Hip pain has dozens of possible causes, and the single biggest clue to narrowing them down is where exactly you feel it. Pain in the front of the hip, pain on the outer side, and pain deep in the buttock each point to a different set of structures. Some causes are minor and resolve on their own; others need professional attention. Here’s a breakdown of the most common reasons your hip might hurt.
Location Tells You a Lot
The hip is the largest ball-and-socket joint in the body, surrounded by layers of muscle, tendon, and connective tissue, with major nerves running nearby. When something goes wrong in any of those layers, it registers as “hip pain,” but the location narrows the list considerably.
Front of the hip or groin: Pain here usually comes from the joint itself or the tendons that flex your hip. Common culprits include osteoarthritis, labral tears, impingement, stress fractures, and hip flexor strains. Occasionally, the pain is actually referred from something in the abdomen or pelvis.
Outer hip: Lateral pain, right over the bony bump you can feel on the side of your thigh, is most often caused by greater trochanteric pain syndrome. That umbrella term covers irritation of the bursa (a fluid-filled cushion), tendon problems in the gluteal muscles, and friction from the thick band of tissue that runs down the outside of your thigh.
Back of the hip or deep buttock: Posterior pain is frequently not the hip joint at all. It may come from the lower back, the sacroiliac joint, a tight or irritated piriformis muscle pressing on the sciatic nerve, or a hamstring tendon issue near where it attaches at the sit bone.
Osteoarthritis: The Most Common Cause Over 50
If you’re over 50 and feel a deep, achy stiffness in the groin or front of the thigh that’s worst first thing in the morning but loosens up within about an hour, osteoarthritis is the leading suspect. The cartilage lining the socket gradually wears down, leaving less cushion between the bones. Over time, the joint stiffens and loses range of motion, particularly the ability to rotate your leg inward or bring your knee to your chest.
Osteoarthritis develops slowly, often over years. Early on, it may only bother you after a long walk or a tough workout. As it progresses, it can interfere with everyday activities like putting on shoes or getting in and out of a car. X-rays can confirm the diagnosis, though many people have visible joint changes on imaging without much pain, and vice versa. Weight management, regular low-impact exercise (swimming, cycling, walking), and strengthening the muscles around the hip are the first-line approach. Joint replacement becomes an option when pain and lost function significantly affect quality of life.
Greater Trochanteric Pain Syndrome
This is the condition most people call “hip bursitis,” though the bursa itself is only part of the picture. The gluteal tendons that attach at the outer hip can become irritated or partially torn, especially in women over 40 and in runners who ramp up mileage too quickly. The hallmark is pain right on the outer hip that worsens when you lie on that side at night, climb stairs, or stand on one leg for a while.
A simple way to distinguish this from a joint problem: you can usually lift your leg straight up without pain, and rolling your hip in circles while lying down doesn’t reproduce the discomfort. Pressing directly over the bony prominence on the side of your thigh, however, is tender. Treatment typically starts with activity modification, targeted strengthening of the hip abductor muscles, and sometimes a corticosteroid injection for short-term relief.
Labral Tears and Impingement
The labrum is a ring of tough cartilage that lines the rim of the hip socket, helping to seal the joint and keep it stable. It can tear from a single injury, but more often it wears down gradually due to repetitive motion or an underlying shape problem in the joint called femoroacetabular impingement (FAI).
FAI comes in two forms. In one, a bump on the ball of the femur keeps it from rotating smoothly in the socket, grinding against the cartilage with certain movements. In the other, the socket itself has extra bone along its rim that pinches the labrum during deep bending or twisting. Many people have both. The classic symptom is a sharp, catching pain in the groin during activities that involve deep hip flexion, like squatting, sitting for long periods, or pivoting. You may notice a clicking or popping sensation, and the hip can feel like it’s about to give way.
Physical therapy focused on hip stability and movement mechanics is the starting point. For people who don’t improve, arthroscopic surgery to reshape the bone and repair the labrum has shown better quality-of-life scores than physical therapy alone in studies of around 650 patients followed for up to two years, though many people do well enough with conservative care to avoid surgery.
When the Problem Is Actually Your Back
One of the trickiest things about hip pain is that it frequently originates somewhere else entirely. The lumbar spine and the hip share overlapping nerve pathways, so a bulging disc or arthritic facet joint in your lower back can send pain straight into the buttock, outer hip, or groin. Sciatica, caused by compression of the sciatic nerve, often masquerades as deep posterior hip pain and may shoot down the back of the thigh.
A few patterns help separate the two. Pain from the spine often changes with sitting, bending forward, or coughing. It may come with numbness, tingling, or weakness below the knee. True hip joint pain, by contrast, tends to be felt in the groin, is provoked by weight-bearing activities, and doesn’t typically cause symptoms below the knee. If your provider suspects the back is the source, they’ll often test your hip range of motion in isolation. A hip that moves freely without reproducing your pain shifts suspicion toward the spine.
Nerve-Related Hip Pain
A compressed nerve near the hip can produce burning, tingling, or numbness rather than the deep ache of a joint or tendon problem. One common example involves a sensory nerve that runs under the ligament near your front hip bone. When that nerve gets pinched, often from tight clothing, weight gain, pregnancy, or prolonged standing, you feel burning or tingling on the outer thigh. The skin there may become so sensitive that even light touch is uncomfortable.
Deeper in the buttock, the piriformis muscle can tighten and squeeze the sciatic nerve, causing pain that radiates down the leg. This tends to worsen with prolonged sitting and may improve with stretching the hip into rotation. Both of these nerve-related conditions generally respond to removing the source of pressure, whether that means loosening a belt, losing weight, or doing targeted stretches.
Bone-Related Causes
Less common but more serious, avascular necrosis occurs when blood flow to the ball of the femur is reduced, causing the bone to gradually die and collapse. The biggest risk factors are long-term use of high-dose steroid medications and heavy alcohol use over several years. Both can cause fatty deposits that block the tiny blood vessels feeding the bone. A traumatic injury like a hip dislocation or fracture can also damage those vessels directly.
Early avascular necrosis may cause only mild groin pain with activity, making it easy to dismiss. As the bone weakens, the pain becomes constant and the joint surface can collapse, eventually requiring replacement. Early detection through MRI gives the best chance of preserving the joint.
Stress fractures of the femoral neck are another bone-related cause, most common in distance runners, military recruits, and people with low bone density. The pain is typically felt in the groin and worsens with impact activities like running or hopping on one leg.
Red Flags Worth Taking Seriously
Most hip pain is musculoskeletal and improves with time, activity changes, or physical therapy. But certain patterns warrant prompt evaluation. Hip pain after a fall or car accident, especially if you can’t bear weight or move the leg, needs emergency care to rule out a fracture. Pain accompanied by fever, chills, or redness over the joint could signal infection. Hip pain that wakes you from sleep every night, comes with unexplained weight loss, or doesn’t respond to any position change raises concern for something beyond a routine musculoskeletal issue. Persistent pain that lasts more than a few weeks, or that’s intense enough to change how you go about your day, is worth getting evaluated even in the absence of red flags.