Hip Pain

Hip pain is a broad symptom that covers a wide range of different conditions, each with different causes, different locations of pain, different aggravating factors, and different treatment requirements. The hip joint itself, the surrounding bursae, the muscles that cross the joint, the hip labrum, the tendons, and referred pain patterns from the lumbar spine all produce symptoms in the hip and buttock region. Getting the diagnosis right matters enormously because the treatments for these conditions are not interchangeable — the exercises that help gluteal tendinopathy can worsen greater trochanteric bursitis, and the stretches commonly prescribed for hip pain can aggravate labral tears.

Gluteal tendinopathy is one of the most common causes of lateral hip pain — the pain felt on the outer hip at or around the greater trochanter. It’s more common in women, particularly perimenopausal or postmenopausal, and in runners. Despite the traditional name “greater trochanteric bursitis,” it’s a tendinopathy in the majority of cases, not a bursitis: the bursa is often just reactive to the underlying tendon problem. The key feature is load sensitivity — crossing the legs, sitting with the hips adducted, sleeping on the affected side, and walking up hills reliably provoke it, and even standing with weight shifted onto the painful side increases the compressive load.

Hip flexor strains and iliopsoas tendinopathy produce anterior hip or groin pain, aggravated by lifting the knee against resistance. Labral tears and femoroacetabular impingement (FAI) both produce deep groin pain often with catching or clicking, reproduced by hip flexion combined with rotation. And not all hip-region pain originates in the hip at all — the lumbar spine, sacroiliac joint, and lumbar nerve roots all refer pain into the buttock, hip, and groin, which is why a proper hip assessment always includes screening the lumbar spine too.