Hip Pain

Hip pain is a localisation puzzle, and getting the location right changes the treatment entirely. True hip joint pain — from osteoarthritis or a labral tear — is felt in the groin, sometimes referring to the front of the thigh or knee, and worsens with weight-bearing and rotation. Pain on the outer hip over the bony prominence is the most commonly misattributed: long labelled trochanteric bursitis, it is now understood to be gluteal tendinopathy in the great majority of cases, which matters because tendinopathy responds to progressive loading exercise while repeated steroid injections can worsen it. Buttock pain frequently originates in the lumbar spine or sacroiliac joint rather than the hip at all. Hip osteoarthritis is the leading cause in older adults, presenting with groin pain, stiffness after rest and progressive loss of rotation — usually noticed first as difficulty putting on socks. In younger active people, femoroacetabular impingement and labral tears predominate. Serious causes are rarer but time-critical: fracture after a fall in an older person, avascular necrosis of the femoral head in those on steroids or with heavy alcohol use, and septic arthritis with fever.

• •Groin pain with weight-bearing and rotation — true hip joint origin
• •Pain over the outer hip, worse lying on that side at night — gluteal tendinopathy
• •Stiffness after sitting or in the morning, easing with movement
• •Difficulty putting on socks and shoes from lost internal rotation
• •Referred pain to the front of the thigh or knee
• •Buttock pain, often spinal or sacroiliac rather than hip
• •Limping or shortened walking distance
• •Clicking, catching or locking suggesting a labral tear
• •Inability to weight-bear after a fall — suspect fracture

• •Hip osteoarthritis — the leading cause in older adults
• •Gluteal tendinopathy, the true source of most outer hip pain
• •Femoroacetabular impingement and labral tears in younger active people
• •Referred pain from the lumbar spine or sacroiliac joint
• •Hip fracture after a fall, especially with osteoporosis
• •Avascular necrosis linked to steroid use, alcohol or sickle cell disease
• •Inflammatory arthritis including ankylosing spondylitis
• •Septic arthritis — rare but an emergency
• •Muscle strains and overuse in athletes
• •Bone stress injuries in runners and military recruits

Osteoarthritis reflects cartilage loss with subchondral bone change and synovial inflammation, driven by cumulative load, joint shape abnormalities and genetics. Gluteal tendinopathy arises from compressive and tensile overload of the gluteus medius and minimus tendons where they wrap the greater trochanter — habits like standing hanging on one hip and crossing the legs increase this compression, which is why posture advice genuinely helps. Impingement occurs when abnormal femoral head or socket shape causes bony contact during movement, tearing the labrum over time.