Common symptoms
- Ache or tenderness on the outside of the hip
- Pain when lying on your side at night
- Groin pain when walking or putting on socks
- Stiffness after sitting or first thing in the morning
- Deep ache in the buttock
- Pain on stairs or standing on one leg
- Limping, clicking or a catching feeling
Hip pain can show up as a sore spot on the outside of your hip that stops you lying on that side, a deep ache in the groin when you pull on your socks, or a nagging pain in the buttock after a long drive. Several structures sit close together around the hip, so where you feel the pain and what sets it off tell us a lot.
Most hip problems respond well to targeted exercise and a few sensible changes to how you sit, stand and sleep. At Tylurs com, our physiotherapists pinpoint the likely source of your pain, explain it in plain language and build a programme that fits your life.
What causes hip pain?
The hip is a deep ball-and-socket joint wrapped in strong muscles and tendons, and it sits close to the lower back and pelvis. These are the causes our physiotherapists see most often.
Gluteal tendinopathy and trochanteric bursitis
Pain on the outer side of the hip is very often caused by greater trochanteric pain syndrome (GTPS). This covers irritation of the gluteal tendons, which attach your buttock muscles to the bony point on the side of the hip, and of a small fluid-filled cushion (bursa) nearby. It used to be called trochanteric bursitis, but the tendons are now thought to be the main source of pain.
GTPS is most common in women from middle age onwards, and it can affect both hips. Lying on the affected side, stairs, standing on one leg and crossing your legs typically aggravate it, because they squeeze the tendons against the bone. Like other forms of tendinopathy, it responds to gradually building tendon strength rather than rest alone.
Hip osteoarthritis
Osteoarthritis of the hip usually causes pain in the groin or the front of the thigh, sometimes spreading to the knee, along with stiffness after rest. Many people first notice it when putting on socks or getting out of a car becomes awkward. It tends to develop gradually from middle age, and symptoms often go up and down rather than steadily worsening.
Femoroacetabular impingement (FAI)
In FAI, the shape of the ball or the socket means the two pinch together at the far end of certain movements, such as deep squats, sitting in low seats or pulling your knee towards your chest. It tends to affect younger, active adults and can cause groin pain with a clicking or catching feeling. Plenty of people have these hip shapes without any pain, so the shape alone is not a problem.
Pain referred from the lower back
Lower back problems can cause pain in the buttock, over the outer hip or down the back of the thigh, even when the hip joint is healthy. Clues include back stiffness, and pins and needles or pain travelling below the knee, which can suggest sciatica. Our guide to lower back pain explains more.
Other causes
Less often, hip pain comes from a groin strain in kicking sports, a stress fracture in runners, inflammatory arthritis or, rarely, infection, which is why we always screen for warning signs.
Hip pain symptoms by location
Where you feel it is a helpful clue, although only an assessment can confirm the cause.
| Where it hurts | Often made worse by | Common causes |
|---|---|---|
| Outer hip, tender to press | Lying on that side, stairs, standing on one leg, crossing your legs | Gluteal tendinopathy or GTPS |
| Groin or front of the hip | Walking, putting on socks, getting out of a car, deep squats | Hip osteoarthritis, FAI, groin strain |
| Buttock | Sitting, bending or standing for long periods, often with back stiffness | Referred pain from the lower back, gluteal tendon problems |
| Down the thigh towards the knee | Varies with the source | Hip osteoarthritis, sciatica |
Hip problems are sometimes felt mainly in the knee, especially in children and teenagers. If your knee hurts most, see our page on knee pain.
How we assess your hip
We start by asking when the pain began, where you feel it, what eases or aggravates it and how you are sleeping. We then watch you walk, stand on one leg and squat, test the strength of your hip, thigh and trunk muscles, and move the hip gently to find which positions reproduce your symptoms. We check the lower back too, to rule out referred pain.
Most people do not need a scan to begin treatment. NICE guidance on osteoarthritis advises diagnosing it from symptoms and examination in people aged 45 or over, without routine imaging. For a picture of how that first session runs, see our guide to a first physiotherapy appointment.
Physiotherapy treatment for hip pain
Exercise sits at the heart of treatment for almost every type of hip pain. Your programme depends on what is driving your symptoms and how irritable they are.
Strengthening the gluteal muscles
Your buttock muscles hold the pelvis level with every step. When they are weak, the pelvis can drop and the thigh drift inwards, compressing the outer hip tendons. With gluteal tendinopathy we often start with gentle holds, such as pressing the side of your leg out against a wall, then progress to bridges, sit-to-stands, step-ups and single-leg work.
Some popular exercises, such as side-lying leg lifts or stretching the leg across your body, can aggravate an irritated tendon. We choose exercises that load the tendon without squashing it.
Exercise for hip osteoarthritis
NICE recommends therapeutic exercise, tailored to the individual, for everyone with osteoarthritis. For the hip, that usually means strengthening the buttocks and thighs, movements to keep the joint supple, and activity such as walking, cycling or swimming. Pain may increase a little at first, but regular exercise is still good for your joints. If you are carrying extra weight, any amount of weight loss is likely to help.
Help for impingement and sports-related pain
For FAI and groin strains, we temporarily limit the deep positions that pinch the hip, strengthen the hip and trunk, then rebuild speed, kicking and change of direction. Our sports injury rehabilitation service plans this around your training and fixtures.
Hands-on treatment and walking aids
Hands-on work such as joint mobilisation and soft tissue release can loosen a stiff hip and make exercise more comfortable. For osteoarthritis, NICE advises using manual therapy only alongside exercise, never instead of it. A walking stick, held in the hand opposite the painful side, can reduce load during a flare-up. If pain is affecting your balance, our balance and falls prevention service can help you stay steady and independent.
Everyday changes that ease hip pain
Small changes to how you sit, stand and sleep make a real difference with outer hip pain, because they reduce the time your tendons spend squashed against the bone.
- Avoid crossing your legs when sitting, and keep your knees roughly hip-width apart.
- Stand evenly on both feet rather than hanging on one hip, for example while cooking or queuing.
- Choose higher chairs over very low, soft seats. The NHS advice for a painful hip notes that low chairs put extra pressure on your hips.
- Take shorter, more frequent walks instead of one long one, and go easy on hills and stairs while symptoms are high.
- Wear comfortable, shock-absorbing shoes with a soft sole.
Sleeping positions
Night pain is a common complaint with outer hip problems. Try lying on your back, or on the pain-free side with a pillow between your knees so the top leg does not drop across your body.
Physio tip: Give a pillow between your knees a full week, even if it feels odd at first. Many people with a sore outer hip are surprised how much it helps their sleep.
How long does hip pain take to improve?
Timescales depend on the cause and how long you have had symptoms:
- Minor strains often settle within a few weeks with sensible activity and self-care.
- Gluteal tendinopathy usually needs three months or more of consistent exercise and load changes, and longer if it is long-standing.
- Hip osteoarthritis is a long-term condition, but symptoms often fluctuate, and regular exercise can reduce pain and improve how much you can do.
- FAI varies widely, and many people manage well with rehabilitation and activity changes.
The NHS suggests seeing a GP if hip pain has not improved after two weeks of home treatment, is stopping you doing normal activities or is disturbing your sleep.
When are scans, injections or surgery considered?
Most people improve without any of these, but each has its place.
- Imaging. An X-ray or MRI may be arranged if symptoms are severe, unusual or not improving with rehabilitation, if a fracture is suspected, or if surgery is being considered.
- Steroid injections. These can ease pain for a short time, for example when outer hip pain is stopping you sleeping or exercising. For osteoarthritis, NICE notes joint injections give only short-term relief (2 to 10 weeks), so they work best as a bridge to exercise, not a replacement.
- Keyhole surgery. Hip arthroscopy is occasionally offered for FAI when symptoms persist despite thorough rehabilitation.
- Hip replacement. NICE advises considering referral when osteoarthritis substantially affects your quality of life and non-surgical treatment has not worked or is unsuitable. If you have surgery, our post-surgery rehabilitation service supports you before and after the operation.
When to seek urgent medical help
Most hip problems are not serious, but some symptoms need a doctor before physiotherapy:
- You cannot stand or put weight on the leg after a fall, or the leg looks shorter or turned outwards. Get emergency care, as this may be a hip fracture. The same applies to tingling or loss of feeling in the hip or leg after an injury.
- Your hip is hot and swollen and you have a high temperature, or feel shivery and unwell. This can be a joint infection and needs urgent medical help the same day.
- A child or teenager has hip, thigh or knee pain with a limp, or cannot put weight on one leg. The NHS advises urgent medical help for a child with a painful hip, as a joint infection, Perthes’ disease or a slipped growth plate needs prompt diagnosis.
- You have unexplained weight loss, night pain that does not ease in any position, or a history of cancer alongside new hip symptoms. See your GP promptly.
- Hip or buttock pain comes with numbness around your genitals or bottom, or new problems controlling your bladder or bowels. These can be signs of cauda equina syndrome, a rare but serious back condition. Go to your nearest emergency department immediately.
- Pain, swelling and warmth in your calf after hip surgery or a long period of immobility. This can signal a blood clot (DVT) and needs medical advice the same day.
Book physiotherapy for hip pain at Tylurs com
You do not have to keep putting up with a hip that disturbs your sleep, shortens your walks or keeps you off the pitch. At Tylurs com, we work out where your pain is really coming from, give you practical changes to start straight away and progress your exercises until your hip feels strong again. If your back is involved, our exercises for lower back pain are a helpful place to start.
Book your hip assessment and get a clear plan for moving more comfortably.
This page is for general information and does not replace a personal assessment. If you have severe, sudden or worsening symptoms, seek medical advice promptly.