In short
Where hip pain is felt points to the cause. Groin pain usually comes from the hip joint itself, most often osteoarthritis in people over 50. Pain on the outer hip is usually a tendon problem. Buttock pain often comes from the lower back. Exercise is the main treatment for most causes. Get urgent help for severe hip pain with a fever, after a fall, or if you can’t put weight on the leg.
On this page
Where is your hip pain?
Hip pain is very common. In a national American survey, 14 per cent of people aged 60 and over reported significant hip pain on most days.1 The word “hip” covers a lot of ground, and where you feel the pain is the best first clue to its source.2
| Where it hurts | Most likely source |
|---|---|
| Groin or front of the hip | The hip joint itself: osteoarthritis, or impingement in younger adults |
| Outer side of the hip | The tendons and bursa over the hip bone. See hip bursitis |
| Buttock, or back of the hip | Often referred from the lower back or a pinched nerve. See sciatica and sacroiliac joint pain |
Hip pain can also spread down the thigh, sometimes as far as the knee. And pain felt in the hip can start elsewhere, such as the lower back or pelvis.2
Common causes of hip pain
Hip osteoarthritis
The most common cause in people over 50.2 It typically causes groin pain, stiffness, a grating feeling on movement and pain that is most noticeable when you first get up.2 Trouble putting on shoes and socks is a telling sign. See hip arthritis.
Greater trochanteric pain syndrome
Pain on the outer side of the hip, worse lying on that side and climbing stairs. It used to be called hip bursitis and is mostly a problem of the gluteal tendons. See hip bursitis.
Hip impingement
In younger, active adults, groin pain with deep bending or twisting can come from the ball and socket of the hip pinching against each other because of their shape. Its full name is femoroacetabular impingement syndrome. An international panel agreed that the diagnosis needs three things together: symptoms, signs on examination and findings on imaging.3
Muscle and tendon strains
Strains of the muscles around the hip and groin are common in sport. See groin pain.
Referred pain
A pinched or irritated nerve in the lower back can be felt in the buttock and hip.2 See lower back pain.
Fracture and infection
A broken hip usually follows a fall in an older person and causes severe pain and an inability to stand. An infected hip joint is uncommon and causes pain with fever. Both are emergencies.2
Pain that keeps coming back?
Talk it through with an Australian doctor online. No referral needed.
Do you need an X-ray or scan?
Your doctor or physiotherapist can often work out the cause by asking about your symptoms and watching how you stand, walk and move.2 Imaging helps in some cases, but it needs to be read with care.
- X-rays can miss arthritis and can overcall it. In a study of more than 4,000 older adults, only 9 per cent of hips that were frequently painful showed arthritis on X-ray, and only 24 per cent of hips with arthritis on X-ray were frequently painful4
- “Abnormal” hip shapes are common in people with no pain. A review of 2,114 pain-free hips in young adults found the bone shape linked with impingement in 37 per cent, and a tear in the rim of cartilage around the socket in 68 per cent of those who had an MRI5
A scan finding matters only when it matches your symptoms and examination.
How is hip pain treated?
Exercise
Exercise is the main treatment for most causes of hip pain. A physiotherapist can advise on stretching, strengthening and low-impact exercise such as swimming.2
For hip osteoarthritis, a Cochrane review of 10 trials found high-quality evidence that exercise reduces pain and improves physical function.6
Self-care
- Ease off the activities that aggravate it, without stopping moving
- Keep to a healthy weight, which reduces the load on the joint2
- A walking stick, held in the hand opposite the sore hip, can take pressure off2
- Simple pain relief, as advised by your doctor or pharmacist2
Surgery
Hip replacement is one of the most successful operations for severe arthritis that hasn’t responded to other treatment.
For hip impingement, a British trial of 348 people compared keyhole surgery with a tailored physiotherapy program. Both groups improved over 12 months. The surgery group improved more, by a margin just above the smallest difference patients would notice.7 The international panel lists conservative care, rehabilitation and surgery as suitable treatments.3
When to get urgent help
Call triple zero (000) if you have severe hip pain with a fever or you can’t put weight on your leg.2 See a doctor as soon as possible if hip pain:2
- Is sudden or intense
- Follows a fall or injury
- Comes with swelling, or you can’t move the hip or leg
- Starts after a hip replacement that had been going well
When to see a doctor
- Hip pain that is ongoing2
- Reduced movement in the hip2
- Pain that wakes you at night or stops you from walking as far as you used to
- A limp
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Christmas C, Crespo CJ, Franckowiak SC, et al. How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey. J Fam Pract. 2002;51(4):345-8.
- healthdirect. Hip pain.
- Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-76.
- Kim C, Nevitt MC, Niu J, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983.
- Frank JM, Harris JD, Erickson BJ, et al. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy. 2015;31(6):1199-204.
- Fransen M, McConnell S, Hernandez-Molina G, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;2014(4):CD007912.
- Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018;391(10136):2225-2235.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.