Common Causes of Hip Pain

Hip pain is something I see often, and one of the most important clues is where the pain is located. Different areas of pain can point to very different causes.

Interestingly, many people who tell me they have “hip pain” will point to the lower back or upper buttock area. In many cases, that pain is actually coming from the lumbar spine rather than the true hip joint itself. That’s a topic for another blog!

The true hip joint is located more in the front of the body, deep in the groin area — around where the panty line sits.

Anterior Hip Pain (Front of the Hip or Groin)

Pain in the front of the hip can have several causes.

One of the most common is osteoarthritis, also called “wear and tear” arthritis. This is more common after age 50. Patients often notice pain that worsens with activity and improves with rest. The pain can sometimes radiate into the thighs.

Another possible cause is a labral tear, which is more of an orthopedic hip issue involving the cartilage of the hip joint.

Inflammatory arthritis can also cause hip pain. In these cases, patients may notice prolonged morning stiffness or stiffness after sitting for long periods. Unlike osteoarthritis, symptoms may actually improve a bit with gentle movement and low-level activity.

A less common but important rheumatologic cause of anterior hip pain is avascular necrosis, which occurs when blood supply to part of the bone becomes compromised. This can sometimes be associated with steroid use or autoimmune disease.

Lateral Hip Pain (Pain on the Side of the Hip)

Pain on the outside of the hip is very commonly caused by hip bursitis, also known as greater trochanteric pain syndrome.

A bursa is a small fluid-filled sac that helps reduce friction where tendons attach to bone. When the bursa becomes inflamed, it can cause tenderness and pain on the side of the hip, especially when lying on that side, walking, or climbing stairs.

This type of pain is often mistaken for “hip arthritis,” but the problem is actually outside the joint itself.

When Should You Get Hip Pain Checked Out?

If you’re having persistent hip pain, it’s a good idea to get evaluated so the underlying cause can be identified. Treatment really depends on why the pain is happening.

Sometimes the issue is mechanical or orthopedic. Other times it may be inflammatory and related to autoimmune disease. A careful history, physical exam, and sometimes imaging can help determine the cause and guide the right treatment plan.

The Bottom Line

Not all “hip pain” is actually coming from the hip joint. The location of the pain really matters and helps guide the diagnosis and treatment.