What Causes Hip Pain?

Quick Breakdown

Hip pain is one of the most common musculoskeletal complaints, but the source isn't always the hip joint itself. Pain may originate from the joint, surrounding muscles and tendons, the lumbar spine, nerves, or even be referred from another area. At True Grit Physical Therapy, we perform a comprehensive evaluation to determine the true cause of your hip pain so treatment addresses the underlying problem—not just the symptoms.

What Causes Hip Pain?

Hip pain can make everyday activities surprisingly difficult such as walking across a parking lot, getting out of your car, climbing stairs, putting on your shoes, and even sleeping comfortably can become a challenge. One of the most frustrating parts of hip pain is that it often isn't obvious where it's coming from. Many people assume: "It must be arthritis." Others think: "I probably pulled a muscle."

While both are possibilities, they're only two of many potential causes. The hip is surrounded by muscles, tendons, ligaments, bursae, nerves, and the lumbar spine—all of which can produce pain that feels remarkably similar. That's why identifying the true source is essential before deciding on treatment.

First, Where Does It Hurt?

The location of your pain provides important clues.

Pain in the Front of the Hip or Groin

Pain deep in the groin often suggests involvement of the hip joint itself. Common causes include:

· Hip osteoarthritis

· Femoroacetabular impingement (FAI)

· Labral pathology

· Hip flexor tendinopathy

· Joint inflammation

Pain in this region often becomes noticeable during:

· Walking

· Climbing stairs

· Sitting for prolonged periods

· Squatting

· Pivoting

However, groin pain can also originate from structures outside the hip, making a thorough examination important.

Pain on the Side of the Hip

Pain along the outside of the hip is frequently associated with the gluteal tendons. This condition, known as gluteal tendinopathy, is one of the most common causes of lateral hip pain. People often report discomfort when:

· Lying on the affected side

· Walking longer distances

· Standing after sitting

· Climbing stairs

· Crossing their legs

Although this pain is often called "bursitis," research has shown that the tendons themselves are frequently the primary source rather than the bursa alone.

Pain in the Buttock

Pain in the buttock may originate from:

· Deep hip muscles

· Gluteal muscles

· The sacroiliac joint

· The lumbar spine

· Irritated nerves

Because multiple structures overlap in this region, determining the true source requires more than simply identifying where it hurts.

The Hip Joint Isn't Always the Problem

One of the biggest misconceptions is that pain felt around the hip must come from the hip joint. In reality, many patients with hip pain have little or no joint pathology. Instead, symptoms may arise from:

· Muscles

· Tendons

· The lumbar spine

· Nerves

· Movement impairments

· Training errors

· Load management issues

This is why imaging alone rarely provides the complete answer.

Hip Osteoarthritis

Hip osteoarthritis occurs when the cartilage within the joint gradually changes over time. Common symptoms include:

· Groin pain

· Morning stiffness

· Difficulty putting on shoes

· Pain after prolonged sitting

· Reduced hip mobility

Fortunately, many individuals with hip arthritis respond extremely well to physical therapy, strengthening, and activity modification. A diagnosis of arthritis does not automatically mean joint replacement is necessary.

Femoroacetabular Impingement (FAI)

Femoroacetabular impingement occurs when the shape of the hip joint causes increased contact between the ball and socket during certain movements. People often notice pain during:

· Deep squats

· Sitting

· Twisting

· Pivoting

· Athletic movements

Interestingly, many individuals have FAI changes on imaging without ever developing symptoms. This highlights an important principle: Imaging findings do not always equal pain.

Tendons Can Become Overloaded

The tendons surrounding the hip work constantly to stabilize your body during walking, running, and standing on one leg. When these tissues are exposed to more load than they can currently tolerate, they may become painful. Common tendon conditions include:

· Gluteal tendinopathy

· Hip flexor tendinopathy

· Proximal hamstring tendinopathy

· Adductor tendinopathy

Rather than viewing these conditions as inflammation alone, we now understand that they often represent changes in tendon capacity. Successful rehabilitation focuses on gradually improving the tendon's ability to tolerate load.

Your Back May Be the Culprit

The lumbar spine frequently refers pain into the hip region. Lower back conditions may create pain in the:

· Buttock

· Groin

· Side of the hip

· Front of the thigh

Sometimes patients are surprised to learn that their hip pain improves after treating the lumbar spine rather than the hip itself. This is one reason we routinely screen the back during every hip evaluation.

Weakness Isn't Always Obvious

Many people with hip pain aren't obviously weak during everyday activities. However, detailed testing often reveals deficits in:

· Gluteus medius strength

· Gluteus maximus strength

· Core stability

· Single-leg control

· Muscular endurance

These deficits may alter movement mechanics and increase stress on the hip over time.

Improving strength isn't just about building muscle. It's about improving your body's ability to tolerate the demands of everyday life and sport.

Movement Quality Matters

Strength alone doesn't guarantee healthy movement. Motor control—the ability to coordinate movement efficiently—is equally important. We assess how your body moves during tasks such as:

· Walking

· Squatting

· Lunging

· Single-leg balance

· Step-down testing

· Running (when appropriate)

These assessments often reveal movement patterns that place unnecessary stress on the hip. Addressing these impairments helps reduce symptoms while improving long-term performance.

Our Evaluation Looks Beyond the Hip

At True Grit Physical Therapy, we don't simply diagnose hip pain. We determine what's driving it. Our evaluation may include:

· Hip mobility assessment

· Strength testing

· Muscular endurance testing

· Functional movement analysis

· Lumbar spine screening

· Neurological examination

· Gait assessment

· Balance testing

· Sport-specific testing

· Load tolerance assessment

This comprehensive approach allows us to identify the underlying contributors to your symptoms rather than treating everyone with the same exercises.

How Physical Therapy Can Help

Treatment depends on the specific cause of your hip pain. Your rehabilitation may include:

· Manual therapy

· Hip strengthening

· Gluteal strengthening

· Mobility exercises

· Tendon loading programs

· Core stabilization

· Motor control training

· Running or gait retraining

· Progressive return-to-sport programming

· Education regarding activity modification

Our goal isn't simply to decrease pain. It's to restore your confidence in movement and help your hip tolerate the activities you enjoy.

When Should You Seek Medical Attention?

Although most hip pain improves with conservative care, certain symptoms require prompt medical evaluation. Seek medical attention if you experience:

· Inability to bear weight after trauma

· Significant swelling

· Fever or signs of infection

· Severe night pain unrelated to movement

· Progressive weakness

· Loss of bowel or bladder control

· Persistent numbness

· Sudden inability to move the hip

These symptoms may indicate conditions requiring immediate medical attention.

The Bottom Line

Hip pain can originate from many different structures—including the hip joint, tendons, muscles, lumbar spine, or surrounding nerves. Because several conditions produce similar symptoms, accurately identifying the source is essential for successful treatment. At True Grit Physical Therapy, we perform a comprehensive evaluation that examines hip mobility, strength, muscular endurance, movement quality, lumbar spine function, and overall biomechanics. By identifying the true cause of your pain, we create an individualized treatment plan that helps you move better, hurt less, and return to the activities that matter most. Because treating hip pain starts with understanding why it's happening—not simply where it hurts.