Hip pain can take many different forms: a stabbing pain in the groin when standing up, pain on the side of the thigh that keeps you from sleeping on your side, pain in the buttock radiating down the leg, or stiffness that makes it hard to put on socks. Behind the single phrase "my hip hurts" there are many possible causes - from overload, through degenerative changes and inflammation, to problems with the spine or abdominal organs. In this article we describe in general terms what hip pain can be a symptom of, how the location of the pain helps a doctor narrow down the search, which symptoms require urgent help and what the diagnostic process looks like. We do not make diagnoses - we want you to know what the doctor will ask and when not to delay a visit.
This article is for informational purposes only and does not replace medical advice. If you have symptoms, consult a doctor.
Where exactly does the hip hurt?
In everyday language the word "hip" covers quite a large area - from the groin, through the side of the thigh, to the buttock and the sacral area. Meanwhile, the hip joint lies deep, at the front, near the groin. That is why one of the first things a doctor will ask about is the exact location of the pain.
| Where it hurts | Examples of possible sources (to be assessed by a doctor) |
|---|---|
| Groin, front of the hip | Hip joint (e.g. degenerative changes, femoroacetabular impingement, labral tear), inguinal hernia, hip flexor muscles, abdominal or gynecological causes |
| Side of the hip (trochanter area) | Trochanteric bursitis, gluteal tendon overload, iliotibial band |
| Buttock, back of the hip | Lumbar spine, sacroiliac joint, gluteal muscles, sciatic nerve irritation |
| Pain radiating to the knee | Hip joint (hip pain is sometimes felt in the knee), nerve roots from the spine |
| Pain running below the knee with numbness | More often nerve root irritation, e.g. in sciatica |
This table is only an approximation. Symptoms of different problems often overlap, and one person may have several causes at the same time.
What can hip pain be a symptom of?
Below we describe in general terms the most commonly mentioned causes. The diagnosis is always made by a doctor.
Degenerative changes of the hip joint
Hip osteoarthritis (coxarthrosis) is more common in older people, although it can appear earlier, e.g. after injuries or with congenital abnormalities of the joint structure. Typical signs include pain in the groin or the front of the thigh that gets worse with walking and standing up, morning stiffness that usually lasts a short time, difficulty putting on shoes and socks, and over time limited mobility and limping.
Trochanteric bursitis and tendon overload
On the side of the hip, over the protruding part of the thigh bone (the greater trochanter), there is a bursa and the attachments of the gluteal tendons. Overload or inflammation of these structures causes pain on the side of the hip, tenderness when pressing there, difficulty sleeping on your side and pain when climbing stairs. Today this is often referred to more broadly as greater trochanteric pain syndrome.
Lumbar spine problems
"Hip" pain is sometimes actually pain referred from the lumbar spine or nerve roots. In that case it is often accompanied by back pain, and when a nerve is irritated, also by pain radiating down the leg, tingling or numbness. We write more about this in our article on sciatica.
Sacroiliac joint
Pain in the buttock, below the belt line, on one side, that gets worse when changing position may be related to the sacroiliac joint. We describe this in more detail in the text on the sacroiliac joint.
Injuries and overload in active people
In people who play sports, hip or groin pain may result from a muscle strain (e.g. of the adductors or hip flexors), a labral tear, femoroacetabular impingement and, with high running loads, a stress fracture.
Inflammatory diseases and other causes
Hip pain can also accompany rheumatic diseases (e.g. rheumatoid arthritis or spondyloarthropathies), joint infections, avascular necrosis of the femoral head and, in children and teenagers, specific developmental conditions. Sometimes the source of the pain is the abdominal or pelvic organs: an inguinal hernia, kidney stones, bowel diseases and, in women, gynecological conditions.
When does hip pain require urgent help?
This is the most important part of this article. Some situations require an immediate medical assessment.
Go to the emergency room or call 112 immediately
- a fall after which you cannot stand on your leg or walk - especially in an older person or someone with osteoporosis (risk of a femoral neck fracture),
- a leg that is shortened or turned outward after a fall,
- sudden, very severe hip pain with a high fever and inability to move the leg,
- groin pain with a painful, hard bulge that cannot be pushed back, especially with nausea or vomiting (possible incarcerated hernia),
- pain with numbness in the groin area, problems urinating or passing stool, or increasing leg weakness,
- sudden pain and swelling of the whole leg, redness, warmth in the calf or thigh, especially with shortness of breath.
Urgent doctor's visit
- hip pain with fever, chills or a general feeling of being unwell,
- constant pain that gets worse at night and does not depend on movement,
- unexplained weight loss, a history of cancer,
- swelling, redness and warmth around the joint,
- hip or knee pain in a child or teenager, limping without an obvious cause.
It is also worth seeing a family doctor when the pain is not alarming but lasts longer than a few weeks, keeps coming back, limits walking or starts to affect your sleep.
What does the diagnosis of hip pain look like?
The diagnosis starts with a conversation. The doctor will ask, among other things:
- where exactly it hurts and whether the pain radiates,
- when it started and whether it was preceded by an injury, increased exertion or a new activity,
- what makes the pain worse and what eases it (walking, sitting, lying on your side, stairs),
- whether there is morning stiffness and how long it lasts,
- whether there are other symptoms: fever, abdominal complaints, problems urinating, skin changes, pain in other joints,
- what conditions you have and what medications you take.
During the examination the doctor assesses your gait, hip mobility in different directions, tenderness on pressure, muscle strength, as well as the lumbar spine and - if needed - the abdomen and groin. A hip examination almost always includes comparing both sides.
Additional tests
| Test | When it may be ordered |
|---|---|
| X-ray of the pelvis and hip joints | Suspected degenerative changes, fracture, abnormal joint structure |
| Ultrasound | Assessment of bursae, tendons, fluid in the joint, inguinal hernia |
| MRI | Suspected labral tear, avascular necrosis, stress fracture, spinal changes |
| Blood tests | Suspected inflammation, infection, rheumatic diseases |
| Other | Depending on symptoms, e.g. urinalysis, abdominal ultrasound, gynecological consultation |
Hip pain is most often diagnosed by a family doctor and an orthopedist, and depending on the symptoms also by a rheumatologist, neurologist, surgeon or gynecologist. Treatment, including any physical therapy, is determined by the doctor based on the specific cause.
How to prepare for a doctor's visit with hip pain?
Hip pain can be hard to describe, and doctors usually have limited time. Before your visit, it is worth preparing a short note:
- point with your finger to where it hurts most - groin, side of the thigh, buttock,
- write down when the pain appears: with the first steps in the morning, after walking for a long time, when sitting, at night, when lying on your side,
- describe your limitations - difficulty putting on shoes, getting into a car, climbing stairs,
- mention injuries and sports, including those from years ago,
- bring results of previous tests, e.g. X-ray or ultrasound, and a list of medications,
- note other symptoms - pain in other joints, morning stiffness, abdominal complaints, fever.
This makes it easier for the doctor to assess whether the source of the pain is the hip joint, the tissues around it, the spine or a completely different area.
Which daily habits matter with hip pain?
Habits will not replace diagnosis and treatment, but they affect how you load your joints every day. General rules worth discussing with a doctor or physical therapist:
- Movement within your comfort zone - regular walks, stationary cycling or swimming are a good form of activity for many people. Agree on the scope and type of movement with a specialist.
- Maintaining a healthy body weight - less load on the weight-bearing joints.
- Good footwear - stable, cushioned, without high heels for everyday wear.
- Sitting - a chair high enough that your knees are not higher than your hips; avoiding sitting cross-legged for long periods.
- Sleeping on your side - a pillow between your knees; with pain on the side of the hip, many people avoid lying on the painful side.
- Gradually increasing loads in sports - no sudden jumps in distance or intensity.
- A safe home - for older people: good lighting, no slippery rugs, grab bars in the bathroom to reduce the risk of falling.
We describe general rules for taking care of the lower spine in our article on the lumbar spine, and gentle stretching exercises in the text on stretching the lower back. Do every exercise without pain, and with hip complaints consult a doctor or physical therapist first.
Frequently asked questions
What can hip pain be a symptom of?
Among other things, degenerative changes of the hip joint, trochanteric bursitis, tendon overload, problems with the lumbar spine or sacroiliac joint, injuries, inflammatory diseases, as well as diseases of the abdominal and pelvic organs. The cause is determined by a doctor.
Pain on the side of the hip - what could it be?
Pain on the side of the hip that is tender to the touch and when lying on your side is often related to the greater trochanter area, e.g. bursitis or gluteal tendon overload. A diagnosis requires an examination by a doctor.
Hip pain radiating down the leg - is it the spine?
It may be, especially when the pain runs below the knee and is accompanied by numbness or tingling. Pain from the hip joint itself can also be felt in the thigh and knee. Telling them apart requires an examination.
When should you go to the emergency room with hip pain?
After a fall when you cannot stand on your leg, with sudden severe pain and a high fever, with a painful, hard bulge in the groin, numbness in the groin area or problems urinating, and also with sudden swelling of the whole leg with shortness of breath.
What kind of doctor should you see for hip pain?
Usually a family doctor first, who refers you to an orthopedist, rheumatologist, neurologist, surgeon or gynecologist if needed - depending on your symptoms.
Is hip pain at night worrying?
Pain when lying on your side is often related to the trochanter area. Constant pain that gets worse at night regardless of position is worrying, especially with fever or weight loss - in that case an urgent doctor's visit is needed.
What tests are done for hip pain?
The basis is a medical history and an examination. A doctor may order an X-ray, ultrasound, MRI or blood tests and, depending on the symptoms, also abdominal tests or specialist consultations.
Can you go for walks with hip pain?
Many people can and should stay active within their comfort zone, but it depends on the cause of the pain. If a fracture or infection is suspected, or after an injury, do not put weight on the leg and see a doctor. Agree on your level of activity with a specialist.
Useful resources
- Sacroiliac joint - what it is, what symptoms it causes and who makes the diagnosis.
- Sciatica - pain radiating down the leg, warning signs and diagnosis.
- Back pain - when to see a doctor and which habits are worth changing.
- Teeter FreeStep LT1 - a recumbent cross trainer (seated stepper) for training your arms and legs in a seated position.
