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Common Hip Conditions: A Guide to Hip Pain and What Might Be Causing It

All information in this blog is supported by peer-reviewed research and current clinical guidelines. Reference numbers appear throughout, with the full list at the bottom of the page.



Hip Pain Is More Common Than You Might Think

Hip pain affects people of all ages and activity levels, and it is one of the most frequently seen presentations in musculoskeletal practice. Research has found that hip pain affects between 12 and 15% of adults over the age of 60, rising to as high as 40% in some older populations, though it is by no means limited to older adults, with younger athletes, active individuals, and working-age adults all commonly affected. ¹


What makes hip pain particularly challenging is that the hip joint sits at the centre of an anatomically complex region, surrounded by muscles, tendons, bursae, nerves, and ligaments, all of which can independently produce pain, and all of which can refer symptoms into the groin, thigh, buttock, or knee. Getting an accurate diagnosis is genuinely the most important first step, since treating the wrong structure leads to incomplete and short-lived recovery.


If you are unsure whether your pain is coming from your hip, your lower back, or your sacroiliac joint, our dedicated blog,



The Most Common Hip Conditions We See in Clinic


Hip Osteoarthritis

Hip osteoarthritis is the most common cause of persistent hip pain in adults, particularly those over 40, and is one of the leading causes of disability in the UK. ² It involves progressive degeneration of the hip joint cartilage, bone changes, and surrounding soft tissue adaptations, producing groin and anterior thigh pain that typically worsens with activity and stiffens after rest.

NICE Guideline NG226 sets out the framework for diagnosing and managing osteoarthritis across the UK, with exercise, weight management where relevant, and manual therapy as the evidence-based foundation of care. ²




Greater Trochanteric Pain Syndrome

Greater trochanteric pain syndrome (GTPS) is a genuinely common cause of lateral (outer) hip pain, most frequently affecting women between their 40s and 60s. The term has replaced the older "trochanteric bursitis" label, since research has shown that true bursal inflammation is present in fewer than 10% of cases, with gluteal tendinopathy being the far more common underlying driver. ³

Typical symptoms include pain and tenderness over the outer hip, often worse lying on the affected side at night and with walking or climbing stairs.




Femoroacetabular Impingement (FAI)

FAI occurs when a bony variation in the shape of the hip joint causes abnormal contact between the femoral head and the acetabulum during movement, particularly with hip flexion. It is one of the leading causes of hip pain in younger and more active adults, and is closely associated with labral tears. ⁴

Symptoms typically include deep groin pain, often described as a catching or pinching sensation, worse with prolonged sitting, squatting, or pivoting movements.




Hip Labral Tears

The acetabular labrum is a ring of cartilage lining the hip socket, contributing to joint stability and load distribution. Labral tears are closely associated with FAI and can also occur following trauma or repetitive loading. ⁴ They produce deep groin and anterior hip pain, often with a characteristic clicking, catching, or locking sensation.

Labral tears are frequently found on MRI in people without any symptoms at all, which is why clinical assessment rather than imaging alone determines whether a tear is genuinely the source of someone's pain.




Sacroiliac Joint Dysfunction

The sacroiliac joints connect the base of the spine to the pelvis on either side, and dysfunction here is a frequently overlooked cause of posterior pelvic and buttock pain that is often mistaken for lumbar disc or hip joint pathology. SIJ dysfunction has a genuinely wide and variable referral pattern, including the buttock, posterior thigh, groin, and anterior thigh in 44% of confirmed cases. ⁵




Hip Flexor Strain (Iliopsoas)

Hip flexor strains typically affect the iliopsoas or rectus femoris muscles, most commonly through sudden eccentric overload during sprinting, kicking, or explosive activity, or through repetitive overuse in runners and cyclists. They produce anterior hip and groin pain, particularly with resisted hip flexion. ⁶

Recurrence rates of 30 to 40% are linked specifically to returning to activity based on pain relief alone rather than completing proper strength-based rehabilitation. ⁶




Piriformis Syndrome

The piriformis muscle sits deep in the buttock and, in some people, has a direct relationship with the sciatic nerve, either passing close to it or, in anatomical variations, through it. When the piriformis becomes tight, overloaded, or goes into spasm, it can compress the sciatic nerve at this point, producing buttock pain and sciatic-type symptoms down the leg without any spinal disc involvement. ⁷

This makes piriformis syndrome an important differential to consider in anyone with apparent sciatica who has a normal lumbar MRI.




Gluteal Tendinopathy

Closely related to greater trochanteric pain syndrome, gluteal tendinopathy describes degenerative change and pain specifically within the gluteus medius and gluteus minimus tendons, the tendons most consistently implicated in lateral hip pain. ³ It is strongly associated with compressive loading of the tendon against the greater trochanter, and responds well to progressive, targeted gluteal strengthening combined with load management advice.




Meralgia Paraesthetica

Meralgia paraesthetica is an entrapment of the lateral femoral cutaneous nerve, a purely sensory nerve supplying the outer thigh, producing burning, tingling, or numbness over the outer thigh without any muscle weakness. ⁸ It is commonly caused by sustained pressure over the inguinal ligament, tight clothing, prolonged standing, pregnancy, or significant weight gain. It is worth knowing specifically because it is frequently mistaken for L2 or L3 lumbar nerve root referral.




Adductor-Related Groin Pain

Adductor-related groin pain is the most common cause of groin pain in athletes, particularly those involved in football, hockey, and other sports requiring rapid change of direction. ⁹ It produces medial (inner) groin pain, tenderness along the adductor muscle group, and pain with resisted adduction, distinguishing it from the anterior and deep groin pain patterns of hip joint pathology and iliopsoas strain.




Hip Pain and the Lower Back: A Note on Overlap

It is worth being genuinely clear that several of the conditions above can coexist with, and be complicated by, lumbar spine pathology. Upper lumbar nerve root referral from L2, L3, and L4 can produce groin and anterior thigh pain that closely mimics hip joint and hip flexor conditions. A thorough assessment always needs to consider the lumbar spine alongside the hip, pelvis, and SIJ, and our dedicated diagnostic blog covers exactly how to distinguish between these sources.



When Should You Be Concerned? Red Flags to Watch For

Please seek prompt medical assessment if you experience:

  • Sudden, severe hip pain following a fall or significant trauma, particularly in older adults (possible fracture)

  • Inability to bear weight on the affected leg

  • Fever, redness, or warmth around the hip (possible infection)

  • Significant, unexplained weight loss alongside hip pain

  • Hip pain in a child or adolescent, which requires prompt assessment to rule out specific growth-related conditions

  • Rapidly worsening neurological symptoms alongside hip pain



How We Can Help

At Stay Strong Therapy we take a thorough, systematic assessment approach to hip pain, working through the hip joint, the surrounding muscles and tendons, the SIJ, and the lumbar spine to identify the true source of your symptoms before building a personalised treatment plan.


We offer a range of treatments well-suited to the most common hip conditions, including osteopathic manual techniques, deep tissue and sports massage, medical acupuncture, cupping, and gua sha, combined with evidence-based exercise prescription tailored to your specific condition and stage of recovery.



Frequently Asked Questions

Do I need a scan to find out what's wrong with my hip? Not always. Many common hip conditions can be accurately identified through a thorough clinical history and hands-on examination. Imaging is most useful for confirming specific diagnoses such as osteoarthritis, labral tears, or fracture, where it would change the management plan.


Could my hip pain actually be coming from my back? Yes, genuinely. Lumbar spine referral from L2, L3, and L4 can produce pain felt entirely in the groin and anterior thigh, closely mimicking hip joint and hip flexor conditions. A thorough assessment always considers both regions.


How long will it take to get better? This genuinely varies by condition. Muscle strains and soft tissue conditions often improve meaningfully within a few weeks of appropriate treatment. Tendinopathies, osteoarthritis, and more structural conditions typically require a longer, more progressive rehabilitation approach.



Not sure what's causing your hip pain? Get in touch using the contact form and we will carry out a thorough assessment to identify exactly what's going on and build the right treatment plan for you.




References

  1. Hip Pain and Mobility Deficits, Hip Osteoarthritis: Revision 2025. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(11):CPG1-CPG31. Available at: https://www.jospt.org/doi/10.2519/jospt.2025.0301

  2. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management. NICE Guideline [NG226]. 2022. Available at: https://www.nice.org.uk/guidance/ng226

  3. Management of Greater Trochanteric Pain Syndrome: A Narrative Review. PMC. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12255468/

  4. Standard of Care: Hip Labral Tears. Brigham and Women's Hospital, Department of Rehabilitation Services. Available at: https://www.brighamandwomens.org/assets/bwh/patients-and-families/pdfs/hip---labral-tear.pdf

  5. Sacroiliac Joint Dysfunction in Patients With Low Back Pain. PMC. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6707638/

  6. Hip Flexor Strain Recovery: Why Athletes Keep Re-Injuring It. Helix Sports Medicine. Available at: https://helixsportsmed.com/hip-flexor-strain-recovery-athletes/

  7. Piazza S, et al. Piriformis syndrome: a systematic review of case reports. BMC Surgery. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12512919/

  8. Meralgia Paraesthetica. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507800/

  9. Weir A, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 2015;49(12):768-774.


 
 
 

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