Causes of Hip Pain and Treatment Options

Everything you need to know about hip pain

In This Article
Table of Contents

Hip pain is a common symptom that can be described as aching, sharp, or burning and can range in intensity from mild to severe. There are many possible causes of hip pain, including serious ones, like a fracture or joint infection, and ones that are less so (though still potentially debilitating), like arthritis or bursitis.

In order to get to the bottom of your pain, your doctor will perform a thorough medical history, physical examination, and possibly, order imaging tests. Once diagnosed, you and your doctor can work together to formulate a treatment plan—one that may entail surgery, but more commonly includes self-care strategies, like rest and ice, pain control with medication, and physical therapy.

Note: Hip pain in children is assessed differently than in adults; this article focuses on the latter.

hip pain causes
Illustration by Alexandra Gordon, Verywell

Causes

The hip is a large "ball-and-socket" joint—the "socket" being a pelvic bone called the acetabulum and the "ball" being the femoral head, which is the upper part of the thighbone. Covering this ball and socket joint is cartilage—a smooth, white tissue that cushions the bones and allows the hip to move easily.

Problems within the hip joint itself tend to result in pain on the inside of the hip (anterior hip pain). On the other hand, pain on the side of the hip (lateral hip pain) or pain on the outside of the hip, near the buttock region (posterior hip pain) is usually caused by problems with muscles, ligaments, tendons, and/or nerves that surround the hip joint.

Differentiating the various causes of hip pain by location—anterior, lateral, or posterior—is perhaps the best way to understand this somewhat complex symptom.

Anterior Hip Pain

Problems within the hip joint, such as inflammation, infection, or a bone fracture, may result in anterior hip pain—pain felt on the inside of your hip and/or within your groin area.

Osteoarthritis

Osteoarthritis of the hip occurs when the cartilage in the hip joint gradually wears away over time. As the cartilage frays and degenerates over time—often with increasing age or as a result of a prior hip injury—the joint space between the bones of the hip joint narrows, so bone may eventually rub on bone.

Depending on the degree of osteoarthritis, pain may be dull, aching, or sharp; although, in nearly all cases, the pain and stiffness of hip osteoarthritis worsen with activity and improve with rest.

Inflammatory Arthritis

Various types of inflammatory arthritis may affect the hip, resulting in dull, aching pain, such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Unlike the pain of osteoarthritis, which is worsened with activity, hip pain from inflammatory arthritis is often eased with activity.

Fracture

A hip fracture, or a break in the upper quarter of the thigh bone, causes a deep, boring pain felt in the outer-upper thigh or groin area.

A hip fracture may occur after a fall or direct blow to the hip. It may also occur as a result of a stress injury. Stress fractures of the hip are most common in female athletes who have an eating disorder, menstrual irregularities, and bone weakening (conditions that, together, are known as the female athlete triad). Steroid use, a history of smoking, and medical conditions that weaken the bone (e.g., cancer or osteoporosis) are additional risk factors.

With a stress fracture, as opposed to a complete break from a fall, a person may experience more of a gradual onset of pain that worsens with weight bearing.

Iliopsoas Bursitis

Bursitis simply translates to irritation or inflammation of a bursa, which is a small, fluid-filled sac that serves as a cushion between joints, muscles, and tendons. One bursa, located on the inner or groin side of your hip—called the iliopsoas bursa—causes anterior hip pain if inflamed.

Iliopsoas bursitis, which is most common in runners or soccer players, causes anterior hip pain that may radiate to the front of the thigh area or into the buttock area. Sometimes, a snapping, catching, or popping sensation is felt in the hip with this type of bursitis.

Hip Flexor Strain

A hip strain refers to a stretching or tearing of a muscle or its associated tendon (or both). Hip flexor muscles, like the iliopsoas muscle or rectus femoris muscle, are often involved in a hip strain.

A person may develop a hip flexor strain from overuse (e.g., cyclists, martial artists, or soccer players), or from some sort of trauma, such as a direct hit during a contact sport. In addition to anterior hip pain, hip flexor strains may result in swelling, restricted movement, and muscle weakness.

Osteonecrosis of the Hip

Osteonecrosis of the hip occurs when the hip bone does not receive a sufficient blood supply, which leads to the death of the bone cells and destruction of the hip joint. The vast majority of cases are due to corticosteroid use and excessive alcohol intake.

Besides anterior hip pain and groin pain that worsens with walking, a person may experience pain in the thighs, buttocks, and/or knees.

Hip Labrum Tear

Your hip labrum is a band of cartilage-like tissue that courses around the outer rim of your hip socket. This labrum helps to support the joint and deepen the socket. Sometimes overuse or an injury to your hip can cause a tear in your labrum, prompting dull or sharp anterior hip pain that worsens with weight bearing.

Femoroacetabular Impingement (FAI)

In femoroacetabular impingement (FAI), bony growths develop around the hip joint. These growths can restrict movement and eventually cause tears of the labrum and hip osteoarthritis.

The symptoms of femoroacetabular impingement include an aching or sharp pain in the groin area that moves toward the outside of the hip. The pain is often felt once standing after sitting for a prolonged period of time. Stiffness and limping are also common.

Infected Hip Joint

Uncommonly, the hip joint may become infected (called a septic joint). In addition to severe anterior hip and/or groin pain, swelling, warmth, and restricted hip movement are typically present. Fever often also occurs, but may not be present in older individuals.

Bone Cancer

Rarely, bone cancer (either primary or metastatic) may cause hip pain. Usually, the pain starts off being worse at night, but as the bone tumor progresses, the pain often becomes constant. Swelling around the hip area may also occur along with weight loss and unusual fatigue. Due to bone weakening from the cancer, a hip fracture may occur.

Lateral Hip Pain

Lateral hip pain refers to pain on the side of the hip, as opposed to the front or back of the hip.

Trochanteric Bursitis

Trochanteric bursitis causes sharp lateral hip pain that often spreads down into the thigh and knee. The pain is usually worse at night when sleeping on the affected hip and when engaging in physical activities like walking or running. Over time, the pain may evolve into a deep aching pain that spreads over a larger area of the hip. Swelling and limping may also occur.

Snapping Hip Syndrome

Snapping hip syndrome causes a snapping or popping sensation and possibly lateral hip pain with walking or other movements, like getting up from a chair. The actual "snapping" is due to one or more tight muscles, tendons, or other soft tissue moving over a bony structure within your hip.

One commonly affected "tight" or irritated tissue is the iliotibial band (IT band)—a thick collection of connective tissue that starts at the hip and runs along the outer thigh. The snapping sound results from the area where the IT band passes over the greater trochanter (the upper portion of the thigh bone).

This condition is most common in people who engage in sports or activities that cause them to frequently bend at the hip (one reason why it's also referred to as "dancer's hip.")

Posterior Hip Pain

Posterior hip pain, which is pain felt on the outside of the hip or buttock area, is usually due to a problem with the muscles, tendons, or ligaments that surround the hip joint, as opposed to the actual joint itself.

Hamstring Muscle Strain

Muscle strains result from small micro tears in muscles caused by a quick twist or pull to the muscle. When this occurs to the hamstring muscles located around the hip joint, buttock pain and/or pain in the back of your hip occurs.

Sacroiliac Joint Problem

The sacroiliac (SI) joint connects the lower spine to the pelvis. You have one located on both sides of your body.

Various problems with the SI joint, including arthritis of the joint, infection of the joint, and injury to the joint ligaments, may result in posterior hip pain. The sharp and/or burning pain is often worse with standing and walking, and may radiate from the hip down the back of the leg.

Piriformis Syndrome

Piriformis syndrome—also called deep gluteal syndrome—occurs when the sciatic nerve (a large nerve that branches off from your lower back into your hip, buttock, and leg) becomes irritated or compressed by the piriformis muscle, which is located deep within the buttock, near the top of the hip joint. The burning or aching pain of piriformis syndrome typically begins in the posterior hip and buttock region and moves down the back of the thigh.

When to See a Doctor

It's important to seek immediate medical attention if your hip pain is sudden, severe, getting worse, or if you have fallen or experienced another form of trauma to your hip.

While not an exhaustive list, other symptoms that warrant immediate medical attention include hip pain associated with:

  • Fever
  • An inability to bear weight or walk
  • Leg or foot weakness
  • Swelling
  • Bruising or bleeding
  • Warmth over the hip

Diagnosis

A medical history and thorough physical exam by a primary care physician, sports medicine doctor, or orthopedic surgeon are essential to properly diagnosing the source of your hip pain.

Depending on your doctor's underlying suspicion, imaging tests, like an X-ray or magnetic resonance imaging (MRI), may be ordered. Less commonly, blood tests are utilized in the diagnosis of hip pain.

Medical History

When you see your doctor for hip pain, he will likely ask you several questions, such as:

  • Is your hip pain better with rest or exercise?
  • Do you have any additional symptoms (e.g., fever, swelling, other joint pain, etc.)?
  • Do you or any family members have arthritis or a history of joint problems?
  • Have you experienced any recent trauma to your hip?

Physical Examination

During your physical exam, your doctor will inspect and press on various landmarks within your hip, leg, lower back, and abdomen. He may also perform a neurological exam to assess muscle weakness and reflexes.

In addition, he will maneuver your hip to evaluate its range of motion, examine your gait (how you walk), posture, and ability to bear weight. Lastly, based on your doctor's underlying suspicion for one or more hip pain diagnoses, he will perform certain "special hip" tests:

One classic test commonly used to evaluate hip pain is the FABER test.

FABER Test

The FABER test (which stands for flexion, abduction, and external rotation) is used to diagnose hip pathologies, such as hip osteoarthritis, hip labrum tear, or femoroacetabular impingement.

During the FABER test, while you are lying flat on your back, your provider will move your leg into flexion by 45 degrees and then place your ankle (from the affected side) just above the kneecap of the opposite leg. He will then press down on the knee from the affected side in order to lower the leg.

The test is positive if pain occurs at the hip joint or if the knee/leg from the affected side cannot be lowered so that it is parallel with the opposite leg.

Other tests include:

Imaging

Certain imaging tests may be needed to confirm or support a diagnosis for your hip pain. For example, an X-ray is the standard test in diagnosing a hip fracture. An X-ray may also reveal changes associated with hip osteoarthritis (e.g., joint-space narrowing and bony growths, called osteophytes).

An MRI may also be used to evaluate for a hip fracture, in addition to other conditions like hip osteonecrosis or an infected hip joint. A magnetic resonance arthrography is the test of choice for diagnosing a hip labral tear. Finally, an ultrasound may be used to confirm a diagnosis of bursitis.

Blood or Other Tests

For certain suspected diagnoses, various blood tests may be ordered. For instance, if an infected joint is suspected, your doctor will likely order a white blood cell count, blood cultures, and inflammatory markers, like an erythrocyte sedimentation rate.

In addition, cultures from a hip aspiration (removing synovial fluid from the hip joint) are usually taken to both diagnose and treat septic arthritis.

Differential Diagnoses

While it is logical to think that hip pain is related to a problem within the actual hip joint, or the muscles or other soft tissues surrounding the joint, this is not always the case.

Here are some conditions that refer pain to the hip, meaning they do not originate within the hip joint or within structures that closely surround the hip:

Kidney Stone

Some lower abdominal processes may cause pain that feels like it is coming from the hip. For example, a kidney stone can cause severe pain in the flank area (between the top of your hip and the bottom of your ribcage in your back). The pain may radiate toward your groin or inner thigh.

Meralgia Paresthetica

Meralgia paresthetica refers to compression of a pure sensory nerve—called the lateral femoral cutaneous nerve—as it passes under the inguinal ligament. Besides a burning pain felt mainly in the upper-outer thigh, numbness and tingling are usually reported.

This condition is most common in older adults and those with diabetes mellitus. Obesity, pregnancy, and wearing tight pants or belts also increases your risk for developing this condition.

Aortoiliac Occlusive Disease

Aortoiliac occlusive disease, which refers to blockage of the aorta (the main blood vessel in your body) and iliac arteries (the two arteries that branch off from the aorta near your belly button), causes an aching, cramping pain in the buttock, hip, and/or thigh.

This pain—termed claudication—is induced by exercise and relieved with rest. The blockages in these arteries are most commonly due to a condition called atherosclerosis, in which plaque builds up in the blood vessel walls, ultimately narrowing them enough that blood flow to the legs and groin area becomes insufficient.

Lumbar Radiculopathy

Sometimes, nerve pain (a burning or tingling sensation) felt in or around the hip joint may actually be referred from an irritated nerve in the lower spine. This condition, called lumbar radiculopathy, can be diagnosed with an MRI of the lower (lumbar) spine.

Treatment

While the treatment of your hip pain depends on the diagnosis made by your healthcare professional, it's common for a patient's therapy plan to involve a combination of self-care, medication, physical therapy, and less commonly, surgery.

Self-Care Strategies

Your doctor may recommend a number of self-care strategies—a way for you to take an active stance in managing your hip pain.

A few examples of these possible strategies include:

  • Limiting or avoiding activities that aggravate your hip pain, like climbing stairs
  • Using a walking assistive aid like a cane or walker to improve independence and mobility
  • The R.I.C.E. protocol: If you experience hip pain while performing a sport or other activity, follow this progression of rest, ice, compression, and elevation until you can get in to see your doctor.

Medications

Various oral medications, such as Tylenol (acetaminophen) or an over-the-counter nonsteroidal anti-inflammatory (NSAID), are used to ease hip pain related to a number of conditions, including osteoarthritis, labrum tear, bursitis, or femoroacetabular impingement. Opioids, which are stronger pain medications, may be prescribed to treat severe pain from a hip fracture or an infected hip joint.

Depending on your diagnosis, other medications, like a disease-modifying anti-rheumatic drug (DMARD) to treat rheumatoid arthritis or intravenous (through the vein) antibiotics to treat an infected joint may be used.

Physical Therapy

Physical therapy is an essential component to easing the pain of and treating most causes of hip pain. In addition to exercises to improve the strength, flexibility, and mobility of your hip, your physical therapist may use massage, ultrasound, heat, and ice to soothe inflammation within the hip. He may also offer guidance on when it is safe to return to sports or other activities (depending on your underlying diagnosis).

Surgery

Surgery may be required for certain hip pain diagnoses. For example, surgery is often used to repair a hip fracture. Likewise, for hip osteoarthritis that worsens despite conservative measures, a surgeon may perform a total hip replacement. Finally, a procedure called a hip arthroscopy may be used to correct a torn hip labrum.

Prevention

While you may not be able to prevent all causes of hip pain, there are several things you can do to be proactive in this regard:

  • Lose weight if you are overweight or obese
  • Eat a balanced, nutritious diet that contains sufficient vitamin D and calcium to maintain bone health
  • Opt for low-impact activities like swimming or biking
  • Stretch before and cool down after exercising
  • Obtain a special shoe insert if you have leg-length inequality
  • Wear properly cushioned, fitted shoes and avoid or limit running on hard surfaces like asphalt
  • Discuss a daily exercise routine for maintaining muscle and bone strength with your doctor
  • Considering yoga or tai chi to help prevent falls, one of the most common causes of hip fractures

A Word From Verywell

Hip pain is a disabling condition with many potential causes. While the diagnostic process can be challenging and a bit tedious at times, try to remain patient and proactive. Once diagnosed, your doctor may move forward with devising a treatment plan that suits your needs—one that uniquely addresses your pain and optimizes your healing.

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