Hip pain is one of the most frequently misunderstood complaints in orthopedic medicine, partly because the hip is not always where the pain actually feels like it is coming from. Some people point to their outer thigh, while others feel it deep in the groin. Some notice it in the buttock or lower back and assume their spine is the problem. Getting the right answer starts with understanding that hip pain has distinct, identifiable causes, and that each one requires a different approach to treat effectively. Here are five of the most common ones.
1. Femoroacetabular Impingement (FAI): When the Joint Does Not Fit Quite Right
Femoroacetabular impingement is one of the most common causes of hip pain in active adults and athletes, and one of the most commonly missed. It occurs when there is a subtle mismatch in the shape of the ball and socket of the hip joint, causing the bones to make abnormal contact during movement. The pain is typically felt deep in the groin, often described as a sharp catch at the end of range of motion, and frequently worsens with prolonged sitting, getting in and out of a car, or during athletic activity that requires hip flexion. There are two main types: cam impingement, where the femoral head is not perfectly round, and pincer impingement, where the socket overcovers the ball. Many patients have a combination of both. Left unaddressed, FAI can cause progressive damage to the labrum and cartilage inside the joint, which is why early identification matters.
2. Labral Tears: The Hidden Source of Deep Hip Pain
The acetabular labrum is a ring of cartilage that lines the hip socket, providing stability, cushioning, and a seal that helps keep the joint lubricated. When this structure tears, whether from a traumatic injury, repetitive motion, or the progressive mechanical stress of underlying FAI, patients often experience a deep, hard-to-localize ache inside the hip joint accompanied by clicking, catching, or a sense that the joint is not moving quite right. Labral tears are often overlooked because standard X-rays do not show soft tissue, and symptoms can be subtle or intermittent in the early stages. MRI with contrast is typically needed to visualize the labrum properly, and clinical examination using specific provocation tests helps correlate imaging findings with actual symptoms. Many labral tears can be repaired arthroscopically rather than requiring open surgery, preserving the tissue and its function rather than simply removing the damaged portion.
3. Hip Dysplasia: When the Socket Does Not Provide Enough Coverage
Hip dysplasia is a condition in which the acetabulum, the socket portion of the hip joint, does not adequately cover the femoral head, leaving the joint less stable than it should be. It is significantly more common in women than men, and while it is often identified in infancy or childhood, many patients reach adulthood before symptoms become noticeable. The pain of hip dysplasia tends to be diffuse, aching, and activity-related, often worsening with walking, standing for long periods, or physical activity that loads the joint. Because the undercoverage increases mechanical stress on the labrum and cartilage over time, untreated dysplasia carries a meaningful risk of early-onset arthritis. Mild cases may be managed with activity modification and physical therapy, while more significant structural instability often requires a periacetabular osteotomy, a procedure that repositions the socket to improve coverage and reduce long-term joint stress.
4. Bursitis and Tendon Conditions: When the Pain Is on the Outside of the Hip
Not all hip pain originates inside the joint. The outer hip has its own set of structures that commonly become painful, most often the greater trochanteric bursa and the gluteal tendons that attach to the prominent bone on the side of the hip. Greater trochanteric pain syndrome, which encompasses bursitis, gluteal tendinopathy, and gluteal tears, produces pain on the outer hip and sometimes the outer thigh that typically worsens with lying on the affected side, climbing stairs, or crossing the legs. It is particularly common in women and in runners. Treatment usually begins with physical therapy targeting gluteal and hip abductor strength, activity modification, and, when appropriate, image-guided injections or surgery. The key clinical distinction from intra-articular hip pain is that this type of pain reproduces with direct pressure over the outer hip bone rather than deep inside the groin.
5. Hip Osteoarthritis:
Osteoarthritis of the hip is the progressive breakdown of the cartilage that cushions the joint surfaces, and it is one of the most common causes of hip pain in adults over 50. The pain is typically felt in the groin or inner thigh, worsens with weight-bearing activity, and is often accompanied by stiffness that is most pronounced after periods of rest. Unlike the sharp, activity-specific pain of impingement, osteoarthritis pain tends to be deeper, more diffuse, and more constant as the condition advances. Early and moderate arthritis is often managed conservatively with physical therapy, weight management, and targeted injections including orthobiologic options that aim to support the joint environment. When cartilage loss is significant and conservative measures are no longer providing adequate relief, hip replacement becomes the appropriate next step for restoring function and quality of life.
Why an Accurate Diagnosis Matters More Than a Label
Each of these five conditions can produce overlapping symptoms, and more than one can be present at the same time. FAI is a well-established contributor to labral tears. Dysplasia can coexist with labral pathology. Early arthritis can develop on a background of years of unaddressed impingement. This is why the diagnosis process matters as much as the treatment that follows it. A thorough clinical evaluation, appropriate imaging, and a clear understanding of which structures are actually involved are what make it possible to choose a treatment plan that addresses the real source of the problem rather than the most likely-sounding one.
If hip pain has been affecting your activity, your sleep, or your daily quality of life and you are not sure what is causing it, getting a proper evaluation is the most direct path to a clear answer.
Frequently Asked Questions
- What are the most common causes of hip pain in adults?
The most common causes include femoroacetabular impingement, labral tears, hip dysplasia, greater trochanteric pain syndrome involving the bursa and gluteal tendons, and hip osteoarthritis, though more than one condition can be present at the same time. - How do I know if my hip pain is serious?
Hip pain that persists beyond a few weeks, worsens with activity, interferes with sleep, comes with clicking or catching sensations, or causes you to limit your daily activities warrants a clinical evaluation rather than continued self-management. - Can hip pain be felt in the groin?
Yes. Deep groin pain is actually one of the most characteristic locations for true hip joint pain, including FAI, labral tears, and hip arthritis. Pain on the outer hip or thigh is more often associated with bursitis or tendon conditions rather than the joint itself. - What is the difference between a labral tear and hip impingement?
Femoroacetabular impingement refers to the structural mismatch between the ball and socket that causes abnormal joint contact, while a labral tear is a specific injury to the cartilage ring lining the socket. The two are closely related, and FAI is one of the most common underlying causes of labral tears. - When is hip replacement necessary for hip pain?
Hip replacement is generally considered when hip arthritis has progressed to a point where cartilage loss is significant, pain is substantially limiting daily function, and a genuine trial of conservative treatment has not provided adequate relief.