It hurts when you lie on that side at night. Or when you stand up after sitting for an hour. Or a few miles into a run, or at the bottom of a squat. Maybe it is a deep ache in the groin that makes putting on your socks harder than it should be.
If you are asking why your hip hurts, the honest answer is that “hip pain” covers several very different problems. The good news is that where it hurts usually tells you a lot about what is going on, and most of the common causes respond well to the right kind of treatment.
Hip Pain Is More Common Than You Think
In a national U.S. health survey, 14.3% of adults aged 60 and older reported significant hip pain on most days over the previous six weeks. But it is not only an older-adult problem. Runners, lifters, people who sit all day, and anyone who suddenly ramps up their activity are all prone to it.
Because the hip carries your body weight with every step, a hip that hurts tends to affect everything: walking, stairs, sleep, workouts, even getting in and out of the car.
Where It Hurts Tells You a Lot
The single most useful clue is location. Put your hand where it hurts and start there.
Outside of the hip: gluteal tendinopathy
Pain on the outside of the hip, over the bony point you can feel at the side, is most often coming from the gluteal tendons. It used to be called “trochanteric bursitis,” but research has shown the tendons are usually the main source.
The classic signs: it hurts to lie on that side, it aches after standing or walking for a while, stairs and standing on one leg are uncomfortable, and crossing your legs makes it worse. It is especially common in women in their 40s to 60s and in runners who have recently increased their mileage.
Front of the hip or groin: the hip joint itself
A deep ache in the groin or the front of the hip usually points to the joint. In adults over 50 the most common cause is hip osteoarthritis, which tends to bring morning stiffness, pain after activity, and difficulty with things like putting on shoes and socks.
In younger, active adults, groin pain that pinches at the bottom of a squat, when you pull your knee to your chest, or when you sit low for a long time often relates to the shape of the hip joint (sometimes called femoroacetabular impingement, or FAI) and the labrum, the ring of cartilage around the socket.
Front of the hip after a hard session: hip flexor or groin strain
Pain that came on during sprinting, kicking, a sudden change of direction, or a big jump in training usually involves the hip flexors or the adductors (the inner thigh muscles). These are muscle and tendon problems and typically improve well with a progressive loading plan.
Back of the hip or buttock: often your lower back
Pain in the buttock or the back of the hip, especially if it travels down the leg or comes with tingling, is frequently coming from the lower back rather than the hip. Nerves and joints in the spine can refer pain into the buttock and leg. If your “hip” has been treated without improvement, your back is worth checking. See how we treat lower back pain.
A Word About Scans
If you have had an MRI that showed a labral tear, read this part before you worry.
Researchers performed MRI scans on 45 people with no hip pain at all, with an average age of about 38. Labral tears showed up in 69% of the hips, and 73% had at least one abnormal finding.
In other words, labral tears and other “abnormal” findings are common in hips that feel perfectly fine. A scan can be useful, but it cannot tell you on its own whether what it shows is the cause of your pain. That comes from an examination of how your hip moves, what reproduces your symptoms, and how strong you are.
What the Evidence Says Actually Helps
For outside hip pain, education and exercise beat injections
The strongest evidence is for gluteal tendinopathy. The LEAP trial, published in the BMJ, compared three approaches in 204 people: education plus a structured exercise program, a single corticosteroid injection, and a wait-and-see approach.
At 8 weeks, 77% of the education and exercise group reported success, compared with 59% after an injection and 29% with wait-and-see. At one year, the exercise group was still ahead at 79%, while the injection group (58%) was no better than wait-and-see (52%).
An injection can quiet things down for a while. Building the tendon’s capacity to handle load is what tends to last.
For hip arthritis, exercise is first-line, but it has to be the right exercise
Clinical guidelines recommend exercise as a first treatment for hip osteoarthritis because it is low-risk and improves strength, mobility, and general health. It is worth being honest about the research, though: a 2026 Cochrane review found that, on average across trials, exercise programs reduced hip arthritis pain by only a modest amount.
That is an average across many generic programs. In practice, results depend on getting the details right: which movements to load, how much, how fast to progress, and what else in your day is aggravating the joint. Arthritis on an X-ray does not mean your hip is finished, and staying strong and active is still one of the best things you can do for it. Our guide to strength training after 40 covers how to do that safely.
For hip impingement and labral tears, start with a proper rehab plan
Many people with FAI or a labral tear improve with a structured physical therapy program that builds hip and core strength and adjusts the positions that provoke symptoms. Surgery has a role for some, particularly when a well-run rehab program has not helped, but it is rarely the place to start.
Common Mistakes That Keep Hip Pain Going
- Stretching a sore outside hip. Stretches that pull the leg across the body, like a figure-four or IT band stretch, compress the gluteal tendons and can make tendinopathy worse.
- Sleeping on the painful side, or with the top knee dropped across. A pillow between the knees helps.
- Standing with your weight hanging on one hip or sitting with your legs crossed for long periods.
- Resting completely. Like other tendons and joints, the hip gets less tolerant of load when you stop loading it. The goal is the right amount, not none.
- Ignoring the rest of the chain. Weak glutes and a stiff lower back or ankle all change how much load the hip has to absorb. This is especially true for runners.
When to Get It Looked At
A day or two of soreness after unusual activity is normal. Get it evaluated if:
- Pain has lasted more than two or three weeks without clear improvement
- It wakes you at night or you cannot lie on that side
- You are limping, or stairs and getting out of the car have become difficult
- Groin pain is limiting your workouts or runs
- Pain travels down your leg or comes with numbness or tingling
Seek urgent care instead if you had a fall and cannot put weight on the leg, if the hip is hot and swollen with a fever, or if a runner has deep groin pain that gets steadily worse with every run. These need a physician first.
The Bottom Line
Hip pain is common, and where it hurts is the best first clue to what is causing it. Scan findings like labral tears are common even in pain-free hips, and for many causes, especially outside hip pain, a structured program of education and exercise outperforms injections and waiting.
At Strike Physiotherapy & Performance in North Hollywood, we start with a full assessment of your hip, lower back, and the rest of the chain to find what is actually driving your pain, then build a plan around your body and your goals. You do not need a doctor’s referral to get started.
If your hip has been bothering you for more than a few weeks, book a free discovery call and talk with a Doctor of Physical Therapy about what is going on.
This article is for general educational purposes and is not a substitute for individual medical advice.
Sources Referenced
Christmas et al., Journal of Family Practice (2002) — hip pain prevalence in adults 60 and older, NHANES III. Register et al., American Journal of Sports Medicine (2012) — abnormal MRI findings in 45 asymptomatic hips. Mellor et al., BMJ (2018), LEAP trial — education plus exercise vs corticosteroid injection vs wait-and-see for gluteal tendinopathy. Cochrane review, exercise for hip osteoarthritis (updated July 2026) — modest average effect of exercise on hip osteoarthritis pain.
