in the muscles that stabilize your pelvis. The pain typically flares with walking, sitting for long stretches, or lying on the affected side at night.
Back of the hip or buttock: Posterior pain frequently originates in the lower back rather than the hip itself. Lumbar disc problems, sacroiliac joint dysfunction, and sciatic nerve compression all refer pain into the buttock and down the leg. True hip-region causes include deep gluteal syndrome (where the sciatic nerve gets pinched by surrounding muscles) and hamstring tendon injuries near the sit bone.
Osteoarthritis: The Most Common Cause After 50
Osteoarthritis is the gradual wearing down of the cartilage that cushions the hip joint. It develops slowly, often over years, and worsens in stages. Early on, you might notice occasional stiffness or discomfort after activity. As the cartilage breaks down further, bone spurs can form and the space between the bones narrows. By the time cartilage loss is significant, everyday movements like walking, kneeling, or squatting cause pain and swelling.
The hallmark symptoms are pain in or near the hip joint, stiffness (especially in the morning or after sitting), audible clicking when you move, and a gradual loss of range of motion. The aching tends to feel deep and hard to pinpoint, centered in the groin or front of the thigh rather than on the outside of the hip. An X-ray is typically the first step in diagnosis. You can’t see cartilage on an X-ray, but a narrowed space between the hip bones signals cartilage loss. MRI is usually not needed to confirm the diagnosis.
Bursitis and Tendon Problems
Greater trochanteric pain syndrome is the leading cause of pain on the outside of the hip. It was traditionally called “hip bursitis,” but the problem often involves irritated or partially torn tendons in the gluteal muscles rather than just an inflamed bursa. It’s especially common in women and in runners or walkers who ramp up their mileage too quickly.
The defining feature is point tenderness right over the bony bump on the outside of your hip. Pressing on it reproduces the pain, and the ache can radiate down the outer thigh. Symptoms tend to worsen with activity, climbing stairs, crossing your legs, or sleeping on the affected side. Rotating your hip outward or resisting sideways leg movement often triggers the pain as well.
Muscle Strains
Your hip flexors, the muscles at the front of the hip that lift your knee, are a common source of aching. Strains happen when muscle fibers are pulled beyond their limit and tear. You don’t need to be an athlete for this to happen. Sudden exertion that’s harder than what you’re used to, like sprinting for a bus or jumping into a new workout, can strain a hip flexor. The pain is typically sharp at first and then settles into a deep ache in the front of the hip that worsens when you lift your knee or stretch the leg backward. Most mild to moderate strains improve within one to two weeks with rest and gradual return to activity.
Labral Tears
The labrum is a ring of tough cartilage that lines the rim of your hip socket, helping to hold the ball of the thighbone in place. When it tears, you may feel a catching, clicking, or locking sensation in the hip, along with deep groin pain. The mechanical symptoms are the key distinguishing feature. You might notice that certain positions, like twisting or squatting, trigger a sharp catch followed by a dull ache. Labral tears are common in athletes who do a lot of pivoting or deep hip flexion, but they can also develop from structural abnormalities or gradual wear. An MRI, sometimes with contrast dye injected into the joint, is the standard way to confirm the diagnosis.
When Your Back Is the Real Problem
One of the trickiest aspects of hip aching is that it may not be coming from the hip at all. A pinched nerve in your lower spine, known as radiculopathy, can send pain into your hip, buttock, and down your leg. A herniated disc is one of the most common causes. The disc bulges and presses on a nerve root where it exits the spinal column, producing pain that radiates into the hip region. Sciatica, which follows the sciatic nerve from the lower back through the buttock and down the leg, is a specific type of this problem.
If your hip aching gets worse when you bend forward, cough, or sneeze, or if it comes with numbness, tingling, or weakness in your leg, the source is more likely your spine than your hip joint. A physical exam can usually distinguish between true hip pathology and referred pain from the back, though imaging of both areas is sometimes needed.
Less Common but Serious Causes
Some causes of hip aching require prompt attention. Stress fractures of the femoral neck (the area just below the ball of the hip joint) develop from repetitive overuse, particularly in distance runners or people with weakened bones. The pain is often vague at first and worsens with weight-bearing activity. Avascular necrosis, where the blood supply to the head of the thighbone is disrupted and the bone begins to die, typically affects middle-aged and older adults. It can develop after prolonged use of certain medications or after a hip injury.
Hip fractures in older adults sometimes occur without dramatic trauma. A weakened bone from osteoporosis can fracture during a simple twist or even while standing. If you can’t bear weight on the leg, can’t move your hip, or your hip ache started after a fall or sudden impact, emergency evaluation is warranted.
How Hip Pain Is Evaluated
The standard starting point is a plain X-ray of the hip and pelvis. These two images together give a view of the joint space, bone alignment, and any signs of arthritis or fracture. If the X-ray doesn’t explain the pain and a soft tissue problem like bursitis or tendinitis is suspected, an MRI or ultrasound is the next step. For suspected labral tears or structural impingement, an MRI (sometimes with contrast injected into the joint) provides the clearest picture.
When both hip arthritis and back problems are present, it can be hard to tell which one is driving the pain. In those cases, a guided injection of numbing medication into the hip joint can help. If the injection temporarily eliminates the pain, the hip is the primary source.
Exercises That Help
For most non-surgical hip aching, a combination of stretching and strengthening exercises can reduce pain and improve function. The goal is to restore mobility in the joint while building strength in the muscles that support it, particularly the glutes.
Stretching exercises to do daily:
- Knee to chest: Lie on your back, bend one knee, and gently pull it toward your chest. This stretches the buttock and back of the hip.
- Standing IT band stretch: Stand next to a wall, cross the leg closest to the wall behind the other, and lean your hip toward the wall. You’ll feel a stretch along the outside of the hip.
- Seated rotation stretch: Sit with legs straight, cross one leg over the other, and twist toward the bent leg to open the deep hip muscles.
- Hamstring stretch: Lie on your back, lift one leg, and clasp your hands behind the thigh, gently pulling the leg toward you.
Strengthening exercises to do two to three times per week:
- Clamshell: Lie on your side with knees bent at 90 degrees, keep your feet together, and lift the top knee. This targets the gluteal muscles that stabilize your pelvis.
- Side-lying hip abduction: Lie on your side with the affected leg on top, keep it straight, and slowly raise it to about 45 degrees.
- Prone hip extension: Lie on your stomach with a pillow under your hips, bend one knee to 90 degrees, and lift the leg straight up to engage the gluteus maximus.
Start with low repetitions and increase gradually. If any exercise causes sharp pain or makes your symptoms worse, stop and try a gentler variation. Persistent hip aching that doesn’t improve after a few weeks of consistent home management, or pain intense enough to change your daily routine, warrants a professional evaluation.