Hip pain is a common complaint at every age, and its source is not always the joint itself. Pain felt in the groin usually points to the joint, pain on the outer side of the hip points to the tendons and soft tissues around it, and pain in the buttock often comes from the lower back. It is worth seeing an orthopedist when the pain lasts more than a few weeks, wakes you at night, causes a limp or limits everyday tasks such as putting on socks, getting into a car and climbing stairs. The orthopedist examines you, identifies the source and matches the treatment to it.
Where exactly it hurts: location points to the diagnosis
The hip joint sits deep, close to the groin, and not on the side of the pelvis as many people assume. Pain that comes from the joint itself is therefore usually felt in the groin crease, and it sometimes spreads to the front of the thigh and even down to the knee. Many patients describe it with a typical gesture: they cup a hand around the side of the pelvis, thumb behind and fingers in the groin.
Pain on the outer side of the hip, over the bony point you can feel with your hand, is usually related to the tendons of the buttock muscles and the soft tissues above them. It gets worse when lying on the painful side and when climbing stairs. Pain in the buttock or the back of the thigh often comes from the lumbar spine or the sacroiliac joint, and may be accompanied by numbness or shooting sensations down the leg. The distinction matters, because the treatment for each of these conditions is completely different.
The common causes of hip pain
In older adults the usual cause is cartilage wear, osteoarthritis of the hip. The cartilage covering the head of the thigh bone and the socket gradually thins, and movement becomes stiff and painful. The pain appears with the first steps after sitting, worsens at the end of an active day, and over time the range of movement narrows. A typical early sign is difficulty turning the leg inward and trouble putting on a sock or tying a shoe.
In young, active people a condition called hip impingement is common. The shape of the bone at the head of the femur or at the rim of the socket causes friction in deep bending movements, and over time the labrum, the ring of cartilage around the socket, may be damaged. The pain is felt in the groin during prolonged sitting, squatting and sport, and there is sometimes a catching sensation or a click.
Other causes the orthopedist considers:
- Pain in the tendons of the buttock muscles at the side of the hip, previously labelled bursitis.
- A strain or partial tear of the groin muscles or the hip flexor.
- A stress fracture of the neck of the femur, mainly in runners and in people who increased their training load quickly.
- Loss of blood supply to the head of the femur, which sometimes follows prolonged steroid treatment.
- Pain referred from the lower back or the pelvis.
Pain on the side of the hip: why it is worse at night
Pain on the outer side of the hip is especially common in middle-aged women, and it is one of the frequent reasons for disturbed sleep. Direct pressure on the tendons when lying on that side provokes the pain, and lying on the other side can hurt too, because the upper leg drops forward and stretches the same tendons. Sitting with crossed legs and standing with the weight resting on one leg make it worse.
Treatment is based mainly on reducing the load on the tendons and on gradual strengthening of the buttock muscles, guided by a physiotherapist. A pillow between the knees during sleep brings relief for many people. In stubborn cases the doctor may suggest additional treatments, and most patients improve without surgery.
How an orthopedist investigates hip pain
The assessment starts with a conversation: where the pain is, when it began, what makes it worse, whether there is morning stiffness, whether there was a fall or a change in activity, and what your background conditions and medications are. In the physical examination the orthopedist watches you walk, checks the joint’s range of movement while you lie down, presses on the tender areas and performs tests that reproduce the pain in specific positions. The lower back and the knee are examined as well, because pain can travel between them.
Based on the findings, the doctor decides whether imaging is needed and refers you for it. An X-ray of the pelvis and hip shows wear, changes in bone shape and fractures. When damage to soft tissue, the labrum or the blood supply of the bone is suspected, the doctor may refer you for an MRI. It is important to remember that an imaging finding is not necessarily the source of the pain, so the interpretation is always made together with the physical examination.
To make the visit efficient, arrive with a few details ready: when the pain began and what preceded it, which actions provoke it and which ease it, which treatments have already been tried and what effect they had. If you have had X-rays or scans in the past, bring the disc or the report, along with a list of your regular medications. Comfortable shoes and clothes that allow the leg to move freely make the physical examination easier, since it includes walking, bending and rotating the joint.
Conservative care, injections and surgery: what suits whom
Most conditions are treated successfully without surgery. The foundation is adjusting the load and not complete rest: you keep moving, but reduce the activity that provokes pain and temporarily replace it with something gentler, such as swimming or cycling. Physiotherapy strengthens the muscles that stabilize the pelvis and improves range of movement. Losing excess body weight reduces the load on the joint, and pain relievers are used for short periods as the doctor advises.
When the pain does not settle, the doctor may suggest an injection into the joint or around the tendons, depending on the diagnosis. Surgery is considered when conservative treatment has been exhausted and the pain continues to affect quality of life. In young people with impingement and labral damage this sometimes means arthroscopy, and in older adults with advanced wear it means a hip replacement. The decision is based on how much daily life is limited and not on the X-ray alone.
When to see an orthopedist and when it is urgent
Book an appointment with an orthopedist when hip or groin pain lasts more than three to four weeks, when it wakes you from sleep, when a limp appears, when bending to your shoes or sitting down and getting up is difficult, and when pain returns with every attempt to go back to sport. Knee pain with no finding in the knee itself also justifies an examination of the hip, particularly in children and teenagers.
Some situations call for the emergency room and not for a scheduled visit: severe pain after a fall with difficulty putting weight on the leg, especially in older age, hip pain with fever and feeling unwell, or a child who stops putting weight on a leg. These need prompt evaluation.
If you have ongoing pain, you can see a private orthopedist in Modi’in at EliteMed in the Ayala 360 complex, with no referral needed. If the knee is the main problem, read our guide to knee pain and when to see an orthopedist, and if the pain travels from the back down the leg, read about epidural steroid injections for back pain. The information here is general and does not replace an individual medical assessment.
Frequently asked questions
How can I tell whether the pain comes from the hip joint or from the back?
Pain from the hip joint is usually felt in the groin and gets worse when rotating the leg, putting on a sock or getting into a car. Pain from the back is felt more in the buttock and the back of the thigh, and may come with numbness or shooting sensations down the leg. Sometimes both sources exist together, which is why the orthopedist examines both the hip and the lower back.
Does hip pain mean I will need a hip replacement?
In most cases, no. Much of the pain around the hip comes from tendons, muscles or overload and improves with conservative treatment. Even with cartilage wear, many people manage for years with physiotherapy, activity adjustment and pain management. Surgery is considered only when pain and loss of function continue despite orderly conservative treatment.
Can I keep walking and exercising when my hip hurts?
Usually yes, and movement even helps. The advice is to temporarily reduce the activity that provokes the pain and choose something gentler, such as swimming or cycling. Sharp pain that worsens with every step, pain after a fall or pain that appears after a quick increase in running load should be examined before you continue training.
Which imaging is needed to investigate hip pain?
The first test is usually an X-ray of the pelvis and hip, which shows wear and changes in the bone. When damage to soft tissue or cartilage, or a stress fracture, is suspected, the doctor may refer you for an MRI. The decision about which test is needed is made after the physical examination, and not every hip pain requires imaging.
Why does the side of my hip hurt mostly at night?
Pain on the outer side of the hip is usually related to the tendons of the buttock muscles. Lying on the painful side presses on them directly, and lying on the other side stretches them as the upper leg drops forward. A pillow between the knees helps many people, and strengthening exercises guided by a physiotherapist address the cause itself.