Erin Pereira, PT, DPT, is a board-certified clinical specialist in orthopedic physical therapy.
Hip pain is a common symptom that can be described as aching, sharp, or burning. It can range in intensity from mild to severe.
There are many possible causes of hip pain. They include serious ones, like a fracture or joint infection, and ones that are less so, like arthritis or bursitis. A healthcare provider, along with medical specialists when necessary, can diagnose the cause and help to plan your treatment.
This article presents information about the potential causes of hip pain. It will help you to learn more about these conditions and the measures used to achieve the best outcomes possible.
Note: Hip pain in children is assessed differently than in adults. This article focuses on the latter.
The hip is a large "ball-and-socket" joint. The "socket" is a bone in your pelvis called the acetabulum and the "ball" is the head of your femur. It is the upper part of the long bone in your leg.
This hip joint is covered in cartilage, a smooth, white tissue that cushions the bones and allows the hip to move with ease.
There are common patterns to the pain you may experience. When you have a problem that's within the hip joint, the pain tends to be on the inside of the hip (anterior hip pain).
When the pain is on the side of the hip (lateral hip pain), or on the outside of the hip closer to your buttocks (posterior hip pain), there is usually another cause. The problem tends to be with muscles, ligaments, tendons, and/or nerves that surround the hip joint.
Knowing the location of your hip pain—anterior, lateral, or posterior—is perhaps the best way to understand your symptoms.
Anterior hip pain is felt on the inside of your hip and groin area. Common causes of this pain may include:
Osteoarthritis of the hip occurs when the cartilage in the hip joint slowly wears away over time. The cartilage breaks down over time, often due to increasing age or because of a prior hip injury. This causes the joint space to narrow within the hip joint, and the bone may begin to rub on bone.
The pain may be dull, aching, or sharp, depending on the degree of osteoarthritis. The pain and stiffness in the hip will almost always get worse with activity. It also tends to improve with rest.
Various types of inflammatory arthritis may affect the hip, resulting in a dull, aching pain. These conditions include:
This type of hip pain often will ease with activity rather than feeling worse when you use it, as is the case with osteoarthritis.
A hip fracture, or a break in the upper quarter of the thigh bone, causes deep pain. You feel it in the outer part of the upper thigh or groin area. These breaks often happen after a fall or a direct blow to the hip. They may also occur due to a stress injury.
Stress fractures of the hip are most common in female athletes who have what's called the "female athlete triad." This means they have three health conditions together, including:
Steroid drug use, a history of smoking, and other medical conditions that can weaken the bone, like cancer or osteoporosis, are additional risk factors.
With a stress fracture, as opposed to a complete break from a fall, you may feel a more gradual onset of pain that gets worse when bearing weight on the legs and hips.
Bursitis simply means an irritation or inflammation of the bursa. These are small, fluid-filled sacs that serve as a cushion between joints, muscles, and tendons. One bursa, called the iliopsoas bursa , is found on the inner or groin side of your hip. It causes anterior hip pain if inflamed.
Iliopsoas bursitis is most common in runners or soccer players. It causes anterior hip pain that may also radiate, or spread, to the front of the thigh or into the buttock. Sometimes, you may feel a snapping, catching, or popping in the hip with this type of bursitis.
A hip strain refers to a stretch or tear of a muscle, its nearby tendon, or both. Hip flexor muscles, such as the iliopsoas muscle or rectus femoris muscle, are often involved in a hip strain.
A hip flexor strain can be caused by overuse, as is the case with cyclists or soccer players. It also may be from some sort of trauma, such as a direct hit during a contact sport. In addition to anterior hip pain, these strains can cause swelling, limited movement, and muscle weakness.
Osteonecrosis of the hip happens when there is not enough blood supplied to the hip bone. This leads to the death of bone cells and can destroy the hip joint. The vast majority of cases are due to corticosteroid drug use and excessive alcohol use.
Besides anterior hip pain and groin pain that gets worse with walking, you may experience pain in the thighs, buttocks, and/or knees.
Your hip labrum is a band of cartilage-like tissue that runs around the outer rim of your hip socket. It helps to support the joint and deepen the socket. Overuse or an injury to your hip can cause a tear in your labrum, leading to pain that gets worse with weight bearing.
In femoroacetabular impingement (FAI), bony growths develop around the hip joint. These growths can limit hip motion and eventually cause tears of the labrum and hip osteoarthritis.
The symptoms of this condition include an aching or sharp pain in the groin area that moves toward the outside of the hip. Often, you can feel the pain when you stand up after sitting for a long period of time. Stiffness and limping are also common.
It's far more rare, but sometimes the hip joint can be infected. This is called a septic joint. The symptoms include:
Rarely, bone cancer may cause hip pain. It can be either cancer that begins in the bone (primary cancer) or one that has spread there from somewhere else in the body (metastatic).
Usually, the pain starts off being worse at night but as the bone tumor grows, the pain often becomes constant. Swelling around the hip area may also occur, along with weight loss and unusual fatigue. A hip fracture may occur because the bones are weakened.
You'll usually feel anterior hip pain on the inside of your hip and groin. It suggests the problem is within the hip joint. Many conditions, from a strained flexor muscle to a fracture or even bone cancer, may be the cause. Their different symptoms will help lead to a diagnosis.
Lateral hip pain refers to pain on the side of the hip, as opposed to the front or back of the hip.
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. It also gets worse with activity, like when you are walking or running.
Over time, the pain may evolve into a deep aching pain that spreads over a larger area of the hip. You may notice swelling or that you have started to limp with the affected leg.
Snapping hip syndrome causes a snapping or popping sensation, possibly with lateral hip pain when walking or 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). This is a thick collection of connective tissue that starts at the hip and runs along the outer thigh. The snapping sound comes from where the IT band passes over the upper part 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. It's for this reason that it also is known as "dancer's hip."
Lateral hip pain will hurt more on the side of the hip, rather than the front or back. The symptoms are different depending on the condition. You may feel sharp pain that gets worse at night or when you're active, as with trochanteric bursitis. The diagnosis will depend on the symptoms you have.
Posterior hip pain is felt on the outside of the hip or buttock area. This is usually due to a problem with the muscles, tendons, or ligaments that surround the hip joint, rather than the actual joint itself.
Muscle strains result from small tears that are caused by a quick twist or pull to the muscle. When this occurs to the hamstring muscles found around the hip joint, buttock pain and/or pain in the back of your hip occurs.
The sacroiliac (SI) joint connects the lower spine to the pelvis. You have one located on each side 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 lead to posterior hip pain. The sharp or burning pain is often worse when you stand and walk. It may spread out from the hip and down the back of the leg.
Piriformis syndrome also is called deep gluteal syndrome. It 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. This muscle is found deep within the buttock, near the top of the hip joint.
The burning or aching pain of this syndrome usually begins in the posterior hip and buttock region and moves down the back of the thigh.
You'll feel posterior hip pain on the outside and back of your affected hip. In many cases, the cause is related to the muscles, tendons and structures around the hip—and not the hip itself.
It's important to seek immediate medical care if your hip pain is sudden, severe, or getting worse. This care also is needed if any trauma to your hip, such as a fall, has happened.
There are many other symptoms that call for evaluation by a healthcare provider when you have hip pain. They include:
See a healthcare provider right away if your hip pain follows a fall or other trauma, or if your symptoms are sudden and severe.
A medical history and thorough physical exam by your healthcare provider, a sports medicine specialist, or an orthopedic surgeon are essential to make sure you have a proper diagnosis.
Your healthcare provider will likely order imaging tests, like an X-ray or magnetic resonance imaging (MRI), to better arrive at a diagnosis. Blood tests also may be used in the diagnosis of hip pain.
A healthcare provider will ask you questions about your pain. Some of these questions may include:
During the exam, your healthcare provider will view and press on a few "landmark" sites within your hip, leg, lower back, and abdomen. They may also perform a neurological exam to assess muscle weakness and reflexes.
It's likely they will move your hip around to evaluate its range of motion, look at the way you walk (your gait), and check your overall posture and ability to bear weight.
Based on what your healthcare provider thinks may be the underlying cause of your hip pain, they will perform more specific tests. One classic test often used to evaluate hip pain is the FABER test.
The FABER test (its name stands for flexion, abduction, and external rotation) is used to diagnose some hip problems, such as hip osteoarthritis or hip labrum tear.
You'll be lying flat on your back for this test while the provider flexes your leg and then puts your ankle from the same side as the affected hip just above the kneecap on the opposite leg. They'll 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 and leg from the affected side cannot be lowered into parallel position with the opposite leg.
Some 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 bony growths or other changes associated with hip osteoarthritis.
An MRI may be used to evaluate for a hip fracture, as well as for other conditions like hip osteonecrosis or an infected hip joint. A magnetic resonance arthrography is the preferred test when a hip labral tear is suspected.
Finally, an ultrasound may be used to confirm a diagnosis of bursitis.
Blood tests may be ordered in some specific circumstances. For instance, your healthcare provider will likely order a white blood cell count, blood cultures, and a test for inflammatory markers in the blood if an infected joint is suspected.
Cultures from a hip aspiration, which uses a needle to remove synovial fluid from the hip joint, are usually taken to both diagnose and treat septic arthritis.
Your healthcare provider will arrive at a diagnosis of your hip pain through a physical exam and related tests to measure how well your hip can move. These tests may include X-rays and imaging, as in the case of a fracture, or blood tests that may point to an infection.
It's 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. Yet this is not always the case.
Some conditions refer pain to the hip, meaning they do not originate within the hip joint or near it. They include:
Some lower abdominal issues 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 that is between the top of your hip and the bottom of your ribcage in your back. The pain may spread out to your groin or inner thigh.
Meralgia paresthetica refers to compression of the lateral femoral cutaneous nerve, a sensory nerve that passes under the inguinal ligament in the groin area. Besides a burning pain felt mainly in the upper-outer thigh, there are often symptoms of numbness and tingling.
This condition is most common in older adults and those with diabetes. Obesity, pregnancy, and wearing tight pants or belts will also increase the risk of developing this condition.
Aortoiliac occlusive disease refers to a blockage of the aorta, the main blood vessel in your body, and the iliac arteries. These arteries branch off from the aorta near your belly button. A blockage causes an aching, cramping pain in the buttock, hip, and/or thigh.
This pain gets worse with exercise and will ease with rest. The condition is most often caused by atherosclerosis, in which plaque builds up in the blood vessel walls. This causes them to narrow so much that blood flow to the legs and groin is impaired.
Sometimes, nerve pain that feels like burning or tingling can be felt in or around the hip joint, but it's actually caused by an irritated nerve in the lower spine. This condition, called lumbar radiculopathy , can be diagnosed with an MRI of the lower spine.
Other medical conditions, such as kidney stones, may cause hip pain even though the source of the problem isn't in your hip. Your healthcare provider may need to rule out these possibilities.
The treatment of your hip pain depends on the diagnosis made by your healthcare provider. Common elements of a treatment plan include self-care, medication, physical therapy, and surgery.
Your healthcare provider may recommend a number of self-care strategies. They give you a way to take an active role in managing your hip pain.
A few examples of these strategies include:
Various 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. They include osteoarthritis and femoroacetabular impingement. Opioids, which are stronger drugs for pain, may be needed to treat a hip fracture or an infected hip joint.
Other drugs may be needed, depending on your diagnosis. A disease-modifying anti-rheumatic drug (DMARD) can be used to treat rheumatoid arthritis. Or, intravenous (IV) antibiotics can be used to treat an infected joint.
Physical therapy is a key piece of the treatment for many causes of hip pain. It is meant to improve strength, flexibility, and mobility in your hip.
A physical therapist may use massage, ultrasound, heat, and ice to soothe inflammation within your hip. They may also offer guidance on if or when it is safe to return to sports or other activities.
Surgery may be required in some hip pain cases, such as a hip fracture. That's also true when osteoarthritis keeps getting worse and other treatments have failed, such that a surgeon may perform a total hip replacement. Finally, a procedure called a hip arthroscopy may be used to repair a torn hip labrum.
You may not be able to prevent all causes of hip pain but there are several things you can do to be proactive about it. They include:
Treatment of your hip pain will depend on a diagnosis of the cause. In some cases, physical therapy and medication may help. Surgery may be required in other situations. Keep in mind that there are steps you can take yourself to prevent hip pain.
Hip pain is usually described by a location: anterior (front), lateral (side), or posterior (back). The site of the pain provides information about what may be causing it.
There are quite a few possible answers, ranging from a muscle strain or osteoarthritis to less common reasons found among athletes or dancers, such as the snapping hip syndrome. Your healthcare provider will need to diagnose the condition to ensure the right treatment.
Don't wait to see a healthcare provider if your hip pain is severe, or comes on suddenly without getting better. That's especially true if you have other symptoms, like a fever or swelling, along with your hip pain.
Hip pain has a direct impact on your quality of life, and it can be frustrating to go through all the steps to find out why you have it. Try to stay patient and positive during the process and take an active role in your treatment plan.
Hip pain while walking can be caused by conditions that affect the muscles, tendons, or the hip bone's blood supply. For example, snapping hip syndrome can be caused by tendons getting caught on a prominent area of bone in the hip area.
Hip pain is common during pregnancy. That's because of the many changes taking place in the body. They include changes in your muscles and bones. One study found that pain is most often felt during the third trimester.
The main symptom of hip arthritis is mild to severe pain felt in or around the hip. It can be described as aching, sharp, burning, throbbing, or dull. Other symptoms include:
There are a few types of hip bursitis. Iliopsoas bursitis causes pain in the front of the hip that spreads down the front of the thighs or toward the buttocks. Outer hip pain passing down along the thigh and knee may be trochanteric bursitis.
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Lespasio MJ, Sultan AA, Piuzzi NS, et al. Hip Osteoarthritis: A Primer. Perm J. 2018;22:17–084. doi:10.7812/TPP/17-084
Gold M, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Hip Joint. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
Byrd JW. Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther. 2007;2(4):231–240. PMID: 21509142
Battaglia PJ, D'Angelo K, Kettner NW. Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging. J Chiropr Med. 2016;15(4):281–293. doi:10.1016/j.jcm.2016.08.004
Hamer AJ. Pain in the hip and knee. BMJ. 2004;328(7447):1067–1069. doi:10.1136/bmj.328.7447.1067
Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013;21(9):1145–1153. doi:10.1016/j.joca.2013.03.018
Kim Y, Oh HC, Park JW, et al. Diagnosis and Treatment of Inflammatory Joint Disease. Hip Pelvis. 2017;29(4):211–222. doi:10.5371/hp.2017.29.4.211
Bateman L, Vuppala S, Porada P, et al. Medical management in the acute hip fracture patient: a comprehensive review for the internist. Ochsner J. 2012;12(2):101–110. PMID: 22778674
Nazem TG, Ackerman KE. The female athlete triad. Sports Health. 2012;4(4):302–311. doi:10.1177/1941738112439685
Pisani P, Renna MD, Conversano F, et al. Major osteoporotic fragility fractures: Risk factor updates and societal impact. World J Orthop. 2016;7(3):171–181. doi:10.5312/wjo.v7.i3.171
Zapparoli FY, Riberto M. Isokinetic Evaluation of the Hip Flexor and Extensor Muscles: A Systematic Review. J Sport Rehabil. 2017;26(6):556-566. doi:10.1123/jsr.2016-0036
An YS, Park S, Jung JY, Suh CH, Kim HA. Clinical characteristics and role of whole-body bone scan in multifocal osteonecrosis. BMC Musculoskelet Disord. 2019;20(1):23. doi:10.1186/s12891-019-2401-y
Pun S, Kumar D, Lane NE. Femoroacetabular impingement. Arthritis Rheumatol. 2015;67(1):17–27. doi:10.1002/art.38887
Long B, Koyfman A, Gottlieb M. Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department. West J Emerg Med. 2019;20(2):331–341. doi:10.5811/westjem.2018.10.40974
Mantyh PW. Bone cancer pain: from mechanism to therapy. Curr Opin Support Palliat Care. 2014;8(2):83–90. doi:10.1097/SPC.0000000000000048
Seidman AJ, Varacallo M. Trochanteric Bursitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. J Orthop. 2016;13(1):15–28. doi:10.1016/j.jor.2015.12.006
Lewis CL. Extra-articular Snapping Hip: A Literature Review. Sports Health. 2010;2(3):186–190. doi:10.1177/1941738109357298
Frank RM, Slabaugh MA, Grumet RC, Virkus WW, Bush-Joseph CA, Nho SJ. Posterior hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2010;2(3):237–246. doi:10.1177/1941738110366000
Tyler TF, Fukunaga T, Gellert J. Rehabilitation of soft tissue injuries of the hip and pelvis. Int J Sports Phys Ther. 2014;9(6):785–797. PMID: 25383247
Moscote-Salazar LR, Alvis-Miranda HR, Joaquim AF, Amaya-Quintero J, Padilla-Zambrano HS, Agrawal A. Sacroiliac Pain: A Clinical Approach for the Neurosurgeon. J Neurosci Rural Pract. 2017;8(4):622–627. doi:10.4103/jnrp.jnrp_171_17.
Wagner T. A rare cause of hip pain characterized by an inability to walk or bear weight. JAAPA. 2011;24(9):34, 36-7. doi:10.1097/01720610-201109000-00006
Martin HD, Palmer IJ. History and physical examination of the hip: the basics. Curr Rev Musculoskelet Med. 2013;6(3):219–225. doi:10.1007/s12178-013-9175-x
Wilson CH. The Musculoskeletal Examination. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 164.
Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014;89(1):27-34. PMID: 24444505
Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105–117. doi:10.1007/s12178-009-9052-9
Fujita K, Kabata T, Kajino Y, et al. Quantitative analysis of the Trendelenburg test and invention of a modified method. J Orthop Sci. 2017;22(1):81-88. doi:10.1016/j.jos.2016.09.007
Annabell L, Master V, Rhodes A, Moreira B, Coetzee C, Tran P. Hip pathology: the diagnostic accuracy of magnetic resonance imaging. J Orthop Surg Res. 2018;13(1):127. doi:10.1186/s13018-018-0832-z
Fritz JM, McDonald JR. Osteomyelitis: approach to diagnosis and treatment. Phys Sportsmed. 2008;36(1):nihpa116823. doi:10.3810/psm.2008.12.11
Chung C, Stern PJ, Dufton J. Urolithiasis presenting as right flank pain: a case report. J Can Chiropr Assoc. 2013;57(1):69–75. PMID: 23483000
Parisi TJ, Mandrekar J, Dyck PJ, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011;77(16):1538–1542. doi:10.1212/WNL.0b013e318233b356
Kita K. Leriche syndrome (Aortoiliac occlusive disease). J Gen Fam Med. 2017;18(5):297–298. doi:10.1002/jgf2.63
Smith RB III. Claudication. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 13.
Tawa N, Rhoda A, Diener I. Accuracy of magnetic resonance imaging in detecting lumbo-sacral nerve root compromise: a systematic literature review. BMC Musculoskelet Disord. 2016;17(1):386. doi:10.1186/s12891-016-1236-z
Towheed TE, Judd MJ, Hochberg MC, Wells G. Acetaminophen for osteoarthritis. Cochrane Database Syst Rev. 2003;(2):CD004257. doi:10.1002/14651858.CD004257
Hsu JR, Mir H, Wally MK, Seymour RB; Orthopaedic Trauma Association Musculoskeletal Pain Task Force. Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. J Orthop Trauma. 2019;33(5):e158–e182. doi:10.1097/BOT.0000000000001430
Köhler BM, Günther J, Kaudewitz D, Lorenz HM. Current Therapeutic Options in the Treatment of Rheumatoid Arthritis. J Clin Med. 2019;8(7):938. doi:10.3390/jcm8070938
Ross JR, Larson CM, Bedi A. Indications for Hip Arthroscopy. Sports Health. 2017;9(5):402–413. doi:10.1177/1941738117712675
Cibulka MT, White DM, Woehrle J, et al. Hip pain and mobility deficits--hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2009;39(4):A1–A25. doi:10.2519/jospt.2009.0301
Higgs J, Derbyshire E, Styles K. Nutrition and osteoporosis prevention for the orthopaedic surgeon: A wholefoods approach. EFORT Open Rev. 2017;2(6):300–308. doi:10.1302/2058-5241.2.160079
Berry SD, Miller RR. Falls: epidemiology, pathophysiology, and relationship to fracture. Curr Osteoporos Rep. 2008;6(4):149–154. doi:10.1007/s11914-008-0026-4
Kesikburun S, Güzelküçük Ü, Fidan U, Demir Y, Ergün A, Tan AK. Musculoskeletal pain and symptoms in pregnancy: A descriptive study. Therapeutic Advances in Musculoskeletal Disease, 2018;10(12):229–234. doi:10.1177/1759720X18812449
Hip pain: MedlinePlus Medical Encyclopedia. MedlinePlus.
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