Skip to main content

Health condition · Clinically reviewed

Hip pain, eight anatomical causes and the pathway that finds the right one.

Hip pain is not one diagnosis. A careful history, a targeted examination and the right imaging separate a joint problem from a tendon, nerve or spine problem, and treatment follows the answer. For a closely related overview, see our guide on hip and groin pain.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BOA, BSSH and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice for adult hip pain, from imaging pathways to arthroscopy and joint replacement.

Key facts

Adult hip pain at a glance.

The essentials, in plain English. What hip pain means, where it usually comes from, and the difference between symptoms that settle and symptoms that need urgent review.

  • What it is

    An umbrella term for pain arising in or around the hip joint, from bone, cartilage, tendon, bursa, nerve or the spine and pelvis referring pain into the hip.

  • Not one diagnosis

    Hip pain has at least eight distinct anatomical origins, and treatment depends entirely on which one is driving your pain.

  • Adults, all ages

    Young adults tend towards labral tears, impingement and dysplasia. Older adults tend towards osteoarthritis, bursitis and fracture.

  • Groin versus outside

    Groin pain usually means the joint itself, outer hip pain usually means the tendons and bursa, buttock pain often means the spine or sacroiliac joint.

  • Imaging matters

    Plain X-ray is first, MRI clarifies soft tissue, ultrasound guides injection and MDT specialist review pulls the strands together.

  • When to worry

    Fever, unexplained weight loss, night pain, inability to weight-bear or bladder and bowel change are red flags that need urgent review.

Why this guide matters

Anatomy first, then the right treatment.

Hip pain gets misdiagnosed because clinicians and patients skip the anatomy. Start with where the pain sits, work through eight structural layers, and treatment becomes obvious.

  • Hip pain is a symptom, not a diagnosis

    Bone, joint, tendon, bursa, muscle, nerve, spine and pelvis can all cause pain felt at the hip. The label matters less than the structure.

  • Location tells you the layer

    Groin means joint, outer hip means tendon and bursa, buttock means spine and sacroiliac, front thigh burning means nerve.

  • A few causes are emergencies

    Septic arthritis, hip fracture, cauda equina and progressive avascular necrosis do not tolerate delay. Recognising them is the point of the red-flag screen.

Causes, by anatomy

Eight layers to work through.

A structured way to think about the adult hip. Each layer generates a recognisable pattern of pain, and each has its own investigations and treatments.

  1. 01

    Intra-articular

    Inside the joint itself. Includes osteoarthritis, labral tear, impingement, dysplasia, hip arthritis .

  2. 02

    Peri-articular

    The tendons and bursae wrapping the joint. See hip bursitis, ischial bursitis .

  3. 03

    Muscular

    Groin, adductor and gluteal muscle strains, common in sport. See sport injuries .

  4. 04

    Nerve

    Meralgia paraesthetica from lateral cutaneous nerve entrapment, and lumbar radiculopathy from a pinched nerve root in the spine.

  5. 05

    Referred

    From the lumbar spine, pelvis and the sacroiliac joint .

  6. 06

    Bone

    Bone-origin pain. Includes hip fracture . plus stress fracture, avascular necrosis, tumour and osteomyelitis.

  7. 07

    Inflammatory

    Rheumatoid disease, gout and spondyloarthropathies. See ankylosing spondylitis, gout .

  8. 08

    Infective

    Septic arthritis of the hip is a same-day emergency. A hot, swollen joint with fever needs immediate orthopaedic review.

How the diagnosis is made

From first consultation to a clear plan.

The steps a UK musculoskeletal specialist or orthopaedic surgeon will normally follow, in order, so you know what to expect and why each step matters.

  1. 01

    Assessing

    A careful history

    Where the pain sits, how it started, what makes it worse, night pain, activity, plus systemic clues like fever, weight loss and sleep disturbance.

  2. 02

    Assessing

    Red-flag screen

    A short list of features that push the assessment towards infection, fracture, tumour, avascular necrosis or cauda equina rather than mechanical pain.

  3. 03

    Assessing

    Focused examination

    Gait, range of movement, impingement and labral tests, trochanteric palpation, neurological screen and a spine and sacroiliac look.

  4. 04

    Confirming

    Plain X-ray first

    A standing pelvic X-ray remains the single most useful first investigation for adult hip pain, screening for osteoarthritis, dysplasia and fracture.

  5. 05

    Confirming

    MRI for soft tissue

    Where the joint itself, labrum, cartilage or bone marrow oedema is suspected, an MRI, sometimes with contrast, adds the detail X-ray cannot.

  6. 06

    Confirming

    Ultrasound and guided injection

    For trochanteric bursitis, gluteal tendinopathy and diagnostic injection, ultrasound guides both the diagnosis and the treatment.

  7. 07

    Planning

    Specialist and MDT review

    Musculoskeletal specialists and orthopaedic surgeons stitch the picture together, especially when imaging and symptoms do not obviously align.

Typical timeline: from first visit to a settled plan in weeks, not months.

Symptoms

What adult hip pain actually looks like.

The classic patterns of pain and movement change, and the features that mean it is time to move faster.

  • Groin pain with movement

    A deep C-sign wrap of pain around the groin and front of the hip usually points to the joint itself, labrum or cartilage.

  • Outer hip pain lying on it

    Point tenderness over the greater trochanter, worse lying on the affected side, typically means gluteal tendinopathy or trochanteric bursitis.

  • Buttock and back pain

    Pain centred in the buttock, worse with sitting or twisting, often means the sacroiliac joint or the lumbar spine referring pain to the hip.

  • Front-of-thigh burning

    A burning or numb patch over the outer front thigh points to meralgia paraesthetica, a lateral cutaneous nerve entrapment, not the hip joint at all.

  • Clicking, catching or locking

    Mechanical symptoms often reflect a labral tear, loose body or femoroacetabular impingement, and are worth imaging.

  • Morning stiffness over an hour

    Prolonged stiffness, especially in a younger adult with buttock pain, raises the question of an inflammatory spondyloarthropathy.

  • Sudden pain after a fall

    Any adult who cannot weight-bear after a fall needs same-day imaging to exclude a hip fracture, regardless of age.

  • Red flag - fever with hot hip

    A hot, swollen, painful hip with fever is a possible septic arthritis and a same-day emergency.

Treatment

How adult hip pain is treated in the UK.

Treatment follows the diagnosis, not the symptom. A labral tear, a bursitis and a septic arthritis of the hip all present as hip pain, and all need very different care.

  • Analgesia and activity modification

    Paracetamol, short-course NSAIDs and a temporary drop in aggravating activity are almost always the sensible first step.

  • Physiotherapy

    Hip strengthening, gluteal loading and movement retraining is the highest-yield conservative treatment for tendinopathy, bursitis and mild joint pain.

  • Ultrasound-guided injection

    A targeted steroid injection can settle trochanteric bursitis and gluteal tendinopathy long enough for rehab to work.

  • Shockwave therapy

    Extracorporeal shockwave is a non-surgical option for stubborn gluteal tendinopathy that has not settled with load management.

  • Hip arthroscopy

    For a labral tear or femoroacetabular impingement in a suitable patient, keyhole hip arthroscopy can preserve the joint.

  • Hip replacement

    For advanced osteoarthritis, hip replacement is one of the highest-satisfaction operations in modern surgery.

  • Disease-modifying therapy

    For inflammatory causes such as rheumatoid arthritis or ankylosing spondylitis, rheumatology-led DMARDs or biologics change the trajectory.

  • Urgent surgical care

    Septic arthritis, displaced hip fracture and cauda equina are all surgical emergencies. The right answer is admission, not another appointment.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, physiotherapist or orthopaedic surgeon knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).

  • NICE. Hip fracture: management (CG124).

  • British Orthopaedic Association (BOA). Standards for trauma and orthopaedic care.

  • British Society for Rheumatology. Guidelines on axial spondyloarthritis.

  • BMJ Best Practice. Assessment of hip pain in adults.

Red flags

When hip pain needs urgent attention.

Most adult hip pain is mechanical and settles. These are the situations that do not, and where a specialist opinion, or a same-day admission, is needed.

  • Hot, swollen hip with fever

    Septic arthritis of the hip is a same-day emergency. Untreated, it destroys the joint within days and can seed the bloodstream.

  • Cannot weight-bear after a fall

    Any adult who cannot stand or walk after a fall needs same-day imaging. A missed hip fracture, especially in older adults, carries serious mortality.

  • Night pain with weight loss

    Deep, unremitting bone pain that wakes you from sleep, combined with weight loss or a history of cancer, needs prompt imaging to exclude metastatic disease.

  • Steroid or alcohol history plus groin pain

    A younger adult on long-term steroids, or with heavy alcohol use, developing new groin pain needs an MRI to exclude avascular necrosis before the femoral head collapses.

  • Saddle numbness or bladder change

    Numbness around the perineum, new urinary retention or faecal incontinence with leg symptoms suggests cauda equina and needs emergency MRI, not a hip clinic.

  • Fever with recent joint injection or surgery

    A new hot painful hip after a procedure needs urgent orthopaedic review to exclude a prosthetic joint infection.

  • Progressive neurological signs

    Foot drop, worsening weakness or expanding numbness points to a spinal cause rather than the hip and needs urgent review.

  • Child or adolescent with hip pain

    Different rules apply. Perthes, slipped upper femoral epiphysis and transient synovitis all sit outside adult guidance and need paediatric orthopaedic input.

  • Bilateral, symmetrical inflammatory pain

    Symmetrical inflammatory hip and buttock pain in a younger adult, worse at night and improving with movement, is spondyloarthropathy until proven otherwise.

Living with it

A treatable problem, with a clear ladder.

Four things that make the biggest difference day to day, and one clear signal that it is time to move up a rung.

A quiet reminder

Consistency beats intensity, every time.

Steady, graded work over three months does more for hip pain than a heroic week that flares things up.

  1. 01 Load

    Manage load, do not avoid it

    Complete rest weakens the muscles that protect the hip. A graded return to walking and strength work almost always beats bed rest.

  2. 02 Sleep

    Protect the outer hip at night

    For gluteal tendinopathy and trochanteric bursitis, a pillow between the knees and avoiding lying on the sore side genuinely helps.

  3. 03 Weight

    Weight matters for the joint

    Every extra kilogram is amplified across the hip joint. Modest weight loss reduces pain and delays progression in osteoarthritis.

  4. 04 Escalate

    Do not settle for chronic pain

    If three months of good conservative care has not worked, that is the signal to escalate to imaging, injection or a surgical opinion.

Frequently asked

Everything we get asked about hip pain.

Quick answers on causes, imaging, red flags and when hip pain needs surgery.

  • What is hip pain and what causes it?

    Hip pain is an umbrella term, not a diagnosis. It covers pain arising inside the joint from cartilage, labrum or bone, around the joint from tendons and bursa, from muscles in the groin and buttock, from trapped nerves such as the lateral cutaneous nerve, and from the spine, sacroiliac joint or pelvis referring pain into the hip. Bone conditions, inflammatory arthritis and, rarely, infection also present as hip pain. See our broader guide on hip and groin pain for the full anatomical picture.

  • How do I know if my hip pain is serious?

    Most adult hip pain is mechanical and settles. Red flags that need urgent review are a hot swollen hip with fever, inability to weight-bear after a fall, unremitting night pain with weight loss, new saddle numbness or bladder change, and progressive neurological weakness. If any of those apply, you should be reviewed the same day, not booked into a routine clinic.

  • Where does hip pain usually point to on the body?

    Groin pain usually points to the joint itself, including osteoarthritis, labral tear or impingement. Outer hip pain over the bony point at the side is most often gluteal tendinopathy or trochanteric bursitis. Buttock pain points to the sacroiliac joint or lumbar spine. Burning over the outer front thigh points to meralgia paraesthetica, a nerve entrapment rather than a joint problem.

  • What tests do I need for hip pain?

    A standing pelvic X-ray is almost always the first investigation and answers most of the mechanical questions. MRI adds detail about the labrum, cartilage, tendons and bone marrow and is the test of choice for suspected avascular necrosis or a labral tear. Ultrasound is used for the outer hip and to guide injections. Blood tests are added when infection or inflammatory arthritis is suspected.

  • When should I consider surgery for hip pain?

    Surgery is considered when good conservative care has failed and imaging shows a mechanical problem that surgery can fix. For labral tears and femoroacetabular impingement in a younger adult, hip arthroscopy can preserve the joint. For advanced osteoarthritis, hip replacement is one of the most reliable operations in modern medicine. Hip fracture and septic arthritis are surgical emergencies rather than elective choices.

  • Is hip pain always from the hip?

    No, and this trips people up. Pain felt in the hip is often referred from the lumbar spine, sacroiliac joint or pelvis. Equally, true hip joint pain is often felt in the groin, buttock or even the knee rather than over the hip itself. A careful clinical assessment, backed by targeted imaging, is what separates a hip problem from a spine problem.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.