Hip pain when walking: causes, what it means and when to get it checked

Walking loads the hip with several times the weight of the body and moves it through its full range, so any problem in the joint, the tendons around it, or the back and pelvis can show up as pain with each step.

Arthritis UK explains the pattern. If the problem is in the hip joint itself, you may feel pain in the groin, down the front of the leg and in the knee, and sometimes knee pain is the only sign of a hip problem, which it calls referred pain. Pain on the outside of the hip or in the buttock can also be caused by problems with the lower back.

The NHS cautions against trying to diagnose the cause yourself. The pattern is a prompt for what to mention to a clinician, not a conclusion.

Osteoarthritis is one of the most common causes of hip pain in adults, according to Arthritis UK. It thins the cartilage and can cause bony lumps, leaving the joint painful, swollen and stiff, with restricted movement and sometimes a limp. The NHS says a GP may suspect it if you are 45 or older, the pain gets worse the more you use the joint, and stiffness is absent in the morning or lasts less than 30 minutes.

Soft tissue problems are the other big group. Arthritis UK describes trochanteric bursitis, where tenderness over the bony part of the outer hip comes from inflammation of the bursa at the top of the thigh bone. It says the condition is very common, often has no obvious cause, can affect both hips, and is now known to involve the muscles and tendons around the area too, which is why it may be called greater trochanter pain syndrome or gluteal tendinopathy.

Other possibilities named in the Arthritis UK hip pain page include iliopsoas tendonitis, a snapping iliopsoas tendon which usually does not cause pain, a torn labrum, which is the ring of cartilage around the socket, and femoroacetabular impingement, where the ball and socket do not move freely. It adds that if hip scans are normal, the symptoms could be referred from the back.

The NHS also lists sprain, strain or tendonitis after intense or repetitive exercise, and bursitis with pain that may spread to the thigh.

For most people the NHS suggests a few practical steps. Keep moving if you can but avoid overdoing it, and use an ice pack or a bag of frozen peas wrapped in a towel on the painful area for up to 20 minutes every 2 to 3 hours. Paracetamol or ibuprofen gel, or ibuprofen tablets if needed, can help. Comfortable, shock-absorbing shoes with a soft sole are recommended, and so is losing weight if you are overweight.

Arthritis UK says a few days of rest may help but that as soon as the pain starts to ease you should begin gentle exercise, because an unmoved hip may become weaker and less flexible. Walking and swimming improve general fitness and take strain off the hip, and it says exercise should stop if you get joint pain that does not go away quickly. It advises not using over-the-counter painkillers for more than two weeks without speaking to a GP.

Everyday adjustments make a difference. The NHS says not to carry anything heavy or sit in low chairs, which add pressure. Arthritis UK suggests pacing yourself, using a shopping trolley instead of a basket, avoiding standing on one leg when getting into a car, and asking an occupational therapist or GP whether a walking stick could make getting about easier, and how to use it at the correct length.

The NHS lists reasons to see a GP: hip pain that stops you doing normal activities or affects your sleep, pain that is getting worse or keeps coming back, pain that has not improved after 2 weeks of home treatment, and hip stiffness lasting more than 30 minutes after waking.

Arthritis UK adds that you should see a doctor straight away if you have fallen or injured your hip, the pain is getting worse, you have difficulty with daily activities such as walking, going up stairs or leaning forward when sitting, or you feel feverish or unwell or have been losing weight.

Urgent help is described by the NHS in two tiers. Ask for an urgent GP appointment or contact NHS 111 if you have severe hip pain that began suddenly without a fall or injury, a swollen hip that feels hot, a change in skin colour around the hip, or hip pain with feeling unwell and a high temperature. Call 999 or go to A&E for severe pain after a fall or injury, if you cannot walk or put weight on the leg, or if you have tingling or loss of feeling in the hip or leg after an injury.

Arthritis UK says your doctor will ask what movements make the pain worse, how it started, how it affects daily activities, and whether it hurts at night. Pain on bending the hip, going up or down stairs, or putting on socks is often a sign of a hip problem. They examine how well the hip moves, which often gives enough information to plan treatment.

Tests are used when needed. X-rays show the bones and are often the best first test but are less useful for soft tissues. CT can show an unusual joint shape, MRI shows muscles and tendons and is particularly helpful for avascular necrosis, and blood tests can help if infection or rheumatoid arthritis is suspected.

The NHS says treatment depends on the cause and can include strong painkillers, simple exercises, physiotherapy, occupational therapy for walking aids, steroid injections, and referral to a specialist who may arrange a scan and discuss surgery. Arthritis UK says a physiotherapist can teach strengthening and stretching, advise on posture and show how to walk when the hip hurts, and that steroid injections are usually helpful for conditions in the trochanteric area on the outside of the hip.

Some people with pain caused by a damaged hip joint may eventually need a hip replacement if other treatments do not help, says the NHS. Arthritis UK says more than 90% of people who have a hip replacement find their pain is greatly reduced, and that a modern artificial hip should last at least 15 years. Waiting times for NHS physiotherapy can be long, and Arthritis UK notes you could be seen quicker privately for a fee.