Hip Pain: Causes, Symptoms and Treatment Options

Written and medically reviewed by Dr Dinesh Sirisena
Consultant in Sports, Exercise & Musculoskeletal Medicine
Triaxis Sports & Joint Clinic

Hip pain may arise from the hip joint, surrounding muscles, tendons, bursae, bones or nerves. It can develop after an injury or gradually through sport, repetitive activity or age-related changes. Many conditions begin with non-surgical management. Following clinical assessment, options may include education, activity modification, rehabilitation and selected image-guided procedures where appropriate.

Key Points at a Glance

• Hip pain may be felt in the groin, outer hip, buttock, thigh or knee.
• Pain location can provide clues, but it does not confirm the diagnosis by itself.
• Common causes include muscle strains, tendon conditions, osteoarthritis, hip impingement and labral injuries.
• Lower-back and nerve conditions can sometimes cause symptoms around the hip.
• Running, golf, football, weight training and prolonged sitting may aggravate certain conditions.
• Not everyone with hip pain requires an X-ray, MRI or ultrasound scan.
• Many hip conditions begin with education, activity modification and rehabilitation.
• Significant trauma, inability to walk or rapidly worsening symptoms require prompt assessment.

What is hip pain?

Hip pain refers to discomfort arising from the hip joint or the surrounding bones, muscles, tendons, bursae, ligaments and nerves. Because pain may also travel from the lower back or pelvis, a clinical assessment often considers several nearby regions rather than examining the hip alone.

The hip is a ball-and-socket joint. The rounded head of the femur sits inside a socket in the pelvis called the acetabulum. Cartilage covers the joint surfaces, while a rim of cartilage called the labrum helps support the socket.

Several strong muscles and tendons surround the joint. These structures help with walking, balance, running, climbing stairs and changing direction.

Because the hip carries body weight during many daily activities, symptoms can affect mobility, exercise, work and sleep.

What does hip pain feel like?

Hip pain may feel aching, sharp, stiff, catching or burning. Some people notice discomfort only during movement, while others experience symptoms after sitting, when lying on one side or while getting out of a chair. The sensation depends on which structure may be involved.

Common symptoms include:

• Groin pain
• Outer hip pain
• Buttock pain
• Hip stiffness
• Clicking or catching
• Pain while walking
• Difficulty climbing stairs
• Pain after sitting
• Discomfort during running
• Pain while lying on one side
• Reduced hip movement
• Limping

Some people also experience pain around the thigh or knee even when the hip is the main source.

Where is hip pain usually felt?

Hip pain may occur in the groin, front of the hip, outer hip, buttock or upper thigh. Pain felt mainly in the groin often points towards the hip joint, while outer hip pain may involve surrounding tendons or bursae. However, these patterns can overlap.

Groin or front of the hip

Pain in this area may relate to the hip joint, hip flexor muscles, labrum or conditions such as femoroacetabular impingement.

Outer hip

Pain over the side of the hip may involve the gluteal tendons or tissues around the greater trochanter. It may become more noticeable when walking, climbing stairs or lying on that side.

Buttock

Buttock pain may arise from the hip, sacroiliac joint, muscles or lower back.

Thigh or knee

Hip joint conditions can sometimes cause discomfort in the thigh or knee. Therefore, assessment may include both regions.

Why does my hip hurt when I walk?

Walking places repeated load through the hip joint and surrounding muscles. Pain during walking may arise from a joint condition, tendon problem, muscle strain, bone injury or referred pain from the lower back. The timing, location and distance walked before symptoms begin can help guide assessment.

Possible patterns include:

• Groin pain with each step
• Outer hip pain after longer walks
• Pain when walking uphill
• Stiffness after starting to move
• Pain when taking longer strides
• Symptoms during single-leg loading
• Limping after activity

A sudden inability to place weight through the leg after a fall requires prompt medical attention.

Why does the outside of my hip hurt when I sleep?

Outer hip pain during side sleeping may occur when pressure compresses sensitive tendons or nearby soft tissues against the outer part of the thigh bone. This pattern is often associated with greater trochanteric pain syndrome, although other hip and lower-back conditions may cause similar symptoms.

Symptoms may also increase during:

• Stair climbing
• Long walks
• Standing on one leg
• Crossing the legs
• Running
• Carrying weight on one side
• Lying directly on the painful hip

Changing sleeping position or placing a pillow between the knees may reduce pressure for some people. However, persistent night pain should be assessed in context.

 

What causes hip pain?

Hip pain has many possible causes, including muscle strains, tendon conditions, joint changes, labral injuries, hip impingement, bursitis, fractures and referred pain. Some conditions begin suddenly after trauma, while others develop gradually through repeated loading or age-related changes.

Common causes include:

Muscle strain

Running, kicking, sudden direction changes or heavy lifting may overload muscles around the hip and groin.

Gluteal tendon conditions

The gluteal tendons attach around the outer hip and help control the pelvis during walking and running.

Greater trochanteric pain syndrome

This term describes pain arising from structures around the outer hip, commonly involving the gluteal tendons.

Hip osteoarthritis

Changes in the hip joint may cause groin pain, stiffness and reduced movement. Symptoms commonly develop gradually.

Femoroacetabular impingement

Differences in the shape of the hip bones may contribute to contact during certain movements. Some people experience groin pain, stiffness or clicking.

Labral injury

The labrum may become injured through trauma, repetitive loading or structural factors. Symptoms may include deep groin pain, clicking or catching.

Hip flexor or adductor conditions

These muscles may become painful after sprinting, kicking, repeated lifting or sudden changes in training load.

Bone stress injury

Repeated loading without adequate recovery can affect the bone. Runners and athletes with rapidly increased training may require assessment for this possibility.

Hip fracture

A fall or direct injury may cause a fracture, particularly in older adults. Severe pain and inability to walk require urgent review.

Referred pain

Conditions affecting the lumbar spine, nerves or sacroiliac joint can produce symptoms around the hip or buttock.

Who is more likely to develop hip pain?

Hip pain can affect people of any age. However, sports involving running, kicking, rotation or repeated changes in direction may increase hip loading. Previous injury, reduced strength, age-related joint changes and certain medical conditions may also contribute.

People commonly affected include:

• Runners
• Football players
• Golfers
• Tennis and badminton players
• Dancers
• Martial arts participants
• Weightlifters
• Gym users
• Manual workers
• People with previous hip injuries

Hip osteoarthritis becomes more common with age. In contrast, muscle injuries, hip impingement and labral conditions may also affect younger active individuals.

Can hip pain come from my lower back?

Yes. Lower-back joints, discs or nerves may refer pain into the buttock, outer hip, groin or leg. This can sometimes resemble a local hip condition. A clinical examination of the lower back, hips and nerve function may help identify the likely source.

Features that may suggest nerve involvement include:

• Tingling
• Numbness
• Burning pain
• Pain travelling below the knee
• Leg weakness
• Symptoms affected by spinal movement

However, hip and spine conditions can occur together. Therefore, the assessment should not rely on one symptom alone.

What activities may make hip pain worse?

Hip pain may become more noticeable during activities that increase load, compression or movement through the affected structures. The trigger varies according to the condition, so activity modification should focus on the relevant movement rather than require complete rest.

Common aggravating activities include:

• Running
• Deep squatting
• Climbing stairs
• Walking uphill
• Prolonged sitting
• Getting out of a low chair
• Crossing the legs
• Lying on one side
• Kicking
• Pivoting
• Heavy lifting
• Sudden increases in training

Modification may involve reducing the load, range, speed or frequency of an activity while maintaining comfortable movement where appropriate.

How is hip pain assessed?

Assessment usually begins with a discussion about the symptom pattern, injury history and activities that aggravate the pain. A physical examination then considers hip movement, muscle strength, joint function, walking and nearby areas such as the lower back and pelvis.

A clinical assessment may include:

• Medical history
• Pain-location mapping
• Hip range of motion
• Muscle-strength testing
• Tendon assessment
• Functional movement tests
• Walking or running assessment
• Neurological screening where appropriate
• Lower-back and pelvic examination
• Sporting and occupational history
• Review of previous imaging

Because several conditions have overlapping symptoms, the findings are considered together rather than relying on one test.

Do I need an X-ray, MRI or ultrasound scan?

Not everyone with hip pain requires imaging. The choice depends on the suspected condition, clinical findings and whether a scan is likely to influence management. A scan may show structural changes that do not always explain the person’s symptoms.

X-ray

An X-ray may help assess bone alignment, fractures and joint changes such as osteoarthritis.

MRI

MRI may provide information about the labrum, cartilage, tendons, muscles, bone and deeper joint structures.

Musculoskeletal ultrasound

Ultrasound may help assess gluteal tendons, bursae, hip flexor structures and selected superficial soft tissues. It can also support dynamic assessment and guide certain procedures.

CT scan

CT may be considered when detailed assessment of the bones is required.

The most suitable investigation should follow the clinical assessment rather than serve as routine screening.

What treatment options are available for hip pain?

Management depends on the underlying diagnosis, symptom duration, activity requirements and clinical findings. Many hip conditions begin with education, temporary activity modification and rehabilitation aimed at improving movement, strength and tolerance for daily or sporting activities.

Management options may include:

• Education about the condition
• Adjustment of aggravating activities
• Hip mobility exercises
• Progressive strengthening
• Gluteal and trunk conditioning
• Balance training
• Walking or running review
• Sport-specific rehabilitation
• Medication following medical advice
• Sports ultrasound where appropriate
• Selected image-guided procedures
• Surgical review where clinically indicated

Depending on the individual’s condition and clinical assessment, certain procedures may be considered as part of a broader management plan.

Can injections and ultrasound-guided procedures help hip pain?

Yes. Many hip conditions respond well to non-surgical, image-guided injections and procedures. Delivered under ultrasound or X-ray guidance for accuracy, these can reduce pain and, in many cases, support healing. The right option depends on the specific diagnosis.

Depending on the condition, options may include:

Corticosteroid (steroid) injection — a steroid injection settles inflammation and can be helpful for an acute flare of joint synovitis or bursitis around the hip. The effect can be temporary, so it is used selectively alongside rehabilitation.

Platelet-rich plasma (PRP) — PRP uses your own concentrated growth factors to support healing, and is often considered for hip osteoarthritis and labral injury, and for gluteal or hip-flexor tendon and muscle tears.

Hyaluronic acid (HA) — a lubricating gel injected into the hip joint that may ease pain and improve movement. It is often used for hip osteoarthritis and can be combined with treatment of a labral injury.

Tenex (ultrasound-guided percutaneous tenotomy) — a minimally invasive procedure that removes degenerated or calcified tendon tissue through a small probe, and may help chronic gluteal tendinopathy or tendon calcification that has not settled with other measures.

These treatments are delivered under ultrasound or image guidance for accuracy and are most effective as part of a broader plan that includes rehabilitation. The right choice depends on the diagnosis, and the potential benefits and limitations should be discussed beforehand.

The response varies between individuals, and an injection should not replace assessment of the underlying condition.

What exercises may help hip pain?

Exercises may help improve hip strength, movement and tolerance for walking or sport. However, there is no single programme for every type of hip pain. Exercise selection should reflect the diagnosis, current function and movements that aggravate symptoms.

A rehabilitation programme may include:

• Hip mobility exercises
• Gluteal strengthening
• Hip-flexor or adductor conditioning
• Trunk-control exercises
• Balance and single-leg training
• Walking progression
• Gradual return to running
• Sport-specific movement practice

Exercises should progress gradually. Repeated increases in pain, limping or loss of function may require adjustment and clinical review.

Can hip pain improve without surgery?

Many people with hip pain begin with non-surgical management and may improve through activity modification, rehabilitation and gradual return to function. However, recovery depends on the diagnosis, severity, duration and individual goals. Surgery is considered only for selected conditions and clinical indications.

Regular review may help monitor:

• Pain
• Hip movement
• Strength
• Walking
• Sporting function
• Response to rehabilitation
• Need for further investigation

Persistent symptoms do not automatically mean that surgery is required.

When should I seek medical assessment?

Seek assessment when hip pain persists, repeatedly returns or affects walking, work, exercise or sleep. Prompt medical review may be required after significant trauma, when the person cannot place weight through the leg or when symptoms include fever, marked swelling or rapidly worsening function.

Consider assessment if:

• Pain lasts several weeks
• Walking becomes difficult
• A limp develops
• Hip movement becomes restricted
• Pain regularly disturbs sleep
• Symptoms follow a fall
• Clicking or catching becomes painful
• Numbness or weakness develops
• Self-management has not helped

Urgent medical attention may be appropriate for severe pain after injury, visible deformity, inability to walk, a hot swollen joint, fever or sudden unexplained symptoms.

Assessment at Triaxis Sports & Joint Clinic

Triaxis Sports & Joint Clinic provides assessment for hip pain, lower-body injuries, sports-related conditions and other musculoskeletal concerns involving the pelvis, thigh and lower back.

Clinical assessment focuses on understanding symptom location, hip movement, strength, walking, activity demands and medical history. Depending on the findings, the assessment may include musculoskeletal examination, neurological screening, functional movement analysis, sports ultrasound where appropriate and review of previous imaging.

Patient education and shared decision-making form an important part of the consultation. Therefore, individuals can better understand the possible cause of their symptoms, whether further investigations may help and which management options may be appropriate following clinical evaluation.

Frequently Asked Questions About Hip Pain

Why does my hip hurt without an injury?

Hip pain may develop gradually through repetitive loading, tendon conditions, joint changes or referred pain from the lower back. A clear injury is not always present. The pain pattern and examination findings may help identify the likely structures involved.

Can hip pain be felt in the knee?

Yes. Hip joint conditions may sometimes cause pain in the thigh or knee. Therefore, persistent knee pain without a clear local cause may require assessment of the hip as well.

Is outer hip pain caused by bursitis?

Not always. Outer hip pain may involve the gluteal tendons and nearby tissues, with or without bursal irritation. Clinicians often use the term greater trochanteric pain syndrome to describe this group of symptoms.

Should I avoid walking when my hip hurts?

Not necessarily. Walking may remain appropriate after adjusting the distance, pace or terrain. However, severe pain, limping or worsening function may require assessment and a temporary change in activity.

Can prolonged sitting cause hip pain?

Prolonged sitting may aggravate some joint, tendon or muscle-related conditions. However, sitting alone does not explain every case, and persistent symptoms should be assessed in context.

Does clicking mean that I have a labral tear?

No. Clicking can occur for several reasons and may be painless. A painful click, catching sensation, instability or loss of function may require further assessment.

Do I need a hip replacement for osteoarthritis?

Not everyone with hip osteoarthritis requires joint-replacement surgery. Management may first include education, exercise, activity planning, medication or other options. Surgery may be considered when symptoms and functional limitations meet clinical criteria.

Can I exercise with hip pain?

Many people can remain active with suitable modifications. Exercise type and intensity should reflect the diagnosis, current symptoms and functional capacity. Activities that repeatedly cause limping or worsening pain may need adjustment.

About the Author

Dr Dinesh Sirisena is a Consultant in Sports, Exercise and Musculoskeletal Medicine. His clinical work includes the assessment and non-surgical management of sports injuries, joint conditions and musculoskeletal pain.

Medical Disclaimer

This page provides general educational information and does not replace an individual medical consultation. Hip pain can have different causes, and suitable investigations or management options depend on each person’s symptoms, medical history and clinical assessment.