Pain that comes from the hip joint itself is mostly felt at the front, in the groin; the most common cause of pain on the outer side is greater trochanteric pain syndrome (bursitis), while pain in the buttock may be referred from the lower back [3]. See a doctor if the pain has not improved in two weeks, is getting worse, or is disturbing sleep and daily activities [1]. Severe pain and inability to walk after a fall, and a hot, swollen hip with a high temperature, need to be assessed without waiting [1].
Where is hip pain felt and where does it spread?
People do not all mean the same place when they say "hip pain"; where the pain is gives a clue to its cause [3]. Pain can also spread elsewhere: hip problems are sometimes felt in the thigh or knee [6], while sciatica, which arises from the lower back, runs from the buttock down the back of the leg, often as far as the foot [5]. The pain is usually in one of three areas [3]:
- At the front, in the groin: pain that comes from the hip joint itself is mostly felt here [3]
- On the outer side, over the bony point of the hip: the most common cause is greater trochanteric pain syndrome; the pain can spread down the outside of the thigh [2][3]
- At the back, in the buttock: pain referred from the lower back, entrapment of the sciatic nerve, or problems of the hamstring tendons [3]
What causes hip pain?
There are many possible causes of hip pain; it may be caused by a sudden injury or by a longer-lasting problem such as a joint disease (arthritis) [1]. In younger adults, pain from inside the joint is often due to the hip bones pinching against each other (femoroacetabular impingement) or a tear of the rim of the socket (the labrum); in older adults the most common cause of pain at the front of the hip is osteoarthritis [3]. The main causes are:
- Osteoarthritis: over 45 years of age, pain that is worse when walking and stiffness after moving [1]
- Sprain or strain, or tendonitis: pain, swelling or bruising after intense or repetitive exercise [1]
- Bursitis: pain that may spread to the thigh and may feel worse when moving or lying on that side [1]
- Rheumatoid arthritis: pain and stiffness that are worse after not moving, for example on waking [1]
- Joint infection (septic arthritis): a hot, swollen hip and a high temperature [1]
- Hip fracture: severe pain and being unable to walk after a fall or injury [1]
- Loss of blood supply to the head of the thigh bone (avascular necrosis) and stress fracture from overuse [3]
- Referred pain: problems of the lumbar spine can cause pain at the back; problems inside the abdomen, such as a hernia or pain arising from the bladder or the female reproductive organs, can cause pain at the front [3]
Pain on the outer side of the hip and hip bursitis
The most common cause of pain on the outer side of the hip is greater trochanteric pain syndrome; it covers tendon problems of the muscle at the side of the hip, bursitis and friction of the band that runs down the outside of the thigh [3], and it is often also called "trochanteric bursitis" [4]. It is more common in women and in middle-aged or older people [2]; it most commonly affects women aged 40 to 60 [3].
The pain is over the bony point on the outside of the hip and usually spreads down the outside of the thigh; it gets worse at night, when lying on that side, when getting up after sitting for a while, with prolonged walking, when climbing stairs and when squatting [2].
Many people can get relief by avoiding the activities that make the pain worse, with anti-inflammatory painkillers and with physiotherapy; a cortisone injection may give temporary (a few months) or permanent relief, and surgery is rarely needed [2]. In a trial of 204 people whose outer hip pain had lasted more than three months, a programme of education and exercise gave better results at eight weeks than a single cortisone injection or a wait-and-see approach; at one year overall improvement was still higher, while pain intensity was similar to that after the injection [4].
Pain coming from the lower back and the buttock
Pain felt in the buttock may be referred from somewhere else: with problems of the lumbar spine the pain is usually in both the lower back and the buttock [3]. Sciatica is irritation or compression of the sciatic nerve, which runs from the lower back to the feet; it usually affects the buttock and the back of one leg only (right or left), often including the foot, and can cause a sharp, burning pain, tingling, numbness or weakness [5]. Pain that arises from the back is assessed by the specialties that deal with disorders of the spine.
What helps hip pain? What you can do at home
If there has been no injury and none of the warning signs in the last section are present, the following measures can help to ease the pain; herbal mixtures are not among these recommendations [1]:
- Avoiding too much strain on the hip, while keeping moving without overdoing it
- An ice pack wrapped in a towel on the painful area for up to 20 minutes every 2 to 3 hours
- A painkiller if needed (gel or tablets); a pharmacist or doctor can advise which one is suitable
- Comfortable, shock-absorbing shoes with a soft sole
- Trying to lose weight if you are overweight
- Gentle stretching exercises for the hip
- Not carrying anything heavy and not sitting in low chairs
Which doctor should you see and how is it assessed?
See a doctor if the pain is stopping normal activities or affecting sleep, is getting worse or keeps coming back, has not improved after two weeks of measures at home, or if the hip is stiff for more than 30 minutes after waking [1]. Problems of the hip joint and of the bones, muscles and tendons around it are dealt with by the orthopaedics and trauma department.
The assessment starts with the history and an examination; the abdomen is also examined in case the pain is referred [3]. If imaging is done, the first test is usually an X-ray of the hip and pelvis taken standing; ultrasound or MRI may be needed for a definite diagnosis [3].
"Bone marrow oedema" in an MRI report means that the bone marrow is inflamed and full of fluid [7]. It is seen, for example, in transient osteoporosis of the hip: a rare condition that causes temporary bone loss in the upper part of the thigh bone; the pain increases with weight bearing and usually goes away within 6 to 12 months [7].
Treatment depends on the cause
Treatment depends on the cause; it can include painkillers, exercises, physiotherapy, walking aids such as a stick, cortisone injections and assessment by a specialist who discusses options such as surgery [1]. Some people with pain caused by a damaged hip joint may eventually need a hip replacement if other treatments do not help [1]. Osteoarthritis, hip replacement and hip fracture are separate topics; here they are mentioned only among the possible causes.
Hip pain and limping in a child
The most common cause of hip pain in children is a condition in which the hip joint becomes sore and inflamed, which usually gets better in 1 to 2 weeks and does not cause lasting problems (known in English as "irritable hip") [6]. Less common but more serious causes are joint infection (septic arthritis), an injury such as a broken bone, and Perthes' disease [6].
For this reason, sudden pain or limping in a child should be seen by a doctor without delay; in addition to the examination, an X-ray and sometimes a blood test or other scans may be requested [6]. Developmental dysplasia of the hip in babies is outside the scope of this article.
When not to wait
In the following situations seek care without delay; in the first three go to the emergency department or call an ambulance [1][5][6]:
- Severe hip pain after a fall or injury, or you cannot walk or put weight on the leg (this may be a hip fracture); do the same if an elderly relative cannot get up after a fall [1]
- Tingling or loss of feeling in the hip or leg after an injury [1]
- Sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or anus, or a new loss of bladder or bowel control [5]
- Severe hip pain that started suddenly without a fall or injury [1]
- The hip is swollen and hot, the skin around it has changed colour, or the pain comes with a high temperature and feeling generally unwell (this may be a joint infection) [1]
- A child with sudden pain in the hip, thigh or knee, a limp, or who cannot put weight on one leg [6]
Frequently asked questions
- Which department deals with hip pain?
- Problems of the hip joint and of the bones, muscles and tendons around it are dealt with by the orthopaedics and trauma department. If the pain is referred from the lower back or from organs inside the abdomen, it is assessed by the relevant specialty [3].
- How can hip pain be eased at home?
- Keeping moving without straining the hip, applying ice for up to 20 minutes every 2 to 3 hours, a painkiller if needed, soft-soled shoes and gentle stretching exercises can help to ease the pain [1]. See a doctor if there is no improvement within two weeks [1].
- What causes hip pain in women?
- Pain on the outer side of the hip (greater trochanteric pain syndrome) is more common in women and most commonly affects women aged 40 to 60 [2][3]. Pain arising from the female reproductive organs can also be felt at the front of the hip [3].
- What does hip pain when walking point to?
- Over the age of 45, pain that is worse when walking, with stiffness after moving, suggests osteoarthritis [1]. Pain on the outer side of the hip can also get worse with prolonged walking and climbing stairs [2]. If you cannot walk after a fall or injury, go to the emergency department [1].
- What does oedema in the hip joint on an MRI mean?
- Bone marrow oedema means that the bone marrow is inflamed and full of fluid [7]. It is seen on MRI in, for example, transient osteoporosis of the hip, in which the pain usually goes away within 6 to 12 months [7]. What the finding means for you is assessed by the doctor who examines you.
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Hip pain in adults. NHS (nhs.uk), 2025. nhs.uk
- Hip Bursitis. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Hip Pain in Adults: Evaluation and Differential Diagnosis. American Family Physician (Chamberlain R), 2021. pubmed.ncbi.nlm.nih.gov
- Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ (Mellor R, et al.), 2018. pubmed.ncbi.nlm.nih.gov
- Sciatica. NHS (nhs.uk), 2024. nhs.uk
- Hip pain in children (irritable hip). NHS (nhs.uk), 2024. nhs.uk
- Transient Osteoporosis of the Hip. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.