Hip Pain: What's Causing It, What Your Body Is Trying to Tell You, and When a Physiotherapist Can Help

⚠ Clinical Note

This article is for educational purposes only. It is based on current clinical practice guidelines and peer-reviewed research and is not a substitute for personalised medical advice, diagnosis, or treatment. If you have hip pain or any concerns about your symptoms, consult a qualified healthcare professional before starting any exercise or treatment program.

Key Facts

✔ One in four adults will develop symptomatic hip osteoarthritis at some point in their lifetime. [1]
✔ Greater trochanteric pain syndrome - one of the most common causes of lateral hip pain - affects around 1.8 per 1,000 adults each year, with women affected two to three times more often than men. [2]
✔ Exercise, patient education, and weight management are the three core first-line treatments for hip osteoarthritis, consistently recommended across international guidelines. [3, 4]
✔ Hip osteoarthritis can be diagnosed clinically in adults over 45 with activity-related joint pain and morning stiffness lasting less than 30 minutes - a scan is not always required. [5]
✔ For gluteal tendinopathy and lateral hip pain, education combined with targeted exercise outperforms corticosteroid injection and a wait-and-see approach at both 8 weeks and 52 weeks. [2]

30-Second Summary

Where your hip pain sits - front, side, or back - is the first clue to its cause, because each zone contains different structures that produce different conditions. [1, 3, 5] Most causes, including osteoarthritis, gluteal tendinopathy, and femoroacetabular impingement, respond well to exercise, manual therapy, and rehabilitation - surgery and imaging are not the starting point for most people. [3, 9] A physiotherapist can assess most hip conditions clinically without a referral or a scan, and earlier treatment tends to produce better outcomes than waiting. [5, 9]

Introduction

If you have hip pain and you are not sure what is causing it, you are probably asking some version of the same question most people ask: is this something serious, do I need a scan, and what should I actually do about it?
Hip pain is genuinely confusing to navigate on your own - not because it is complicated, but because it does not always behave the way you expect. The pain might not sit where you think the hip is. It can feel like a groin strain, a lower back problem, or a nerve issue depending on what is actually going on. And the right response depends entirely on which structure is involved. This article works through all of that - the different causes, what your symptoms might be telling you, and when it makes sense to get it assessed.

What the Hip Actually Is - and Why Location Matters

The hip is a ball-and-socket joint where the rounded head of your thigh bone (femur) sits inside a cup-shaped socket in your pelvis (the acetabulum). It carries your body weight, absorbs impact when you walk, run, or climb stairs, and gives your leg its full range of movement. Around the joint sits a complex arrangement of muscles, tendons, bursae (small fluid-filled sacs), and a fibrocartilage ring called the labrum that deepens and stabilises the socket.
Because so many structures share this region, the location of hip pain carries real diagnostic weight. Clinicians organise hip and groin pain into three broad zones - anterior (front), lateral (side), and posterior (back) - and the conditions most likely to be responsible differ meaningfully between them. [1] Where your pain sits is not always a definitive answer, but it is a reliable starting point.

Causes

Anterior Hip Pain: Often Coming from Inside the Joint

Pain felt at the front of the hip, in the groin, or deep in the joint tends to come from intra-articular (inside the joint) causes. In adults over 45, hip osteoarthritis (OA) is the most common cause. Hip OA occurs when the cartilage that cushions the joint gradually wears down, causing the bones to move less smoothly against each other.
It is more common than most people realise - around 6.7–9.7% of adults over 45 have radiographic hip OA (osteoarthritis visible on X-ray). Across a lifetime, one in four adults will develop symptomatic hip OA. [1]
In younger and more active adults - particularly people in their 20s, 30s, and 40s who play sport or exercise regularly - anterior and groin pain more often reflects femoroacetabular impingement (FAI) syndrome or a labral tear. FAI syndrome occurs when the ball and socket do not move together smoothly, usually because of subtle differences in the shape of the femoral head or acetabular rim. The Zurich 2018 international consensus identified FAI syndrome, acetabular dysplasia, and labral and chondral conditions (problems affecting the labrum and joint cartilage) as the most common hip-related conditions in young to middle-aged active adults presenting with hip pain. [6] Someone with FAI syndrome typically reports deep groin or front-of-hip pain that is worse with hip flexion, rotation, or prolonged sitting.
Other conditions that can cause anterior hip pain include hip flexor strains (especially after a sporting incident), femoral neck stress fractures in athletes with high training loads, and avascular necrosis of the femoral head - a condition caused by disrupted blood supply to the bone that is more common in people with a history of systemic corticosteroid use, heavy alcohol use, or certain blood disorders. [1]

Lateral Hip Pain: Usually About Tendons and Bursae

Pain on the outer side of the hip is most commonly caused by greater trochanteric pain syndrome (GTPS). [1] This is the area you feel when you lie on that side at night, or when you press your fingers against the bony prominence of the hip. GTPS is an umbrella term covering conditions that affect the tendons of the gluteal muscles and the bursa over the greater trochanter - the bony point at the top of your thigh bone.
The gluteal muscles most commonly involved are gluteus medius and gluteus minimus. The most common driver is abductor tendon pathology - degeneration or irritation of the tendons that pull your leg outward - which accounts for 15–50% of GTPS presentations. [2]
A typical presentation is a woman in her 50s who finds the outer hip aches when she lies on it at night, worsens when she crosses her legs sitting at her desk, and flares after walking longer distances. If this pattern sounds familiar, lateral hip pain is the most likely explanation - but pain further back in the buttock or thigh points somewhere different.

Posterior Hip Pain: Look at Both the Hip and the Lower Back

Pain felt deep in the buttock, radiating down the back of the thigh, or settled in the upper gluteal area can originate from several different sources. Lumbar spine pathology - a problem in the lower back - is a common cause of posterior hip pain. [1] Nerves from the lower back refer pain into the hip and buttock region, which is particularly likely in people who also have back stiffness. The article on lower back pain causes and symptoms covers this overlap in more detail.
Deep gluteal syndrome is another recognised cause, in which the sciatic nerve becomes compressed as it passes through the deep buttock muscles. [1] When nerve involvement produces symptoms down the leg, the sciatica exercises and stretches guide explains what that presentation typically looks like. Hamstring tendinopathy - irritation of the tendons where they attach to the sit bone (ischial tuberosity) - can cause a deep, aching pain that worsens with prolonged sitting on hard surfaces. [1]
This overlap between the hip and lumbar spine is one reason that getting an assessment from a clinician trained in musculoskeletal assessment matters. A physiotherapist can systematically examine both regions to determine where the problem is actually originating.

Symptoms

Hip pain does not feel the same across different conditions, but there are patterns worth knowing. The most common descriptions include: [1, 2]

• A deep, aching pain in the groin or front of the hip that is worse after walking, stair climbing, or getting up from a chair (often hip OA or FAI syndrome)
• A sharp catch or clicking sensation with certain movements, particularly at the end of hip range, or when getting in and out of a car (often associated with FAI or labral pathology)
• Outer hip pain at night that wakes you when you roll onto that side, or pain in the same spot when sitting cross-legged (consistent with GTPS or gluteal tendinopathy)
• Stiffness in the morning that eases within 30 minutes of moving around (a hallmark of hip OA)
• Pain radiating down the outside or back of the thigh, which may indicate hip OA (pain can refer into the thigh), posterior hip conditions, or lumbar referred pain [1]
• Groin discomfort when walking, particularly in older adults, which commonly traces to a problem inside the hip joint itself

Hip pain that is accompanied by significant systemic symptoms - unexplained weight loss, night sweats, constant pain that is not affected by position or movement, or a history of cancer - warrants prompt medical review rather than a physiotherapy assessment as the first stop. The same applies to hip pain that starts after a fall in an older adult, given the risk of fracture. [5]

Treatment Options

Most hip conditions can initially be managed without surgery, and in many cases physiotherapy is the most effective first step. [3] Treatment depends on the diagnosis, the person's activity levels, goals, and overall health - but there are some well-established patterns. The physiotherapy and hip assessment service covers the full range of hip conditions described in this article.

Exercise Therapy

Exercise is the best-evidenced treatment for hip OA and is strongly recommended across every major international guideline. [3, 4, 5] Multiple meta-analyses confirm that land-based exercise reduces pain and improves physical function in people with hip OA. Effect sizes fall in the small-to-moderate range but are consistent across studies. [7, 8] Supervised exercise with high compliance produces better outcomes than unsupervised home programs, particularly for pain reduction. [9] The evidence supports a range of exercise types, including strengthening, flexibility, and walking - what matters more than the specific type is that the program is progressive, individualised, and sustained. [9]
For GTPS and gluteal tendinopathy, a landmark Australian randomised controlled trial found that education combined with targeted exercise was superior to both corticosteroid injection and a wait-and-see approach, at 8 weeks and at 52 weeks. [2] In one study examining structured physiotherapy and home exercise for GTPS, 60.5% of participants reported complete resolution of symptoms at 15 months. [2]
For FAI syndrome, the 2016 Warwick international consensus of 25 clinical societies endorses physiotherapist-led rehabilitation targeting hip stability, neuromuscular control (the coordination between muscles and the nervous system), strength, and movement patterns as a core treatment pathway. [10]

Manual Therapy

Manual therapy - including joint mobilisation and soft tissue techniques - carries a Grade A (strong) recommendation for mild-to-moderate hip OA from the 2025 APTA/Academy of Orthopaedic Physical Therapy clinical practice guideline. [9] High-quality evidence shows that manual therapy improves range of motion, reduces pain, and improves function in people with hip OA. [9] A single session of hip mobilisation with movement can produce immediate reductions in pain and improvements in mobility and functional tasks in people with hip OA. [9]

Education and Self-Management

Every major guideline recommends patient education as a core component of hip OA management - not as an add-on, but as a treatment in its own right. [3, 4, 5] Understanding the condition, what makes it better or worse, and how to manage load and activity leads to better long-term outcomes. This is one reason physiotherapy for hip conditions is not simply about exercise prescription - the conversation about your lifestyle, activities, and what you are trying to return to is part of the treatment.

Weight Management

For people who are overweight or obese, weight management is strongly recommended as part of hip OA management. [4] International guidelines suggest a target weight loss of 5–7.5% for those with a BMI over 25, noting that this is most effective when achieved through a combination of dietary modification and exercise. [9] A physiotherapist can work with your GP, dietitian, or relevant specialist to support this as part of a wider care plan.

Injections

Intra-articular corticosteroid injection may provide short-term relief for hip OA flares, but evidence for sustained benefit beyond a few weeks is limited. [3] Importantly, higher-quality international guidelines - including the AAOS (2023) and multiple systematic reviews - consistently recommend against intra-articular hyaluronic acid (viscosupplementation) for hip OA. [3, 11] For GTPS, corticosteroid injection can help manage acute pain and allow participation in rehabilitation - but exercise is more effective for long-term outcomes and injection effects often diminish over time. [12, 13]

Surgery

For hip OA, surgery becomes relevant only when conservative management has been optimised and symptoms remain severe with significant functional impairment. The RACGP guideline advises against arthroscopic procedures for hip OA unless there is true mechanical locking - meaning the joint becomes physically stuck and cannot move. [5] When symptoms remain severe despite all conservative options, orthopaedic referral for joint replacement becomes appropriate. For FAI syndrome, the 2016 Warwick consensus supports arthroscopic or open surgery to correct hip morphology (the shape and structure of the hip joint) as a pathway for people who do not respond to conservative management, provided the full diagnostic criteria are met. [10]

Self-Management

While waiting for an assessment, or between sessions, there are practical things you can do that will not make most hip conditions worse and may genuinely help.
Keep moving. This is particularly important for hip OA. Sustained rest - especially prolonged sitting or avoiding stairs - leads to deconditioning that makes recovery harder. Gentle walking, swimming, or cycling within a comfortable range is generally safe and beneficial. [4]
Modify the positions and activities that provoke it. For lateral hip pain (GTPS), activity modification - including temporary changes to how you sit, stand, and sleep - is part of first-line conservative management (non-surgical treatment). The goal is to reduce provocative loading on the tendon and bursa without stopping movement entirely. [2]
Manage load rather than avoiding it. For tendon conditions in particular, completely offloading the tendon is rarely the answer. [2] The goal is staying within a load range the tendon can tolerate while gradually building its capacity over time - a structured physiotherapy program will guide this progression based on your specific presentation.
Track your pain patterns. Note when pain is worse, what positions trigger it, and whether it eases with gentle movement or stays constant regardless of what you do. This pattern is clinically useful and helps a physiotherapist reach a faster, more accurate assessment of what is going on.

When to See a Physiotherapist

Most hip pain benefits from a proper assessment - not because something is always seriously wrong, but because the right diagnosis determines the right treatment path.
See a physiotherapist if:

• Your hip pain is persisting and not clearly improving
• Pain is affecting your sleep, walking, or ability to perform activities you care about
• You are unsure whether it is safe to continue exercise or return to sport
• You have been told you have hip OA, FAI, or another hip condition but have not had it properly explained or managed
• Your pain is worsening despite rest or activity modification

See a doctor urgently rather than a physiotherapist first if:

• You had a fall or trauma and have significant pain or difficulty bearing weight
• You have hip pain alongside fever, unexplained weight loss, or pain that is constant and unaffected by position
• You are an older adult with sudden onset of severe hip pain - this warrants medical review to rule out fracture or serious pathology [1, 5]
• Your pain started after prolonged steroid use and is worsening progressively

For adults over 45 whose hip pain comes on with activity, eases with rest, and is accompanied by morning stiffness that settles within 30 minutes, current clinical guidelines support a clinical diagnosis of hip OA without the need for imaging as a first step. [5] A physiotherapist can assess and begin treatment based on clinical findings - you do not need to wait for a referral or a scan to get started.

Key Takeaways

• Hip pain is not one condition - it has multiple causes, and where the pain sits (front, side, or back of the hip) is an important first clue to what is happening
• Most hip conditions respond well to physiotherapy-led exercise, manual therapy, and education - surgery is not the first answer for the majority of people
• Exercise is the highest-evidenced treatment for hip OA and is recommended across all major international guidelines; the effects are modest but consistent
• For lateral hip pain from GTPS or gluteal tendinopathy, targeted exercise and education outperform corticosteroid injection for long-term outcomes
• You do not always need a scan before starting treatment - a clinical assessment can establish a working diagnosis and begin evidence-based management for many common hip conditions

References

1. Chamberlain R. Hip pain in adults: evaluation and differential diagnosis. *American Family Physician.* 2021;103(2):81–89.
2. Gill JK, Neal-Smith G, Saed A, Burgan A, Fernquest S. Management of greater trochanteric pain syndrome: a narrative review. *Cureus.* 2025;17(6):e85859.
3. Gibbs AJ, Gray B, Wallis JA, Taylor NF, Kemp JL, Hunter DJ, Barton CJ. Recommendations for the management of hip and knee osteoarthritis: a systematic review of clinical practice guidelines. *Osteoarthritis and Cartilage.* 2023;31(10):1280–1292.
4. Royal Australian College of General Practitioners (RACGP). Guideline for the management of knee and hip osteoarthritis. 2nd edition. 2018.
5. Royal Australian College of General Practitioners (RACGP). Guideline for the management of knee and hip osteoarthritis - Appendix 1: Algorithm for holistic assessment, diagnosis and management. 2nd edition. 2018.
6. Reiman MP, Agricola R, Kemp JL, et al. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. *British Journal of Sports Medicine.* 2020;54(11):631–641.
7. Teirlinck CH, Verhagen AP, van Ravesteyn LM, et al. Effect of exercise therapy in patients with hip osteoarthritis: a systematic review and cumulative meta-analysis. *Osteoarthritis and Cartilage Open.* 2023;5:100338.
8. Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. *Cochrane Database of Systematic Reviews.* 2014;(4):CD007912. Published in: *Physical Therapy.* 2016;96(11):1689–1696.
9. Koc TA Jr, Cibulka M, Enseki KR, Gentile JT, MacDonald CW, Kollmorgen RC, Martin RL. Hip pain and mobility deficits - hip osteoarthritis: revision 2025. *Journal of Orthopaedic & Sports Physical Therapy.* 2025;55(11):CPG1–CPG31.
10. Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. *British Journal of Sports Medicine.* 2016;50(19):1169–1176.
11. American Academy of Orthopaedic Surgeons (AAOS). Management of osteoarthritis of the hip: evidence-based clinical practice guideline. 2023.
12. Wang Y, Wang K, Qin Y, Wang S, Tan B, Jia L, Jia G, Niu L. The effect of corticosteroid injection in the treatment of greater trochanter pain syndrome: a systematic review and meta-analysis of randomised controlled trials. *Journal of Orthopaedic Surgery and Research.* 2022;17:283.
13. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait-and-see approach on global outcome and pain from gluteal tendinopathy: prospective, single-blinded, randomised clinical trial. *BMJ.* 2018;361:k1662. [Cited via: Gill et al. 2025]