Hip Pain: Complete Guide

Hip pain affects approximately 19% of adults over 60. This statistic often causes a lot of concern. Here's the good news: this pain rarely indicates a serious problem requiring surgery. In most cases, it responds well to conservative treatment. This guide explores what modern science teaches us about hip pain: why it occurs, what it truly means, and why your hip is much more robust than you might think. We recommend physiotherapy as a first-line intervention. To understand how it can help you, consult our complete guide to physiotherapy and its therapeutic approaches.

What is Hip Pain and How Common Is It?

Hip pain refers to discomfort felt in or around the hip joint. It can originate from the joint itself or from the surrounding muscles, tendons, and bursae. The location varies: some feel it in the groin, others on the side or in the buttock.

Approximately 19% of adults over 60 report significant hip pain. Women are more affected than men, with a prevalence of 16% compared to 12%. After age 50, between 15% and 35% of people develop lateral hip pain.

A surprising fact: many people believe that hip pain is felt on the side. In reality, pain originating from the joint itself often appears in the groin. Pain on the side generally comes from the tendons or bursa, not the joint.

The good news? Most hip pain responds well to conservative treatment. Physiotherapy, exercises, and education are the cornerstones of treatment for the majority of conditions.

How Does Hip Anatomy Influence Your Pain?

Your hip is a ball-and-socket joint, where the round head of the femur (thigh bone) fits into a socket in the pelvis called the acetabulum. This structure allows for a wide range of motion in multiple directions.

A ring of cartilage called the labrum surrounds the rim of the acetabular socket. It acts as a seal and stabilizes the joint. Smooth cartilage covers the bone surfaces to allow for smooth gliding.

Several muscle groups surround the hip:

• The gluteal muscles (buttocks) at the back and side

• The hip flexor muscles at the front (including the iliopsoas)

• The adductor muscles on the inner thigh

• The deep rotator muscles beneath the glutes

Bursae (small fluid-filled sacs) are located around the hip. They reduce friction between bones, muscles, and tendons. The most well-known is the trochanteric bursa on the side of the hip.

This anatomical complexity explains why hip pain can have multiple sources. The joint itself, muscles, tendons, bursae, or even neighboring structures can all be responsible.

Where do you feel your pain?

The location of your pain provides important clues about its cause. Groin pain often suggests a problem with the joint itself. Pain on the side, however, points to the gluteal tendons or the bursa.

Here is a guide to typical locations:

Pain can also spread. Hip osteoarthritis can cause pain that travels down to the knee. Back problems can appear as hip or buttock pain. This is why a professional evaluation is important. Thigh pain itself can also have specific causes distinct from hip pain. To understand the different conditions affecting the thigh and their treatments, consult our guide on thigh pain.

What are the main conditions that cause hip pain?

Eight main conditions account for the majority of hip pain. Some affect the joint itself. Others affect surrounding structures like tendons and muscles. Understanding these conditions helps you communicate better with your healthcare professional.

What is hip bursitis?

Hip bursitis, now called greater trochanteric pain syndrome (GTPS), causes pain on the side of the hip. It affects 15% to 35% of people over 50 years old.¹ Women are affected four times more often than men.²

The term "bursitis" is actually misleading. Recent research shows that true inflammation of the bursa is rare. In most cases, the problem comes from the gluteal muscle tendons that attach to the greater trochanter (the bony prominence on the side of the hip).

Typical symptoms include:

• Pain on the side of the hip

• Increased pain when sleeping on the affected side

• Pain when climbing stairs or walking for long periods

• Tenderness to the touch on the side of the hip

This condition is often chronic. Approximately 36% of people still have symptoms after one year. However, it responds well to gluteal strengthening exercises. Our complete guide to hip bursitis explains the best treatment strategies in detail.

What is hip osteoarthritis?

Hip osteoarthritis (coxarthrosis) is the gradual wear and tear of the joint cartilage. It affects 15% to 20% of adults over 50. It is a common cause of groin pain in older individuals.

Typical symptoms include:

• Groin pain that can spread to the thigh

• Morning stiffness (usually less than 30 minutes)

• Progressive loss of mobility

• Pain that increases with activity

An important point: the severity of changes seen on imaging doesn't always predict the intensity of pain. Some people with 'severe' osteoarthritis on X-rays function very well. Others with minimal changes experience a lot of pain.

Exercise is the first-line treatment.³ It can reduce pain and improve function for years. Hip replacement remains a very effective option when conservative treatment is no longer enough. Our complete guide to hip osteoarthritis explores all treatment options.

What is femoroacetabular impingement (FAI)?

Femoroacetabular impingement occurs when the abnormal shape of the hip bones creates friction during movement. This friction can damage the labrum and cartilage over time.

There are three types:

• Cam: A bump on the head of the femur

• Pincer: The rim of the acetabular socket extends too far

• Mixed: A combination of both (the most common, about 70% of cases)

FAI often affects active adults between 20 and 45 years old. Symptoms include:

• Groin pain during or after activity

• Clicking or catching sensation

• Stiffness after prolonged sitting

• Reduced range of motion

Surprisingly, 37% of adults without any pain have a cam deformity on imaging. This means that an abnormal structure doesn't always cause problems. Conservative treatment with physiotherapy works for many. Our complete guide to femoroacetabular impingement explains when surgery becomes necessary.

What is snapping hip syndrome?

Snapping hip syndrome (coxa saltans or 'snapping hip') causes an audible or palpable snap during hip movement. It affects 5% to 10% of the population. Most cases are painless.

There are three types:

• External: The most common. The iliotibial band or gluteus maximus muscle passes over the greater trochanter.

• Internal: The iliopsoas muscle tendon slides over the head of the femur.

• Intra-articular: Caused by a labral tear or a loose body within the joint.

This condition is common among dancers, runners, and gymnasts. The snapping typically occurs with specific movements like standing up from a chair or pivoting.

If the snapping is not painful, it generally doesn't require treatment. When pain is present, stretching and muscle strengthening are effective. Our complete guide to snapping hip syndrome details therapeutic approaches.

What is a Hip Fracture?

A hip fracture is a medical emergency. It usually occurs after a fall and requires prompt surgical intervention. Approximately 86% of hip fractures affect people aged 65 and older.

Risk factors include:

• Osteoporosis (weakened bones)

• Advanced age

• Falls

• Muscle weakness

The symptoms are generally obvious:

• Severe hip or groin pain after a fall

• Inability to bear weight on the leg

• Leg appears shortened and turned outward

Action required: If you suspect a hip fracture, call emergency services immediately. Surgical treatment within 24 to 48 hours yields the best results.

Rehabilitation after a hip fracture is crucial. It aims to restore mobility and prevent future falls. Our complete guide to hip fracture explains the recovery process.

What is Adductor Tendinopathy?

Adductor tendinopathy causes pain in the groin and inner thigh. It's the most common groin injury in sports such as soccer, hockey, and football.

The term "tendinitis" is now considered inaccurate. Research shows that inflammation is not the primary issue. Instead, the tendon undergoes degenerative changes. This is why the term "tendinopathy" is now used.

Symptoms include:

• Pain in the groin or inner thigh

• Pain that increases with kicking, sprinting, or changes in direction

• Morning Stiffness

• Tenderness to touch near the pubic bone

Risk factors include:

• Previous injury (the greatest factor)

• Weakness of the adductor muscles

• Older Age

Treatment focuses on progressive strengthening. Exercises advance from isometric contractions to concentric, then eccentric movements. Recovery typically takes 4 to 8 weeks for acute cases, while chronic cases may require 3 to 6 months. Our complete guide to adductor tendinopathy details the rehabilitation program.

What is gluteal tendinopathy?

Gluteal tendinopathy is the most common tendinopathy of the lower limb, affecting up to 23.5% of middle-aged women. It is the primary cause of lateral hip pain.

This condition affects the tendons of the gluteus medius and gluteus minimus muscles. These muscles attach to the greater trochanter on the side of the hip. Their role is to stabilize the pelvis when you walk or stand on one leg.

Typical symptoms include:

• Pain on the side of the hip

• Pain when sleeping on the affected side

• Pain when climbing stairs

• Pain when walking for extended periods

• Nighttime pain that disrupts sleep

The severity can be significant. Studies show that the disability associated with this condition is comparable to that of end-stage hip osteoarthritis.

The most effective treatment combines education and progressive exercises. A key point is to avoid positions that compress the tendons, such as crossing your legs or performing iliotibial band stretches. Our complete guide to gluteal tendinopathy explains the recommended exercises.

What is an Adductor Strain?

An adductor strain is a sudden muscle tear in the inner thigh. It typically occurs during an explosive movement like a sprint, a soccer kick, or a rapid change of direction.

Professionals classify strains into three grades:

• Grade 1: Minor tear, mild pain, preserved function

• Grade 2: Partial tear, moderate pain, partial loss of function

• Grade 3: Complete tear, severe pain, significant disability

Symptoms include:

• Sudden, sharp pain in the groin or inner thigh

• Possible "pop" sensation at the time of injury

• Bruising that may appear after a few days

• Difficulty walking or spreading the leg

Initial treatment follows the PRICE protocol: Protection, Rest, Ice, Compression, Elevation. Progressive rehabilitation is then essential.

Recovery time varies depending on the grade:

• Grade 1-2: Return to activity in 2 to 3 weeks

• Grade 3: Up to 3 months of recovery

An important warning: do not return to your activities too quickly. Acute muscle strains can easily become chronic if not given enough time to heal. Our complete guide to adductor strains describes the return-to-sport protocol.

When should you see a doctor?

Seek emergency medical attention immediately if you experience these symptoms:

Consult a doctor within the next few days if you have:

• Severe night pain that doesn't change with position

• Unexplained weight loss with hip pain

• Pain that has persisted for more than 6 weeks without improvement

• History of cancer with new hip pain

Rest assured: serious causes of hip pain are rare. In the vast majority of cases, the pain comes from benign conditions that respond well to treatment.

How do professionals diagnose hip pain?

Diagnosis relies mainly on your medical history and a physical examination. Your healthcare professional will ask you questions about:

• Where exactly you feel the pain

• When it started

• What makes it worse and what relieves it

• Your activities and sports

The physical examination includes several specific tests:

• FADIR Test: Flexion, adduction, and internal rotation of the hip. Groin pain suggests an intra-articular problem like FAI.

• FABER Test: Flexion, abduction, and external rotation. This test assesses the sacroiliac joint and the hip.

• Trendelenburg Test: Assesses the strength of the gluteal muscles.

• Palpation: Involves touching the greater trochanter, muscles, and tendon attachments.

Imaging is not always necessary. It is indicated when:

• Red flags are present

• Conservative treatment fails after several weeks

• A surgical decision needs to be made

X-rays show bones and osteoarthritis. MRI reveals soft tissues like tendons, the labrum, and muscles. However, imaging results must be interpreted with caution.

Why doesn't imaging always predict pain?

Imaging abnormalities are common in people who have no pain. This surprising fact has important implications for understanding your condition.

For example:

• 37% of adults without symptoms have a cam deformity (FAI)

• 67% have a pincer deformity

• Labral tears are common in asymptomatic individuals

These figures mean that finding an 'abnormality' on your MRI does not necessarily explain your pain. Structure does not always determine the pain experience.

Why this disconnect? Pain is a complex experience. It results from the interaction between biological (tissues, nerves), psychological (stress, anxiety, expectations), and social (work, relationships) factors. The same structural change can cause a lot of pain in one person and none in another.

This understanding is liberating. If your imaging report mentions wear and tear, osteoarthritis, or degenerative changes, don't panic. These terms describe normal age-related changes that do not necessarily cause problems.

How do physiotherapy and exercises help hip pain?

Physiotherapy is the first-line treatment for most hip pain. Clinical guidelines recommend it before injections or surgery.

The main components of physiotherapy treatment:

Education

Understanding your condition reduces fear and improves outcomes. Your physiotherapist explains what causes your pain and why movement aids recovery.

Progressive Exercises

Exercises target specific deficits identified during the assessment. They may include gluteal strengthening, improving mobility, motor control exercises, and progressing towards functional activities.

Manual therapy

Manual techniques like joint mobilization and soft tissue work can provide short-term pain relief. They are most effective when combined with exercise.

Load management

Your physiotherapist helps you find the right balance between rest and activity. The goal is to keep moving while avoiding overloads that worsen symptoms.

For gluteal tendinopathy (GTPS), research shows that education and exercises are superior to cortisone injections in the long term. Injections provide temporary relief but do not address the root cause.

What specific exercises help?

Hip exercises target several muscle groups. A well-designed program includes:

Gluteal muscle strengthening

Hip abduction exercises strengthen the muscles on the side of your hip. Examples include side leg raises (lying down or standing), side walks with a resistance band, and modified single-leg squats.

Adductor Exercises

Strengthening the inner thigh muscles is crucial for adductor issues. Exercises progress from isometric contractions (without movement) to dynamic movements.

Hip Mobility

Range of motion exercises maintain or improve joint flexibility. They are especially important for osteoarthritis and FAI.

Trunk stability

Core muscles help stabilize the pelvis during hip movements.

Important Points to Remember:

• For lateral hip pain (gluteal tendinopathy/GTPS): Avoid crossing your legs and iliotibial band stretches. These positions compress the tendons.

• For tendinopathies: Gradual progression is essential. Doing too much, too soon, will worsen symptoms.

• For osteoarthritis: Movement is your friend. Exercise lubricates the joint and strengthens protective muscles.

Consult a physiotherapist for a personalized program. Our pain and stiffness treatment services offer a comprehensive assessment and a plan tailored to your condition.

Our physical therapists can assess your condition and provide you with a personalized treatment plan.

Make an appointment

Can You Treat Hip Pain Yourself?

Self-treatment can relieve mild hip pain (ice, rest, gentle stretches). However, without differentiating between osteoarthritis, bursitis, and tendinitis, you risk doing counterproductive exercises. Without an accurate diagnosis, you might maintain compensatory movements or perform exercises that hinder recovery.

A physiotherapist differentiates between intra-articular and extra-articular causes of pain to tailor treatment. An assessment helps identify the exact cause, rule out red flags, and create a progressive treatment plan. Exercises are customized to your specific condition, not generic.

Our approach: professional assessment + supervised home exercise program = better long-term results.

Are you hesitating between self-treatment and a consultation? Free 15-min consultation to discuss your situation.

Does Physiotherapy Work for Hip Pain?

Physiotherapy is recognized as an effective treatment for hip pain, with results supported by scientific research.

Studies show a 70-80% success rate for treating hip pain with physiotherapy. The combination of therapeutic exercises, manual therapy, and education proves particularly effective in reducing pain and improving function.

Treatment effectiveness depends on several factors: how early you seek consultation (earlier = better results), consistency with home exercises, the severity of osteoarthritis, gluteal muscle strength, and range of motion. A comprehensive assessment allows for treatment to be tailored to your specific situation.

Most patients notice improvement within the first 3-4 sessions, with complete resolution typically in 10-14 weeks.

Are you suffering from hip pain? Book an appointment for a comprehensive assessment and a personalized treatment plan.

What Are Common Myths About Hip Pain?

Several persistent myths can increase anxiety and hinder your recovery. Here's the reality:

The most harmful myth is probably that of fragility. Your hip is a remarkably robust structure. It was designed to withstand significant loads and years of use. The "abnormalities" radiologists describe often represent normal variations or natural adaptations to aging.

What is the prognosis for hip pain?

Most hip pain improves with conservative treatment. The prognosis depends on the specific condition:

Greater Trochanteric Pain Syndrome (GTPS) / Gluteal Tendinopathy

This is often a chronic condition, but it is very manageable. Exercise and education significantly reduce symptoms for most people. Expect improvement over several weeks to months.

Hip osteoarthritis

Progression varies greatly. Some individuals remain stable for years with exercise and weight management. When hip replacement becomes necessary, it is a very successful procedure with excellent outcomes.

Femoroacetabular Impingement (FAI)

Physiotherapy works for many. When conservative treatment fails, hip arthroscopy offers good results.

Tendinopathies (adductor and gluteal)

Patience is essential. Unlike muscle injuries, tendinopathies take time to heal. Allow several months for chronic cases. However, gradual improvement is the norm with the right treatment.

Hip Fracture

The prognosis depends on the overall health status before the fracture. Intensive rehabilitation significantly improves outcomes.

Factors that positively influence your prognosis:

• Positive attitude and active engagement in treatment

• Maintaining appropriate physical activity

• Good understanding of your condition

• Adequate social support

• Absence of catastrophizing (exaggerated negative thoughts)

What should you remember and what should you do?

How to prevent hip pain?

Prevention involves several strategies:

Stay physically active

Regular activity keeps muscles strong and joints mobile. Walking, swimming, and cycling are excellent options. An active body is a resilient body.

Strengthen your hip muscles

Strong gluteal muscles protect the joint and tendons. Simple hip abduction exercises performed regularly can make a big difference.

Progress Gradually

Increase the intensity of your activities gradually. Sudden overloads are a major risk factor for injuries.

Manage your weight

Excess weight increases the load on the hip joint. Weight loss can relieve osteoarthritis symptoms.

Warm up before sports

An adequate warm-up prepares muscles and tendons for exertion.

Do not ignore persistent pain

Pain that lasts deserves an evaluation. Early treatment can prevent it from becoming chronic.

Questions to Ask Your Healthcare Professional

Being an informed patient improves your care. Here are some helpful questions:

• What is the most likely cause of my pain? Ask for a clear explanation.

• What evidence supports this diagnosis? Is it based on a physical exam? Imaging? Ensure the findings are solid.

• What is my prognosis? How long until I see improvement? What kind of recovery is realistic?

• Are there any red flags to watch out for? What symptoms should make me return for another consultation?

• How can I stay active safely? What activities can I continue? Which ones should I temporarily modify?

• Why do you recommend this treatment? What are the alternatives? What is the evidence of its effectiveness?

• When should I return if it doesn't improve? How long should I give the treatment before re-evaluation?

What are the key takeaways?

1. Your hip is robust and adaptable. It is designed to withstand significant loads throughout your life. Do not treat it as fragile.
2. Most conditions respond to conservative treatment. Physiotherapy, exercises, and education are effective for the majority of hip pains.
3. Movement is your ally. Adapted activity aids healing. Prolonged rest can make things worse.
4. Structure does not always determine pain. Imaging abnormalities exist in many people without symptoms. Do not panic over an MRI report.
5. Physiotherapy is the first-line treatment. Before injections or surgery, try an active approach.
6. Know the red flags. Most pains are benign, but some symptoms require immediate attention.
7. Patience is necessary for tendinopathies. These conditions take months, not weeks. Gradual progression is key.
8. You have more control than you think. Your choices, beliefs, and behaviors significantly influence your recovery.

These principles do not guarantee a quick recovery for everyone. Hip pain remains complex and sometimes persistent. However, adopting these understandings creates the best possible conditions for your recovery.

References

1. Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B. Prognosis of trochanteric pain in primary care. Br J Gen Pract. 2005;55(512):199-204.

2. Fearon AM, Scarvell JM, Neeman T, et al. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med. 2013;47(10):649-653.

3. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;(4):CD007912.

4. Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-1176.

5. Reiman MP, Bolgla LA, Loudon JK. A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiother Theory Pract. 2012;28(4):257-268.