Hip pain can originate from the hip joint itself, the surrounding muscles, tendons and bursae, the pelvis, the lower back or other structures. The hip is a deep ball-and-socket joint formed by the femoral head and acetabulum and is surrounded by substantial muscles and connective tissues. Common causes include osteoarthritis, greater trochanteric pain syndrome, muscle or tendon injuries, bursitis, fractures, labral pathology, inflammatory arthritis and referred pain from the lumbar spine. The location of pain is particularly informative.
Groin or deep anterior hip pain often suggests an intra-articular problem, lateral pain is commonly associated with structures around the greater trochanter, and buttock pain may arise from the hip, gluteal tissues or lower back. Hip pain can also be referred to the knee, meaning knee pain does not necessarily indicate a knee disorder.
Hip osteoarthritis is a common cause of persistent hip pain, particularly in older adults. Degenerative changes affect articular cartilage, subchondral bone and other joint tissues and can reduce the smoothness and range of hip movement. Pain is often felt in the groin and can spread to the thigh or knee, and activities involving walking, standing or rotating the hip may become increasingly difficult. Stiffness can make putting on shoes, getting into a car or rising from a chair harder. Risk factors include age, previous joint injury, obesity, congenital or developmental hip abnormalities and certain structural conditions. Severe symptomatic osteoarthritis can eventually be treated with total hip replacement when conservative management is insufficient and functional impairment is substantial.
Greater trochanteric pain syndrome is a common cause of pain on the outside of the hip. It encompasses disorders involving the gluteus medius and gluteus minimus tendons and surrounding tissues and is often associated with what was historically called trochanteric bursitis. Lateral hip pain may be aggravated by lying on the affected side, walking, climbing stairs or prolonged standing. Tendon loading, hip abductor weakness or altered biomechanics can contribute, although the condition is not simply inflammation of a bursa. Modern understanding emphasises gluteal tendinopathy and compression or load-related mechanisms. Treatment commonly centres on progressive strengthening and appropriate management of mechanical load rather than prolonged rest alone.
Muscle and tendon injuries can cause hip or groin pain. The hip flexors, adductors, hamstrings and gluteal muscles may be strained through sudden acceleration, kicking, lifting or other activities. Tendinopathy can develop gradually when tendon loading exceeds its capacity to adapt, producing activity-related pain and reduced function. In athletes, groin pain may have several overlapping causes, including adductor-related, iliopsoas-related and abdominal or pubic-region disorders. Because many structures are close together, diagnosis requires careful examination rather than assuming that all groin pain originates inside the hip joint.
Fractures are an important cause of acute hip pain, particularly in older adults with osteoporosis or other factors that increase fracture risk. A hip fracture often follows a fall but can occasionally occur after relatively minor trauma when bone strength is reduced. Severe pain, inability to stand or bear weight and a shortened or externally rotated leg can occur, although presentations vary. Stress fractures can develop gradually in people exposed to repetitive loading and may initially cause activity-related pain. Hip fractures require urgent medical assessment because delayed treatment can lead to complications related to immobility, blood supply and general health.
Hip pain can also result from inflammatory or infectious disease. Rheumatoid arthritis and other inflammatory arthritides can affect the hip, although some forms of inflammatory arthritis more commonly involve other joints. Septic arthritis can occur when microorganisms enter a joint and can cause severe pain, restricted movement, fever and systemic illness; it is a medical emergency. In children, acute hip pain has a different differential diagnosis and can include transient synovitis, septic arthritis, developmental hip disorders and conditions affecting the blood supply or growth plate. Age, fever, trauma and ability to bear weight are therefore especially important when evaluating hip symptoms.
The lower back is a major source of pain that can be felt around the hip or buttock. Lumbar nerve-root irritation can produce pain radiating into the leg, sometimes with numbness, tingling or weakness. Sacroiliac and pelvic disorders can also cause pain that is perceived near the hip. Conversely, true hip disease can refer pain down the thigh and into the knee. This bidirectional diagnostic confusion is clinically important because treating the wrong anatomical source can fail to resolve symptoms. A physical examination assessing hip movement, lumbar movement, gait, strength and neurological function helps distinguish intra-articular hip pathology from spinal and soft-tissue causes.
Investigation depends on the suspected cause. Plain X-rays can identify osteoarthritis, fractures and some structural abnormalities, while MRI can detect stress fractures, labral pathology, osteonecrosis and soft-tissue abnormalities not visible on X-ray. Ultrasound can assess superficial tendons and bursae and can guide some injections or aspirations. Persistent or severe pain without a clear mechanical explanation may require further investigation, especially if accompanied by fever, unexplained weight loss, night pain or systemic illness. Management ranges from rehabilitation and load modification to medicines, injections and surgery, with urgent treatment required for suspected fracture, septic arthritis or other serious pathology.
