Hip pain in adults may be caused by a wide variety of conditions that affect the bones or soft tissues that surround them. Mild, temporary discomfort in the hip can occur in individuals of all ages as the result of overuse of a muscle or tendon, for example, while training with weights or participating in sports or other recreational activities. In middle-aged and older adults, degenerative changes to and injury of cartilage and other soft tissues are likely to cause gradually increasing and longer lasting pain in the joint.
The hip is a ball-and-socket joint composed of two bones connected by cartilage, ligaments, tendons and muscles:
A protective layer of cartilage lines the ball and socket to allow the leg to glide smoothly backward, forward, and sideways. An additional ring of specialized cartilage in the acetabulum called the labrum further protects and stabilizes the joint.
The location of hip pain provides additional information about the underlying problem. For example, patients with pain in older adults that runs along the front of the hip as well as the thigh and groin suggests the presence of arthritis. Pain along the outer part of the hip may be due to bursitis, inflammation of the small fluid-filled sacs called bursae that provide cushioning around the hip joint. Pain that occurs in the back of the hip or buttock area is often due to a problem in the spine rather than the hip joint itself.
Mild, temporary discomfort in the hip can occur in individuals of all ages as the result of overuse, for example, while training with weights or participating in sports or other recreational activities. A wide range of other non-traumatic conditions may be responsible for persistent hip joint pain. Some of the more common ones include:
Among patients in their 50s, 60s, and older, osteoarthritis of the hip is among the most commonly seen. Osteoarthritis is diagnosed when either normal wear and tear, or an injury, damages the cartilage that lines the bones that make up the joint. Pain occurs when “bone on bone” contact is made without any cushioning. Patients with osteoarthritis often experience stiffness together with pain along the front of the hip and the thigh and groin. Osteoarthritis can come about from a variety of factors including genetics, wear and tear, injuries, and other lifestyle factors.
Less often, people of any age may develop some type of inflammatory arthritis, which can also affect the hip and cause pain or stiffness.
The labrum is a cartilaginous ring that covers the hip socket in the pelvis. A torn hip labrum (labral tear) causes front hip pain, as well as symptoms in the groin.
A stress fracture – the result of pressure that is repeatedly placed on a bone – can be a source of significant hip pain. These fractures differ from those that occur with a traumatic injury and result in misalignment of the bone. Stress fractures can occur in individuals who do a lot of high intensity sports or running. However, people with poor bone quality are also at increased risk of this injury.
Conditions that affect the soft tissues include inflammation or injury to a muscle, ligament, tendon or bursa in or around the hip. The location of pain associated with injuries of soft tissues around the hip varies. For example, pain on the outer part of the hip may be due to a problem affecting the abductor muscles, which control sideways movement of the leg, or as a result of hip bursitis – inflammation in one of the bursae in the hip. (A bursa is small fluid-filled sac that provides cushioning in various joints.) A dislocated or subluxated hip can also damage soft tissues and cause pain.
Since the lower spine connects to the hip, various conditions of the lumbrosacral spine may also present as hip pain. The most common example is sciatica resulting from a herniated disc or spinal stenosis, in which nerves that exit the spine become pinched, causing pain that may radiate to the hip as well as down the leg to the toes. A less common example is sacroiliitis – inflammation of the joint between the sacrum of the spine and the pelvis, which itself can have various causes.
The term hip-spine syndrome is used to describe a situation in which a person has conditions in the hip and the spine which are both causing pain, such as osteoarthritis of the hip and lumbar spondylosis. Diagnosing the precise cause of hip pain in such cases can be challenging, since the pain arises from two or more sources.
An infection in the hip joint, which can result from injury, spread from an infection in another part of the body, or result from a previous surgery, may produce pain in the front of the hip, though the location of symptoms may vary.
Avascular necrosis (AVN, also known as osteonecrosis) is a less common source of hip pain that develops when blood flow to the femoral head (the upper end of the long bone in the thigh) is poor or absent, resulting in damage to the bone and eventual collapse of the head of the femur. In children, AVN may occur in a rare condition known as Legg Calve Perthes disease.
People with mild hip pain often achieve relief with over-the-counter pain relievers, activity modification, rest, and icing the joint, and may not require further treatment. However, those experiencing pain that is increasing or which occurs when putting weight on the hip or while walking should seek prompt medical attention. Having an X-ray, physical examination, and, where needed, additional imaging, is the best way to ensure that the cause is not due to a fracture or other serious condition. Individuals who have undergone surgery for a hip replacement or other condition, and whose pain persists past the anticipated recovery period, should also seek medical attention.
Timely treatment of hip pain is an important way to prevent discomfort in other joints that can develop when patients compensate for an injury by altering the way they move or walk to alleviate pain.
Make an appointment if:
In most cases, you will want to first consult an orthopedist specialist. However, these physicians frequently specialize in specific types of conditions within orthopedics. If you suffered an obvious, acute injury to your hip, it is best to consult with a sports medicine surgeon or orthopedic trauma surgeon to learn whether you may need surgery.
For milder symptoms that began during exercise or physical labor, or which have no obvious cause, consider seeing a nonsurgical primary sports medicine physician or physiatrist to diagnose your condition.
If you are over age 50 and think you may be developing arthritis, you may opt to first see either a rheumatologist, an orthopedic surgeon specializing in hip replacement, or a metabolic bone specialist to learn whether you may be developing degenerative arthritis, osteoporosis or both.
At HSS, our Hip Preservation Service is a cross-disciplinary team of doctors and surgeons who work to help patients avoid or delay hip replacement surgery in favor of less invasive options whenever possible.
Many hip conditions do not require surgery and may improve after conservative treatments such as physical therapy, NSAIDs (nonsteroidal anti-inflammatory medications) such as ibuprofen, corticosteroids injections or other injection therapies.
An orthopedic surgeon (also known as an orthopedist) performs surgeries of the hip. However, since the hip is a complex system of bones, cartilage and other soft tissues, orthopedists frequently specialize in specific types of hip injuries or patient populations. At HSS, hip surgery is performed by subspecialists in multiple surgery services:
Learn about various hip conditions treated at Hospital for Special Surgery.
Reviewed and edited by Cynthia A. Kahlenberg, MD, MPH