Hip pain

Medically reviewed by Dr. K. G. Gopalakrishna, Consultant Orthopaedic Surgeon · Last reviewed: August 2026

The hip is a deep ball-and-socket joint, built for stability as much as movement, which is why hip pain can show up in different places depending on what's actually involved - sometimes it's felt in the groin, sometimes on the outer hip, sometimes in the buttock. Understanding which "hip pain" you actually have is the first step, since the causes and treatment differ quite a bit depending on where it's coming from.

What's actually there

The hip joint is the femoral head (the ball at the top of the thigh bone) sitting inside the acetabulum (the socket in the pelvis). A ring of cartilage called the labrum lines the socket for extra stability. Around the joint sit the muscles that actually cause most "hip pain" complaints - the gluteus medius and gluteus maximus (buttock muscles, also key hip stabilizers), the iliopsoas (the main hip flexor, at the front), and the piriformis (a small deep muscle that can irritate the nearby sciatic nerve when tight or inflamed).

Common causes

• Wear-related: Osteoarthritis of the hip joint itself, usually felt as deep groin pain, worse with prolonged walking or after sitting.
• Injury-related: A fall, especially in older adults, can fracture the femoral neck - a genuine emergency. Younger, active people can tear the labrum from twisting movements.
• Inflammatory or overuse: Gluteal tendinopathy (irritation where the gluteus medius attaches to the outer hip bone) causes lateral hip pain, common in middle age, especially with hip-hitching walking patterns or lying on that side at night. Bursitis is a related overuse cause.
• Referred pain: The hip and lower back share nerve pathways closely. Genuine spine problems - a pinched nerve, sciatica - can present as hip or buttock pain with no actual damage in the hip joint at all.
• Gym and training-related: Heavy squats, deadlifts, and hip thrusts can strain the hip flexors or glutes, particularly when weight is increased before technique and warm-up are properly in place.

What it tends to feel like

Groin pain, worse with walking and improved by rest, points toward the joint itself (arthritis or labral issues). Pain over the outer point of the hip, especially when lying on that side or after prolonged walking, points toward the gluteal tendons rather than the joint. Pain that runs down the back of the leg, sometimes with tingling, points toward the piriformis or the spine rather than the hip joint at all.

When to seek care urgently

• After a fall, you cannot bear weight on the leg at all
• The leg appears shortened or rotated outward after an injury (a classic sign of hip fracture)
• Sudden, severe pain with no clear cause
• The joint area is hot, red, and rapidly swelling

What's usually tried first

• Activity modification - reducing movements that provoke pain without becoming completely inactive
• Physiotherapy focused on strengthening the gluteal muscles, which stabilize the joint and often relieve outer-hip pain specifically
• Weight management, since hip joint load increases significantly with body weight during walking
• A walking aid temporarily, if pain is affecting your gait
• Anti-inflammatory medication for flare-ups
• For gluteal tendinopathy or early arthritis, injections can meaningfully reduce pain and buy time

Myths vs facts

• Myth: All hip pain means arthritis.
  Fact: A large share of hip pain, especially on the outer hip, comes from tendon irritation or referred back pain, not joint damage at all.
• Myth: A clicking or snapping sound in the hip means something is tearing.
  Fact: This is usually a tendon moving slightly over a bony prominence, harmless on its own unless paired with actual pain.

When surgery enters the conversation

If a femoral neck fracture is confirmed after a fall, surgery - either fixation or replacement depending on the break - is usually necessary and often urgent, particularly in older adults. Total hip replacement for arthritis is considered only when imaging confirms significant joint damage, pain persists despite the options above, and daily activities or sleep are meaningfully affected. It is not the first response to hip pain, and gluteal tendinopathy or referred back pain - the more common causes - are not treated with hip replacement at all.

Recovery from a planned hip replacement, broadly:

• Week 1: walking short distances with a frame or crutches, pain managed with medication.
• Weeks 2-6: progressing to a stick, physiotherapy focused on regaining full range of motion.
• Months 2-6: building strength and confidence, most people returning to normal daily activity and gentle exercise.

Looking after your hip

• Keep the gluteal muscles strong through regular activity, even without existing pain
• Maintain a healthy weight to reduce load through the joint
• Avoid lying on one side for very long periods if you notice outer-hip discomfort at night
• Get persistent lower back issues checked, since they can masquerade as hip pain
• Warm up hip flexors and glutes properly before heavy lower-body lifts, and build up weight gradually rather than rushing technique
• Don't ignore a fall in an older adult, even if walking still seems possible afterward

FAQs: questions worth asking your doctor