Hip Pain

Where the hip meets the whole body

The hip is the link between your trunk and your legs. It bears your full body weight with every step, and it has to balance mobility with stability in a way few other joints are asked to do. When it isn't working right, you feel it in your groin, your buttock, your thigh — and often in your low back and knee, because the hip's neighbors inherit its workload.

What makes hip pain tricky is that "my hip hurts" means different things from different patients. Pain on the side of the hip is a different problem from pain in the groin, which is different again from pain deep in the buttock. Location is the first diagnostic sorting, and it's worth learning your own map: true hip joint pain usually lives in the groin (patients often show it with a cupped hand around the front and side — the "C sign"), lateral hip pain is usually tendon, and buttock pain is usually the SI joint, the deep gluteal structures, or the spine wearing a disguise.

Common causes

Hip osteoarthritis. Gradual cartilage loss causing groin pain and stiffness — the sock-and-shoe struggle, the deepening loss of internal rotation, the shortening walking range. It typically develops after 50, earlier with prior injury or impingement. As with the knee, X-ray severity and symptoms correlate imperfectly, exercise is the best-evidenced core treatment, and hip replacement — for the joint that truly needs it — is one of the most successful operations in medicine.

Femoroacetabular impingement (FAI). A shape mismatch between ball and socket causing abnormal contact in deep flexion and internal rotation — groin pain with prolonged sitting, squatting, getting out of a car. Common in young, active adults. The caution: the bony shapes of FAI are also common in pain-free athletes, so the shape on imaging is the beginning of the conversation, not a surgical verdict.

Greater trochanteric pain syndrome. Pain over the bony prominence on the side of the hip — worse lying on that side, climbing stairs, standing on one leg. Long called "bursitis," it's now understood to be primarily gluteal tendinopathy — a tendon-loading problem in the gluteus medius and minimus, which is why it behaves like every other tendinopathy: it hates rest, cortisone helps briefly then fades, and progressive loading is what actually resolves it. Most common in women over 40, and a frequent imposter of "hip arthritis" and even sciatica.

Sacroiliac joint dysfunction. The SI joint sits behind the hip and refers pain to the buttock, posterior hip, and down the thigh. Pregnancy, pelvic asymmetry, falls, and prolonged sitting predispose to it. It hides from imaging and reveals itself on a hands-on exam — SI dysfunction is bread-and-butter osteopathic territory.

Labral tears. The cartilage ring that deepens the socket can tear — often alongside FAI — causing catching, clicking, or a deep groin ache. But labral tears show up on MRIs of pain-free hips at remarkable rates, so the tear must match the exam before it earns the blame.

Referred pain from the lumbar spine. Upper lumbar nerve roots supply the anterior thigh and groin; a disc or foraminal problem at L2–L4 can imitate hip joint pathology closely. The spine gets examined in every hip evaluation here, without exception — treating a hip for a spine problem is a classic three-month detour.

The ones not to miss. Groin pain after a fall or in an osteoporotic patient (fracture), groin pain in a runner that came on with training load and hurts with every step (femoral neck stress fracture — an urgent diagnosis), a hip that's hot and irritable with fever (infection), and unexplained night pain with systemic symptoms. These are exactly why persistent hip pain deserves an exam rather than a guess.

How we approach it

Location, provocation, examination. Where it hurts, what brings it on, and what a thorough exam of hip, lumbar spine, pelvis, and SI joints shows — that combination sorts the list above most of the way before any imaging enters.

Ultrasound and imaging where they earn it. In-office ultrasound sees the gluteal tendons, the iliopsoas, effusions, and guides any injection precisely. X-ray stages arthritis when it will change the plan; MRI is for surgical questions and the not-to-miss list, not for routine aches.

OMM for the pelvic mechanics, lumbar spine, SI joints, and soft-tissue restrictions feeding abnormal hip loading. A rotated pelvis or a locked SI joint changes what every step costs the hip, and manual treatment is the direct tool for it.

A loading program matched to the actual diagnosis. Gluteal tendinopathy gets progressive tendon loading and a temporary truce with compression (less leg-crossing, less lying on that side). Arthritis gets the strength-and-walking program with the same evidence base as the knee version. FAI gets hip and trunk strength and range managed around the impingement positions — with surgery in reserve for the right young, mechanical cases.

Ultrasound-guided injections where precision pays: the joint itself for arthritis flares (also a useful diagnostic — if numbing the joint kills the pain, we've found the source), and only sparingly around gluteal tendons, where — as with all tendons — steroid buys weeks and costs months. Shockwave therapy has solid evidence for chronic gluteal tendinopathy and pairs with the loading work.

Motion analysis to see the dynamic picture — the Trendelenburg drop, the gait asymmetry you've stopped feeling — and to give the rehab hard numbers to move.

When to seek care

Come in if hip pain limits your walking, wakes you at night, has lasted more than a few weeks, or is interfering with stairs, socks, or the car. A hip that's changing your gait is already re-loading your knees, back, and ankles — the secondary problems are on the clock. Come in urgently for groin pain after a fall, inability to bear weight, a hot swollen hip, or worsening groin pain in a training runner.

What you can do right now

Strengthen your glutes — weak hip abductors run through nearly every pattern above. Start with side-lying leg lifts, bridges, and sit-to-stands; progress toward single-leg work as tolerance allows.

Sit higher. Deep couches and low seats hold the hip in the flexed positions that aggravate impingement and flexor tightness. If the pain is on the side, stop crossing your legs and put a pillow between your knees at night — compression is that tendon's enemy.

Keep walking at the dose your hip accepts, and grow it gradually. Gentle hip circles and figure-four stretches can ease tension, but the hip responds far better to gradual loading than to forcing range — stretch to comfort, load for change.