Hip Pain: Causes by Location and Treatment

Hip pain by location

Pain from the hip joint often spreads down the front of the thigh to the knee. Some people, especially children, feel hip problems only in the knee.

Common causes of hip pain in adults

Osteoarthritis of the hip

The most common cause of groin pain after 50. Cartilage wears down, causing pain in the groin or thigh, stiffness after rest, difficulty putting on socks or shoes, and a limp. Pain usually builds over months to years. See arthritis of the hip.

Greater trochanteric pain syndrome (hip bursitis)

Pain and tenderness over the outer hip, worse when lying on that side, climbing stairs, standing on one leg or getting up from a low chair. It is especially common in women over 40. Most cases are due to gluteal tendon irritation rather than true bursitis. See hip bursitis.

Hip labral tear and impingement

The labrum is a ring of cartilage around the hip socket. A labral tear causes groin pain with clicking, catching or locking, often in active young adults. It is frequently linked to femoroacetabular impingement, where extra bone on the ball or socket pinches the labrum during deep bending.

Muscle and tendon strains

Groin (adductor), hip flexor and hamstring strains cause pain after sport, sprinting or kicking, with tenderness over the muscle.

Referred pain from the back

Lumbar spine problems, sciatica and sacroiliac joint dysfunction often cause buttock and "hip" pain, sometimes radiating down the leg below the knee.

Serious causes

• Hip fracture: usually after a fall in an older adult with osteoporosis. Pain in the groin, inability to stand, and a shortened, outward-turned leg. Some people can still walk with a small crack, so pain after a fall needs an X-ray.
• Stress fracture of the femoral neck: groin pain with running that worsens over weeks. A tension-side stress fracture can progress to a full break.
• Avascular necrosis: loss of blood supply to the femoral head, linked to steroids, heavy alcohol use, sickle cell disease and hip injury. Causes deep groin pain, sometimes at rest.
• Septic arthritis: a bacterial joint infection. A hot, extremely painful hip with fever. A surgical emergency.
• Inflammatory arthritis: rheumatoid arthritis and ankylosing spondylitis.
• Cancer: spread of cancer to bone, or rarely a primary bone tumor, causing persistent night pain.
• Non-hip causes: inguinal or femoral hernia, kidney stones, and pelvic or ovarian problems can cause groin pain.

Hip pain in children and teens

A limp or hip pain in a child always needs assessment:

• Transient synovitis: a temporary inflammation after a viral illness, aged 3 to 10. Usually settles within a week.
• Septic arthritis: fever, severe pain and refusal to move the leg. An emergency.
• Perthes disease: loss of blood supply to the growing hip, aged 4 to 10, with a painless or mildly painful limp.
• Slipped capital femoral epiphysis: the ball slips off the growth plate, aged 10 to 16, often in overweight children. Groin, thigh or knee pain and a limp. Needs urgent surgery.
• Developmental dysplasia of the hip: a shallow socket, sometimes first noticed as a limp.

Hip pain in women

Women are more likely to have greater trochanteric pain syndrome and hip dysplasia. Pregnancy loosens pelvic ligaments and can cause pelvic girdle pain felt at the front or back of the pelvis. Gynecological conditions such as endometriosis and ovarian cysts can cause pain felt in the groin or hip. After menopause, osteoporosis raises the risk of hip fracture.

Hip pain at night and when walking

• Night pain lying on the side: typical of trochanteric pain syndrome.
• Night pain at rest unrelated to position: can be advanced arthritis, avascular necrosis, infection or a tumor. Get it checked, especially with weight loss or fever.
• Pain when walking that eases with rest: arthritis, stress fracture, or, if in the buttock and calf, poor circulation (claudication) or spinal stenosis.

How hip pain is diagnosed

The doctor will ask where it hurts, how it started, what makes it worse and about falls, sport, steroids and alcohol. They will watch you walk, test hip rotation and strength, press over the outer hip and examine your back.

• X-ray: arthritis, fractures, dysplasia and impingement.
• MRI: labral tears, stress fractures, avascular necrosis and tendon problems.
• Ultrasound: tendons, bursitis and fluid in the joint, and to guide injections.
• Blood tests and joint aspiration: if infection or inflammatory arthritis is suspected.

Treatment and relief

Self-care

• Modify activity: reduce running, deep squats or stairs for a while, but keep moving.
• Pain relief: acetaminophen (paracetamol) or an NSAID such as ibuprofen or naproxen, following the label. Avoid NSAIDs with kidney disease, stomach ulcers or blood thinners.
• Ice or heat for 15 to 20 minutes.
• Sleep position: for outer hip pain, avoid lying on the painful side and place a pillow between the knees.
• Avoid crossing your legs and standing with weight on one hip.

Exercise and physical therapy

Strengthening the gluteal and core muscles is the most effective treatment for outer hip pain and helps arthritis. Programs usually take 6 to 12 weeks. Low-impact activities such as cycling, swimming and walking keep the joint moving.

Medical treatments

• Weight loss: even 5 to 10 percent reduces hip arthritis pain for many people.
• Walking aid: a cane held in the hand opposite the painful hip.
• Steroid injections for bursitis or arthritis flare-ups.
• Arthroscopy for selected labral tears and impingement.
• Total hip replacement for advanced arthritis, with excellent long-term results.
• Urgent surgery for fractures and slipped growth plates, and drainage for infection.

Frequently asked questions

When should I worry about hip pain?

Get emergency care after a fall if you cannot walk or put weight on the leg, and for a hot, swollen hip with fever. See a doctor soon for night pain at rest, a child's limp, hip pain with steroid or heavy alcohol use, or pain that limits walking or sleep for more than a few weeks.

How do I know if hip pain is from my back?

Pain mainly in the buttock, pain that spreads below the knee, numbness or tingling, and pain linked to bending or sitting suggest the back. Groin pain and pain on rotating the hip, such as putting on socks, suggest the hip joint itself. A doctor can test both.

What does arthritis pain in the hip feel like?

It is usually a deep ache in the groin or front of the thigh, sometimes reaching the knee. It is worse with walking and after rest, with stiffness in the morning lasting under 30 minutes. Over time, putting on shoes and getting in and out of cars becomes harder.

Why does my hip hurt at night?

The most common reason is greater trochanteric pain syndrome, where lying on the affected side compresses irritated tendons. Advanced arthritis also causes night pain. Constant night pain unrelated to position, especially with fever or weight loss, should be checked promptly.

Is walking good for hip pain?

Usually yes. Walking keeps the joint mobile and muscles strong, and helps arthritis pain over time. Pace yourself, use supportive shoes and a cane if needed, and break walks into shorter sessions. Stop and seek advice if walking causes sharp pain or a worsening limp.