| What We Treat
Hip Pain
“Hip pain” means very different things to different people — groin, buttock, or the bony point on the side. Where it sits narrows the diagnosis enormously, and it’s the first thing you’ll be asked.
Overview
What’s Actually Causing It?
The word hip covers a large area, and the structures underneath it are quite distinct. True hip joint pain is usually felt in the groin. Pain on the outer bony point is almost always tendon or bursal. Buttock pain often comes from the lower back or the gluteal tendons. Sorting these apart properly at the outset saves a great deal of wasted treatment, because they respond to completely different approaches.
Tap an area, or use the buttons, to see what typically causes pain there.
Hip Joint Pain
Pain felt in the groin, sometimes wrapping round to the front of the thigh, and often described by cupping the hand around the side and front of the hip. Worse on twisting, getting out of a car, and putting socks on. Usually osteoarthritis in older adults, or impingement in younger ones.
Symptoms
What Your Physio Will Want to Know
These details narrow the field before any examination begins:
Exactly Where
Groin, outer point, buttock or inner thigh — the single most useful piece of information.
Socks and Shoes
Difficulty reaching your foot to put a sock on is a classic marker of true hip joint restriction.
Lying on That Side
Pain lying on the affected side at night strongly suggests a lateral tendon or bursal problem.
Groin Pain on Twisting
Turning while weight-bearing, or getting out of a car, points towards the joint itself.
Referral Down the Leg
Symptoms travelling below the knee, with pins and needles, suggest the lower back rather than the hip.
Onset
A gradual build-up over months, a specific sporting injury, or a fall all point in different directions.
Causes & Risk Factors
The Usual Suspects
Most hip pain falls into a handful of recognisable categories:
Hip Osteoarthritis
The most common cause of true groin pain from middle age onwards, and considerably more treatable than most people expect.
Gluteal Tendinopathy
The most common cause of lateral hip pain by a distance, and frequently mislabelled as bursitis.
Femoroacetabular Impingement
A common cause of groin pain in younger, active adults, particularly in sports involving deep hip flexion.
Referred Lumbar Pain
The lower back refers into the buttock and outer hip often enough that it must be screened in every case.
Adductor-Related Groin Pain
Common in kicking and pivoting sports, and often part of a broader groin picture rather than an isolated problem.
How We Can Help You
Treatment & Management
The first job is working out which of these you have, because the treatments differ substantially. Then we get on with it.
What the evidence says
The location of hip pain has good diagnostic value: groin pain is substantially more predictive of intra-articular hip pathology than lateral or buttock pain, and lateral hip pain is far more often tendinopathy than bursitis on imaging.
NICE guidance on osteoarthritis emphasises that hip osteoarthritis can be diagnosed clinically without imaging in people over 45 with activity-related joint pain and no morning stiffness lasting beyond 30 minutes — and that therapeutic exercise is a core treatment regardless of what a scan shows.
When to Seek Help
Red Flags — Don’t Ignore These
Most hip pain is musculoskeletal. These features need medical assessment:
⚠ Seek prompt medical assessment if you notice:
- Inability to weight-bear after a fall, particularly in an older adult or someone with osteoporosis (possible hip fracture — attend A&E)
- A hot, swollen hip with fever or feeling generally unwell (possible joint infection — seek emergency care)
- Groin or hip pain in a child or adolescent, particularly with a limp (needs prompt assessment)
- Constant, unrelenting night pain unrelated to position, with unexplained weight loss or a history of cancer
- Sudden severe groin pain with an inability to move the leg, or an obviously shortened or rotated leg
These symptoms can point to a cause that needs medical rather than physiotherapy assessment. Please don’t wait for a physiotherapy appointment — contact your GP, call 111, or attend A&E as appropriate.
Common Questions
Frequently Asked Questions
Where should true hip pain be felt?
In the groin, most often. People frequently point to their outer hip or buttock and call it hip pain, but the joint itself sits deep in the groin. If your pain is on the bony point at the side, it’s far more likely to be a tendon problem — which is good news, because those respond well.
Do I need an X-ray?
Not usually to start with. Hip osteoarthritis can be diagnosed clinically in people over 45 with a typical pattern, and X-ray findings correlate imperfectly with symptoms. Imaging becomes useful if the picture is atypical, if a fracture is suspected, or if surgery is being considered.
Could my hip pain be coming from my back?
Quite possibly, particularly if it’s in the buttock or travels below the knee. The lumbar spine refers into the hip region frequently enough that it’s screened in every hip assessment. It’s a common reason hip treatment fails to help.
Is walking good or bad for it?
Generally good, though the dose matters. For hip osteoarthritis in particular, staying active is one of the most protective things you can do. If walking flares things, the answer is usually adjusting distance and terrain rather than stopping.
Let’s Work Out Which Hip Problem You Have
A thorough assessment that distinguishes joint from tendon from referred pain — because they need completely different plans.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.