Hip Pain and Stiffness: What Could It Be, and How We Can Help

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

Hip Pain Can Come From Several Different Places

Hip pain is genuinely common, but it isn't a single condition, it can arise from several distinct structures within and around the hip joint, each with a different cause, pattern, and treatment approach. Working out exactly where your pain is coming from is the first and most important step toward effective treatment.

What Could It Potentially Be?

A thorough differential diagnosis for hip pain includes a genuinely wide range of possibilities. Recognised differential diagnoses for hip-related symptoms include lumbar disc disease, hip osteoarthritis, fracture, avascular necrosis, congenital disorders, sacroiliac joint pathology, greater trochanteric bursitis, iliotibial band syndrome, iliopsoas (hip flexor) tendinitis, synovitis, and systemic inflammatory conditions such as rheumatoid arthritis. ¹ Below are the most common causes we see in clinical practice.

Hip osteoarthritis: degenerative wear of the hip joint itself, typically causing groin pain, stiffness, and reduced range of movement, particularly with rotation. The most common cause of persistent hip pain in older adults.

Greater trochanteric pain syndrome: pain over the outer (lateral) side of the hip, covered in detail below, encompassing what used to simply be called "trochanteric bursitis."

Hip flexor strain (iliopsoas tendinopathy): pain at the front of the hip or groin, often related to repetitive hip flexion activities such as running, kicking sports, or cycling.

Femoroacetabular impingement (FAI) and labral tears: pain deep within the hip or groin, often in younger, more active people, related to the shape or movement of the hip joint itself.

Sacroiliac joint dysfunction and lumbar spine referral: pain felt in the hip or buttock that actually originates from the lower back or pelvis, a genuinely common source of confusion.

Iliotibial band syndrome: pain along the outer thigh, often associated with greater trochanteric pain syndrome and linked to running or repetitive activity.

Greater Trochanteric Pain Syndrome: A Closer Look

This deserves particular attention, because much like "shoulder impingement," the older terminology here is genuinely outdated and doesn't reflect current understanding.

"Trochanteric bursitis" was historically used to describe pain over the outer hip, but the term has turned out to be largely inaccurate. Research using MRI found bursal distention in only 8.3% of people with this presentation, while gluteal tendon tears and tendinitis were far more common findings, at 45.8% and 62.5% respectively. ² A separate ultrasound study of 877 people with this presentation found no signs of bursitis at all in nearly 80% of cases. ² This is why the broader, more accurate term greater trochanteric pain syndrome (GTPS) is now preferred, encompassing trochanteric bursitis, gluteal tendinopathy or tearing, and external snapping hip syndrome together. ³

GTPS mainly affects women, with a female predominance of around 2 to 3 to 1, most frequently in their 40s to 60s. ⁴ It is a genuinely common condition, negatively affecting work, physical activity, and quality of life. ⁵

Common Signs and Symptoms

Hip osteoarthritis: groin pain, stiffness particularly after rest, reduced rotation, pain worsening with activity over time.

Greater trochanteric pain syndrome: pain and tenderness over the outer hip, often worse lying on the affected side at night, with walking, or climbing stairs.

Hip flexor strain: pain at the front of the hip or groin, worse with lifting the leg or sudden acceleration.

Femoroacetabular impingement: deep groin pain, often worse with prolonged sitting, squatting, or twisting movements.

Risk Factors

• Age, hip osteoarthritis and GTPS both become more common with age, GTPS particularly from the 40s onward ⁴

• Female sex, GTPS shows a clear female predominance, likely related to pelvic biomechanics and hormonal factors ⁴ ⁶

• Repetitive loading activities, including running, particularly relevant to hip flexor strain and iliotibial band-related pain

• Previous hip or pelvic injury

• Obesity and reduced activity levels, recognised contributors to hip osteoarthritis risk

• Underlying bony hip shape variations, such as femoroacetabular impingement, which can predispose to both labral pathology and a higher risk of chronic GTPS, with one study finding 7% of people with FAI also had bursitis, suggesting these conditions can be genuinely interconnected ⁷

• Sedentary lifestyle combined with sudden activity increases, a common pattern across several hip conditions

What to Look Out 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 weight-bear 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

• Numbness, weakness, or pain radiating down the leg, which may suggest a lumbar spine origin rather than the hip itself

How Is It Diagnosed?

Diagnosis is primarily clinical, based on history and hands-on examination, though imaging is often used to help rule out other causes of hip pain, such as osteoarthritis or femoroacetabular impingement, rather than to confirm GTPS itself. ⁴ Plain X-rays are valuable for ruling out competing diagnoses, allowing appropriate treatment to begin without the need for more advanced imaging in most cases. ⁸ A diagnostic injection can sometimes help distinguish whether symptoms are genuinely coming from within the hip joint itself or from the surrounding structures. ⁸

Myths vs Facts

"I have trochanteric bursitis." You may well have been told this, but current evidence shows true bursitis is actually one of the least common findings in people with lateral hip pain. Gluteal tendon problems are far more frequently the genuine cause. ²

"A steroid injection is the best long-term treatment." Research has found that targeted physiotherapy offers superior long-term outcomes compared to corticosteroid injections, with around 60% of patients achieving symptom resolution at 15 months through physiotherapy-based management. ⁹ Combining physiotherapy with an injection can be more effective for managing acute symptoms specifically than physiotherapy alone, but exercise-based treatment remains central to lasting improvement. ⁹

"Hip pain at my age must mean arthritis." Not necessarily. Several distinct conditions can cause hip pain at any age, a thorough assessment is needed to identify the actual source rather than assuming osteoarthritis by default.

How We Can Help

NICE guidance for osteoarthritis (NG226) emphasises education, weight advice where relevant, and staying physically active as the foundation of management, with non-drug approaches prioritised over medication. ¹⁰ The most recent 2025 clinical practice guideline for hip osteoarthritis similarly supports structured physical therapy interventions as a core part of management. ¹¹

Osteopathic manual techniques and manual therapy: used to maintain and improve hip joint mobility, address compensatory tension in the surrounding muscles, and support overall function, whether the underlying cause is osteoarthritis, GTPS, or a hip flexor strain.

Deep tissue and sports massage: targeted soft tissue work for the gluteal muscles, hip flexors, and iliotibial band, areas commonly involved across several hip conditions.

Medical acupuncture: used alongside exercise-based treatment to support pain management.

Activity and load management advice: practical guidance on adapting aggravating activities, particularly relevant for repetitive loading conditions such as hip flexor strain and GTPS.

Exercise and Rehabilitation

Targeted exercise is the evidence-based cornerstone of treatment across the most common causes of hip pain.

• Gluteal strengthening: particularly important for GTPS, given the strong link to gluteal tendinopathy rather than simple bursal inflammation.

• Hip flexor stretching and progressive strengthening: relevant for hip flexor strain, gradually rebuilding tolerance to loading.

• Range of motion and mobility exercise: supports joint health and function in hip osteoarthritis, in line with NICE's emphasis on staying active.

• Core and pelvic stability work: supports overall hip mechanics and can help where sacroiliac or lumbar referral is contributing to symptoms.

• Graded return to activity: a structured, progressive approach to returning to running, sport, or other aggravating activities.

Your practitioner will guide a programme tailored to the specific structure identified as the source of your symptoms.

What to Expect at Your First Appointment

We will take a thorough history and carry out a hands-on assessment to identify which of the several possible structures is most likely driving your symptoms, hip joint, gluteal tendons, hip flexors, or referral from the lower back or pelvis. We will explain clearly what we find, using current, accurate terminology, and build an evidence-based treatment plan focused on restoring strength and function.

Frequently Asked Questions

Do I need a scan? Not always. Imaging is often more useful for ruling out other causes than for confirming conditions like GTPS, and a thorough clinical assessment is generally the starting point.

Will I need surgery? Most people don't. Conservative, exercise-based treatment is the recommended first-line approach across the most common hip conditions.

Why does my hip pain come and go? This is common across several hip conditions, particularly GTPS and hip flexor strain, often relating to activity levels, sustained positions such as lying on the affected side, and how well the surrounding muscles are coping with load.

Could my hip pain actually be coming from my back? Yes, genuinely. The lower back and sacroiliac joint are well-recognised sources of referred pain felt in the hip and buttock, which is why a thorough assessment considers the whole picture, not just the hip joint itself.

Recognise these symptoms? Get in touch using the contact form and we will assess and build the right treatment plan for you.

BOOK YOUR APPOINTMENT HERE

References

1. 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

2. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. Journal of Hip Preservation Surgery. 2023. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10234389/

3. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. Journal of Hip Preservation Surgery. Available at: https://academic.oup.com/jhps/article/10/1/48/6967092

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

5. A narrative review on greater trochanteric pain syndrome: diagnostic imaging and non-surgical treatments. Musculoskeletal Surgery. 2025. Available at: https://link.springer.com/article/10.1007/s12306-025-00924-7

6. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). StatPearls Publishing. Updated February 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557433/

7. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557433/

8. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557433/

9. Management of Greater Trochanteric Pain Syndrome: A Narrative Review. PubMed. 2025. Available at: https://pubmed.ncbi.nlm.nih.gov/40656316/

10. 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

11. 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