Pain on the outside of the hip, often over the bony prominence (the greater trochanter), is usually a sign of an issue outside the joint (extra-articular).
Common Causes: Trochanteric bursitis (inflammation of the bursa), gluteal tendinopathy (damage to the tendons of the gluteal muscles), or iliotibial (IT) band syndrome.
Characteristics: This pain is often worse when lying on the affected side at night, or when standing up from a seated position. It can feel like a sharp, burning ache.
3. Posterior Hip Pain (Buttock Pain)
Pain in the buttocks, especially on one side, is often referred pain from the lower back or the sacroiliac (SI) joint.
Common Causes: Sciatica (compression of the sciatic nerve), lumbar disc herniation, SI joint dysfunction, or piriformis syndrome (where the piriformis muscle compresses the sciatic nerve).
Characteristics: The pain may radiate down the back of the leg and is often accompanied by tingling or numbness.
The Major Causes of Hip Pain
Hip pain can arise from a staggering number of conditions. Here are the most common culprits.
1. Osteoarthritis (OA)
Osteoarthritis is the most common cause of hip pain, particularly in adults over the age of 50. It is often referred to as “wear and tear” arthritis. What Happens: Over time, the protective articular cartilage in the joint begins to break down. As the cartilage wears away, the bones begin to rub against each other, causing friction, inflammation, and pain. The body may try to repair the damage by growing new bone (bone spurs) around the joint, which can further restrict movement. Symptoms: A dull, aching pain in the groin or thigh; stiffness, especially in the morning; a decrease in the range of motion (e.g., difficulty putting on socks); and a “crunching” sensation (crepitus) when moving the hip.
2. Trochanteric Bursitis
The bursae are fluid-filled sacs that reduce friction. The largest bursa in the hip is the trochanteric bursa, located on the outer point of the hip. What Happens: Repetitive stress, injury, or an inflammatory condition can cause the bursa to become irritated and inflamed. Symptoms: Sharp, intense pain on the outside of the hip. The pain is often worse at night when lying on the affected side. It is common in runners, cyclists, and middle-aged women.
3. Tendinitis and Tendinopathy
Tendons attach muscles to bones. In the hip, the gluteal tendons are frequently injured. What Happens: Overuse or sudden increases in physical activity can cause micro-tears in the tendon, leading to inflammation (tendinitis) or chronic degeneration (tendinopathy). Symptoms: Pain on the outer hip that worsens with activity, especially climbing stairs or walking on uneven ground.
4. Hip Fractures and Trauma
A hip fracture is a break in the upper part of the femur. It is a severe medical emergency. What Happens: In younger people, fractures are usually the result of high-impact trauma. In older adults, particularly those with osteoporosis, a simple fall from standing height can cause a fracture. Symptoms: Inability to bear weight on the leg, severe pain in the groin or outer hip, and the affected leg may appear shorter and turn outward.
5. Labral Tears
The labrum is the ring of cartilage that lines the socket of the hip joint. What Happens: A tear can occur due to a sudden twisting injury (common in sports like hockey or golf), or it can be the result of structural abnormalities like hip impingement. Symptoms: A sharp, catching pain in the groin, especially with twisting movements. It may feel like the hip is “giving way” or locking up.
6. Rheumatoid Arthritis (RA)
Unlike osteoarthritis, which is caused by mechanical wear and tear, rheumatoid arthritis is an autoimmune disease. What Happens: The body’s immune system mistakenly attacks the synovial membrane that lines the joints, causing chronic inflammation. Over time, this inflammation can destroy the cartilage and bone. Symptoms: Pain and stiffness in multiple joints (often on both sides of the body), accompanied by fatigue, fever, and general malaise. The stiffness is usually worse in the morning and lasts for more than an hour.
7. Avascular Necrosis (AVN)
AVN occurs when the blood supply to the bone is disrupted. What Happens: Without blood, the bone tissue dies and eventually collapses. If AVN affects the femoral head, the smooth ball of the hip joint will collapse, leading to severe arthritis and pain. It can be caused by long-term steroid use, excessive alcohol consumption, or certain medical conditions. Symptoms: Initially, there may be no symptoms. As the condition progresses, there is a deep, throbbing pain in the groin that worsens with weight-bearing.
Demographic Variations: Who Gets Which Type of Hip Pain?
Hip pain does not affect all age groups equally. Understanding the demographic trends can help narrow down the possible causes.
