Hip pain: what it might be and what helps

Where it hurts matters

People say hip pain to mean pain in quite different places, and each area has a different list of likely causes. Pointing to exactly where it hurts is one of the most useful things you can do at an assessment.

• Front of the hip or groin: often the hip joint itself, such as hip osteoarthritis, femoroacetabular impingement (FAI) or a labral problem. A hip flexor strain or groin strain can also cause pain here.
• Outside of the hip: often gluteal tendinopathy, also called greater trochanteric pain syndrome, which is sensitive tendons at the bony point on the side of the hip.
• Buttock or back of the hip: commonly referred from the lower back, or from the hamstring tendon where it attaches to the sitting bone.

Common causes and who gets them

Gluteal tendinopathy is very common in women over 40, particularly around menopause, and in runners who increase their mileage. It often flares with lying on the affected side, crossing the legs, climbing stairs and standing with weight shifted onto one hip, such as holding a child on your hip.

FAI describes a hip shape where the ball and socket meet earlier than usual in deep bending. It is common in active young adults and many people with this shape have no pain. When it does cause pain, it tends to be a deep groin ache in deep squats, sitting in low chairs or getting in and out of the car.

Hip osteoarthritis becomes more common from middle age, with groin pain, stiffness first thing and difficulty with socks and shoes. In children and teenagers, hip or knee pain with a limp needs a GP assessment promptly, because there are specific childhood hip conditions that need early diagnosis.

Typical symptoms

Hip joint problems usually cause a deep groin ache, sometimes with stiffness, clicking or catching, and pain with twisting, deep bending or long walks. Tendon problems on the outside of the hip cause tenderness when you press on the side of the hip and pain lying on that side at night. Referred pain from the back often varies with back movements and may come with back stiffness.

Knee pain can sometimes come from the hip, especially in older adults and in children, so a physio will often check both joints.

What a physio assessment looks at

Your physio will ask where and when it hurts, screen for warning signs and check your back. They will test hip range of movement in different directions, strength of the gluteal and hip muscles, and how you move in tasks like single-leg standing, squatting and stair climbing. Specific tests help point towards the joint, tendons or referred pain.

An X-ray may be useful to look for osteoarthritis or bony shape, and an MRI is sometimes used for suspected labral or tendon problems, but many people get a clear enough picture from the examination to start treatment.

What usually helps

Most hip conditions respond well to an exercise-led plan combined with changes to the daily habits that aggravate them. For gluteal tendinopathy, that means building side-hip strength progressively while avoiding positions that compress the tendons, like crossing the legs or sleeping on the painful side without a pillow between the knees. Research supports this education and exercise approach over a steroid injection alone for longer-term results.

For hip joint pain, the plan usually includes strengthening the muscles around the hip, working in comfortable ranges, and adjusting deep squats and lunges for a while. Manual therapy can ease stiffness and pain in some cases. Keeping active with walking, cycling or swimming usually helps the joint rather than harming it.

What you can start with at home

1. Glute bridges, 3 sets of 10 to 15, building to single-leg bridges.
2. Isometric hip abduction: lying on your back with a band around your knees, push gently outwards and hold for 30 to 45 seconds, 4 to 5 times.
3. Sit to stand from a chair, 3 sets of 10, lowering the chair height over time.
4. Step-ups onto a low step, keeping the pelvis level, 2 to 3 sets of 8 to 10 each side.
5. Walk daily at a comfortable pace and distance, adding a little each week.

Avoid stretching the outside of the hip hard if you suspect tendon pain, as it compresses the tendon and can flare it. Keep discomfort mild during exercise and check it settles by the next day.

Recovery time and when to get urgent help

Recovery varies by cause. Tendon problems commonly take 3 months or more of consistent work to settle, while muscle strains can resolve in weeks. Hip osteoarthritis is managed over the longer term, with many people improving pain and function considerably through exercise. The on-site physio at Lycan Strength can assess your hip, with 20% off for members, and you can book a physio appointment online.

• Call 999 or go to A&E if you cannot put weight on your leg after a fall, or the leg looks shortened or turned out, particularly if you are older or have osteoporosis.
• Go to A&E if the hip is very painful and hot, or you cannot move it and have a fever.
• See a GP the same day if a child has hip or knee pain with a limp, or refuses to walk.
• See your GP if you have unexplained weight loss, a history of cancer, constant night pain, or long-term steroid use with new hip pain.

Questions