Hip Pain: Causes, Symptoms & Treatment Options

What Are the Most Common Causes of Hip Pain?

The most common causes of hip pain include osteoarthritis (wear and tear of joint cartilage), bursitis (inflammation of fluid-filled sacs around the hip), tendinitis, muscle strains, and labral tears. In older adults, osteoarthritis is the leading cause, affecting 10-25% of people over 60. Other causes include referred pain from the lower back, hip fractures, and inflammatory conditions.

Hip pain can arise from numerous structures in and around the hip joint. The hip is a ball-and-socket joint where the rounded head of the femur (thigh bone) fits into the acetabulum (hip socket) of the pelvis. This design allows for a wide range of motion while bearing significant weight, making it vulnerable to various conditions. Understanding the anatomy helps identify why different conditions cause pain in specific locations.

The hip joint is surrounded by strong muscles, tendons, and ligaments that provide stability and enable movement. Additionally, small fluid-filled sacs called bursae cushion the bones, tendons, and muscles around the joint. Any of these structures can become a source of pain. The hip's proximity to the lower spine also means that back problems frequently cause referred pain to the hip area, sometimes making diagnosis challenging.

Age plays a significant role in determining the likely cause of hip pain. In younger individuals, sports injuries, muscle strains, and conditions like hip labral tears are more common. In middle-aged and older adults, degenerative conditions like osteoarthritis become predominant. Women are more likely to experience certain conditions such as trochanteric bursitis and osteoarthritis, particularly after menopause when hormonal changes affect bone and joint health.

Hip Osteoarthritis

Osteoarthritis is the most common form of arthritis affecting the hip and the leading cause of hip pain in adults over 50. This condition develops when the protective cartilage that cushions the ends of bones gradually wears down over time. As the cartilage deteriorates, the bones may begin to rub against each other, causing pain, stiffness, and reduced range of motion. The condition typically develops gradually over years.

Risk factors for hip osteoarthritis include age, family history, previous hip injury, obesity, and certain occupations involving repetitive hip stress. Women are more commonly affected than men, particularly after age 50. The condition causes deep, aching pain typically felt in the groin or front of the thigh that worsens with activity and improves with rest. Morning stiffness lasting less than 30 minutes is characteristic.

Bursitis

Bursitis occurs when the bursae become inflamed. The most common type affecting the hip is trochanteric bursitis, which causes pain on the outer (lateral) side of the hip. This condition frequently affects middle-aged women and is often associated with activities that involve repetitive hip motion, direct trauma to the hip, or prolonged pressure from lying on one side.

The hallmark symptom of trochanteric bursitis is tenderness over the outer hip that may radiate down the thigh. Pain typically worsens when lying on the affected side, climbing stairs, or getting up from a seated position. Unlike hip joint arthritis, which causes groin pain, bursitis pain is felt on the outer hip.

Tendinitis and Muscle Strains

Hip tendinitis involves inflammation of the tendons connecting muscles to the hip bones, commonly affecting the hip flexors, hamstrings, or adductors. Muscle strains occur when these muscles are overstretched or torn, often during sports or sudden movements. Both conditions cause localized pain that worsens with specific movements and improves with rest.

Hip Labral Tears

The labrum is a ring of cartilage around the hip socket that helps stabilize the joint and seal it. Labral tears can result from trauma, repetitive motions (common in athletes), or structural abnormalities like hip impingement. Symptoms include deep groin pain, clicking or catching sensations in the hip, and stiffness.

Referred Pain from the Lower Back

Problems in the lumbar spine, such as disc herniation, spinal stenosis, or sacroiliac joint dysfunction, can cause pain that radiates to the hip and buttock area. This referred pain can sometimes be difficult to distinguish from primary hip problems, making a thorough examination essential for accurate diagnosis.

What Are the Symptoms of Hip Problems?

Hip problem symptoms include pain in the groin, outer hip, or buttock, stiffness (especially in the morning), reduced range of motion, limping, clicking or catching sensations, and pain that worsens with activity. Night pain, inability to bear weight, and sudden severe pain are warning signs requiring prompt medical evaluation.

The symptoms of hip problems vary depending on the underlying cause, but certain patterns can help identify the source. Pain is the most common symptom and its location provides important diagnostic clues. Hip joint problems typically cause groin pain, while conditions affecting the outer hip structures cause lateral pain. Understanding these patterns helps both patients and healthcare providers identify the likely cause.

Stiffness is another hallmark symptom, particularly in arthritis. People with hip osteoarthritis often experience morning stiffness that typically improves within 30 minutes of movement. In contrast, inflammatory conditions like rheumatoid arthritis may cause prolonged morning stiffness lasting over an hour. Stiffness may also develop after periods of inactivity, a phenomenon sometimes called "gelling."

Reduced range of motion progressively limits daily activities. Early hip arthritis may first affect internal rotation, making it difficult to put on socks or shoes. As the condition advances, other movements become limited, eventually affecting walking, climbing stairs, and getting in and out of chairs or cars. This limitation often leads to compensatory movement patterns that can cause secondary problems in the back, knee, or opposite hip.

Pain Patterns and Their Significance

The pattern of hip pain provides valuable diagnostic information. Pain that worsens with activity and improves with rest typically indicates mechanical problems like osteoarthritis or bursitis. Pain that is worse at night or at rest may suggest inflammatory conditions, infection, or more serious pathology that warrants prompt evaluation. Pain that occurs immediately upon weight-bearing suggests joint surface problems.

Radiating pain that travels down the leg may indicate nerve involvement, either from the hip or referred from the lower back. Pain that shoots below the knee is more likely to originate from the spine than the hip joint itself. Numbness, tingling, or weakness accompanying hip pain suggests nerve compression that requires evaluation.

Mechanical Symptoms

Clicking, catching, or locking sensations in the hip often indicate labral tears or loose bodies within the joint. A sensation of the hip "giving way" may suggest muscular weakness or instability. Audible grinding (crepitus) during movement is common in advanced osteoarthritis. While these mechanical symptoms can be alarming, they don't always indicate severe problems and may occur in healthy hips as well.

When Should You See a Doctor for Hip Pain?

See a doctor for hip pain if it persists beyond 2 weeks despite home treatment, started after an injury, prevents weight-bearing, includes fever, causes significant night pain, or limits daily activities. Seek emergency care for sudden severe pain, inability to move the hip, visible deformity, or signs of infection like fever with joint swelling.

Mild hip pain that develops gradually and responds to rest and over-the-counter medications can often be managed at home initially. However, certain characteristics of hip pain warrant medical evaluation to rule out serious conditions and prevent progression. Knowing when to seek care helps ensure timely diagnosis and treatment.

The duration of symptoms is an important consideration. While acute muscle strains and minor injuries typically improve within one to two weeks with conservative care, pain persisting beyond this timeframe suggests a condition requiring professional assessment. Early intervention for conditions like osteoarthritis can slow progression and improve long-term outcomes.

Pain severity and its impact on function guide decision-making. Pain that interferes with sleep, prevents normal walking, or limits basic activities like dressing warrants evaluation. Similarly, pain requiring frequent or increasing use of pain medications should prompt a medical visit to identify the underlying cause and develop an appropriate treatment plan.

Situations Requiring Urgent or Emergency Care

Certain presentations require immediate medical attention. Hip pain following trauma, especially in older adults, may indicate fracture even if the injury seems minor. People with osteoporosis can fracture their hip from falls from standing height or even from twisting movements. Hip fractures require urgent surgical treatment for best outcomes.

Hip pain accompanied by fever, chills, or general illness may indicate septic arthritis (joint infection), which is a medical emergency requiring immediate treatment to prevent permanent joint damage. Redness, warmth, and swelling around the hip joint with fever are particularly concerning signs. Immunocompromised individuals, those with diabetes, and people with artificial joints are at higher risk.

Making the Most of Your Medical Visit

Preparing for your appointment helps ensure efficient and accurate evaluation. Consider documenting your pain patterns, including when it started, what makes it better or worse, and how it affects your daily activities. Bring a list of all medications and supplements you take, and note any relevant medical history including previous hip or back problems.

How Is Hip Pain Diagnosed?

Hip pain is diagnosed through a combination of medical history, physical examination, and imaging studies. X-rays reveal bone changes and arthritis severity. MRI shows soft tissue problems like labral tears, cartilage damage, and muscle injuries. Blood tests may be ordered if infection or inflammatory arthritis is suspected. Physical exam includes range of motion testing and specific maneuvers to identify the pain source.

Accurate diagnosis of hip pain begins with a thorough medical history and physical examination. Your doctor will ask detailed questions about your pain characteristics, how it started, what aggravates or relieves it, and how it affects your daily activities. Past medical history, family history of joint problems, occupation, and activity level all provide important diagnostic clues.

The physical examination assesses hip range of motion, strength, and identifies specific pain patterns. Your doctor will observe your gait (walking pattern), check for leg length differences, and palpate (press on) various structures around the hip to identify tender areas. Specific examination maneuvers can help distinguish between hip joint problems, bursitis, and referred pain from the spine.

Range of motion testing is particularly important. Hip osteoarthritis typically causes early limitation of internal rotation, while maintaining relatively preserved range in other directions until advanced stages. Loss of motion in multiple directions suggests more advanced disease. Comparing both hips helps identify asymmetry and disease severity.

Imaging Studies

X-rays are usually the first imaging study for hip pain and can diagnose most common conditions. They show the bones clearly and reveal osteoarthritis through joint space narrowing, bone spurs (osteophytes), and changes in bone density. X-rays also detect fractures, hip dysplasia, and certain tumors. Standing X-rays may better show weight-bearing changes.

MRI (Magnetic Resonance Imaging) provides detailed images of soft tissues including cartilage, labrum, muscles, tendons, and ligaments. MRI is particularly useful for diagnosing labral tears, avascular necrosis, stress fractures, and soft tissue injuries not visible on X-rays. MRI may be recommended when symptoms don't match X-ray findings or when soft tissue pathology is suspected.

CT scans may be useful for assessing complex fractures or bony abnormalities in greater detail than X-rays. Ultrasound can evaluate tendons, bursae, and guide injections. Bone scans may help identify stress fractures, infections, or metastatic disease when other imaging is inconclusive.

Laboratory Tests

Blood tests are not routinely needed for typical hip osteoarthritis but may be ordered when inflammatory arthritis, infection, or systemic disease is suspected. Tests may include inflammatory markers (ESR, CRP), rheumatoid factor, anti-CCP antibodies for rheumatoid arthritis, uric acid for gout, and complete blood count. Joint fluid analysis (from hip aspiration) may be needed to diagnose infection or crystal-related arthritis.

How Is Hip Pain Treated?

Hip pain treatment follows a stepwise approach starting with conservative measures: physical therapy and exercise, weight management, activity modification, and pain medications like acetaminophen or NSAIDs. If conservative treatment fails, options include corticosteroid injections, hyaluronic acid injections, and ultimately hip replacement surgery for severe cases. Treatment is individualized based on the specific diagnosis, severity, and patient goals.

The treatment approach for hip pain depends on the underlying cause, severity, and individual patient factors. For most conditions, treatment begins with conservative (non-surgical) measures that can effectively manage symptoms in many patients. The goal is to reduce pain, improve function, and slow disease progression while minimizing side effects.

A comprehensive treatment plan typically combines multiple approaches. Exercise and physical therapy form the foundation of treatment for most hip conditions, supported by weight management in overweight individuals, appropriate use of medications, and activity modification. This multimodal approach is more effective than any single treatment alone and helps patients take an active role in managing their condition.

Treatment goals should be discussed and agreed upon with your healthcare provider. For some patients, the primary goal may be pain relief, while others prioritize maintaining specific activities or avoiding surgery. Understanding your goals helps guide treatment decisions and set realistic expectations.

Exercise and Physical Therapy

Exercise is one of the most effective treatments for hip osteoarthritis and many other causes of hip pain. Structured exercise programs can reduce pain by 40-50% and improve function significantly. Despite concerns that exercise might worsen joint damage, research shows that appropriate exercise does not accelerate arthritis and provides substantial benefits.

An effective exercise program for hip pain typically includes:

• Strengthening exercises for the hip and thigh muscles, particularly the gluteal muscles and quadriceps
• Flexibility exercises to maintain or improve range of motion
• Aerobic exercise like walking, swimming, or cycling for overall fitness and weight management
• Balance training to reduce fall risk, especially in older adults

A physical therapist can design an individualized program appropriate for your condition and fitness level. They can also teach proper exercise technique, provide manual therapy, and use modalities like heat or ultrasound if beneficial. Water-based exercise (aquatic therapy) is particularly helpful for those who find land-based exercise too painful initially.

Weight Management

For overweight individuals with hip pain, weight loss is one of the most impactful interventions. Every pound of body weight translates to approximately three to six pounds of force across the hip joint during walking. Losing just 5% of body weight (about 10 pounds for a 200-pound person) can significantly reduce hip pain and slow osteoarthritis progression.

Medications

Acetaminophen (Paracetamol) is often recommended as a first-line medication for mild to moderate hip pain. It has fewer side effects than NSAIDs but provides more modest pain relief. The maximum recommended dose should not be exceeded to avoid liver toxicity.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like ibuprofen, naproxen, or diclofenac reduce both pain and inflammation. They are more effective than acetaminophen for many patients but carry risks including stomach ulcers, kidney problems, and cardiovascular effects, particularly with long-term use. They should be used at the lowest effective dose for the shortest necessary duration.

Topical NSAIDs applied directly to the skin over the hip can provide relief with fewer systemic side effects, though absorption through the hip area is limited due to depth of the joint.

Injections

Corticosteroid injections can provide significant short-term pain relief for hip osteoarthritis and bursitis. The injection is typically performed under ultrasound or fluoroscopic (X-ray) guidance to ensure accurate placement. Relief may last weeks to months, though effects diminish with repeated injections. Most doctors limit injections to 3-4 per year due to concerns about potential joint damage with frequent use.

Hyaluronic acid injections (viscosupplementation) aim to supplement the joint's natural lubricant. Evidence for their effectiveness in hip osteoarthritis is mixed, and they are less commonly used in the hip compared to the knee.

Surgical Treatment

When conservative treatments fail to provide adequate relief, surgical options may be considered. The decision to proceed with surgery depends on pain severity, functional limitation, imaging findings, and patient preferences and health status.

Hip replacement (total hip arthroplasty) is one of the most successful surgical procedures in medicine. It involves replacing the damaged hip joint with artificial components made of metal, plastic, or ceramic. Hip replacement has a 95% success rate, with most patients experiencing significant pain relief and improved function. Modern implants typically last 15-20 years or longer.

Hip replacement is typically recommended for patients with:

• Severe hip pain that limits daily activities despite conservative treatment
• Significant X-ray evidence of hip arthritis
• Pain not adequately controlled with medications
• Substantial impact on quality of life

Hip arthroscopy is a minimally invasive procedure using small incisions and a camera to treat certain hip conditions, particularly labral tears and hip impingement in younger patients. Recovery is faster than hip replacement, but it is not appropriate for advanced arthritis.

What Can You Do at Home for Hip Pain?

Home management of hip pain includes rest and activity modification, ice for acute inflammation (15-20 minutes several times daily), heat for chronic stiffness, gentle stretching exercises, over-the-counter pain medications, maintaining healthy weight, proper sleeping position (pillow between knees), and avoiding activities that aggravate pain. Regular low-impact exercise like walking or swimming helps maintain joint health.

Many mild hip problems can be effectively managed at home, and self-care strategies are also important components of treatment for more significant conditions. Understanding appropriate home management can provide relief while avoiding measures that might worsen the condition.

Rest and activity modification are important initial steps for acute hip pain. However, complete bed rest is rarely recommended as it can lead to stiffness, weakness, and prolonged recovery. Instead, reduce activities that aggravate pain while maintaining gentle movement and gradually resuming normal activities as symptoms allow.

Applying cold packs (ice wrapped in a towel) to the hip for 15-20 minutes several times daily can help reduce acute inflammation and pain, particularly after activity or for conditions like bursitis. Heat application is often more helpful for chronic stiffness and muscle tension, promoting relaxation and blood flow. Some people find alternating between ice and heat beneficial.

Exercise and Stretching

Gentle stretching and strengthening exercises are crucial for long-term hip health. Key muscle groups to address include:

• Hip flexors: Often tight from prolonged sitting; gentle stretching helps relieve anterior hip pain
• Piriformis and gluteal muscles: Stretching these muscles can relieve buttock and outer hip pain
• Quadriceps and hamstrings: Balanced strength and flexibility support the hip joint
• Core muscles: A strong core provides stability and reduces stress on the hip

Start with gentle movements and gradually increase intensity as tolerated. Stop any exercise that causes sharp pain or significantly worsens symptoms. Exercises should produce mild discomfort at most, and pain should not persist after exercise.

Sleeping Position

Sleep position can significantly affect hip pain, particularly for those with bursitis or arthritis. Sleeping on your back distributes weight evenly and is often the most comfortable position. If you prefer sleeping on your side, place a pillow between your knees to keep the hips aligned and reduce strain. A supportive mattress that prevents excessive sinking also helps maintain proper alignment.

Weight Management and Nutrition

Maintaining a healthy weight is one of the most impactful self-care measures for hip pain. Even modest weight loss reduces joint stress significantly. A balanced diet rich in anti-inflammatory foods (fruits, vegetables, fish, whole grains) may provide additional benefits, though dietary supplements have limited evidence for osteoarthritis treatment.

Can Hip Pain Be Prevented?

While not all hip pain can be prevented, risk can be reduced through maintaining healthy weight, regular exercise to strengthen hip muscles and maintain flexibility, avoiding hip injuries through proper technique in sports and activities, wearing appropriate footwear, and addressing hip problems early before they progress. For those at risk, targeted exercise programs can delay or prevent hip osteoarthritis development.

Prevention of hip pain focuses on modifiable risk factors while recognizing that some causes, like genetics and aging, cannot be changed. A proactive approach to hip health can reduce the likelihood of developing problems and slow the progression of existing conditions.

Regular exercise is perhaps the most important preventive measure. Strong muscles around the hip absorb shock, stabilize the joint, and reduce stress on the cartilage. A balanced program including cardiovascular exercise, strength training, and flexibility work provides comprehensive joint protection. Exercise also helps maintain healthy weight, another key factor in hip health.

Preventing hip injuries requires attention to proper technique in sports and activities. This includes adequate warm-up before exercise, using appropriate equipment and footwear, gradually increasing training intensity, and avoiding overuse. Cross-training helps prevent repetitive stress injuries by varying the demands on the hip.

Lifestyle Factors

Prolonged sitting and sedentary lifestyle contribute to hip stiffness and weakness. If your work involves long periods of sitting, take regular breaks to stand, walk, and stretch. Ergonomic workspace setup can also reduce hip strain. Avoid crossing legs while sitting as this can stress the hip.

Footwear affects hip alignment and joint stress. Supportive shoes with good cushioning reduce impact forces transmitted to the hip. High heels alter pelvic position and may contribute to hip and back problems with prolonged use. For those with leg length differences, appropriate shoe modifications may help.

Early Intervention

Addressing hip symptoms early, before significant damage occurs, can improve long-term outcomes. Mild stiffness or occasional pain shouldn't be ignored as "just aging." Early treatment of conditions like hip impingement may prevent progression to osteoarthritis. Regular physical activity and maintaining joint mobility become increasingly important with age.

What Causes Hip Problems in Children?

Hip problems in children have different causes than adults. Common conditions include developmental hip dysplasia (detected in newborns), transient synovitis (viral-related hip inflammation), Perthes disease (affecting blood supply to the hip in children 4-10), and slipped capital femoral epiphysis (SCFE) in adolescents. Children with hip pain, limping, or refusal to walk should be evaluated promptly.

Hip problems in children require special attention because growing bones and joints respond differently than adult structures. Some conditions are unique to childhood, and early detection and treatment are often crucial for normal hip development. Parents should be aware of signs that warrant medical evaluation.

Developmental Dysplasia of the Hip (DDH)

DDH refers to a spectrum of hip abnormalities present from birth where the hip socket is too shallow, allowing the femoral head to slip partially or completely out of position. All newborns are screened for DDH through physical examination, and ultrasound is performed for babies at higher risk (family history, breech presentation, female infants).

Early detection is essential because treatment in the first few months of life (using a soft brace to hold the hips in proper position) is highly effective and minimally invasive. Delayed diagnosis may require more intensive treatment including surgery. Risk factors include family history, breech birth position, firstborn status, and female sex.

Transient Synovitis

Transient synovitis is the most common cause of sudden hip pain and limping in children aged 3-10 years. It typically follows a viral illness and causes hip inflammation. Children may limp, refuse to walk, or complain of hip or knee pain. The condition is benign and self-limiting, usually resolving within 1-2 weeks with rest and anti-inflammatory medication.

Perthes Disease

Perthes disease affects children (mostly boys) aged 4-10 years when the blood supply to the femoral head is temporarily disrupted. This causes bone death (avascular necrosis) followed by gradual regeneration. Symptoms include limping and hip or knee pain. Treatment aims to keep the femoral head properly positioned within the socket during healing, ranging from observation to bracing or surgery depending on severity and age.

Slipped Capital Femoral Epiphysis (SCFE)

SCFE typically affects adolescents during growth spurts, when the growth plate at the top of the thigh bone weakens and the femoral head slips backward. Risk factors include obesity, rapid growth, and certain hormonal conditions. Symptoms include hip or knee pain and limping, often with the affected leg turning outward. SCFE requires urgent surgical treatment to prevent further slipping and complications.