Hip pain in adults
"My hip hurts" means very different things to different people: for one it pulls in the groin, for another it aches on the outside, for a third the buttock…
On this page
- Where it hurts and what that tells you
- Osteoarthritis, the commonest cause
- Outer-side pain that stops you lying on that side
- When it is not the joint at all
- Fracture after a fall: the thing that must not be missed
- Signs that change the conversation
- What you can do yourself
- What the doctor will suggest
- If it is a child whose hip hurts
- Online consultation
Medicines commonly prescribed for Hip pain in adults
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: GEL, 23.2 mg/gActive substance: diclofenacManufacturer: Laboratorios Cinfa S.A.Prescription not requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription requiredDosage form: CAPSULE, 400 mgActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription not required
"My hip hurts" means very different things to different people: for one it pulls in the groin, for another it aches on the outside, for a third the buttock hurts and the pain runs down the leg. The hip joint itself sits deep, closer to the groin than to the spot where people usually put a hand. So the first useful thing to do is work out exactly where the pain is. Both the list of causes and how urgently a doctor is needed follow from that.
Where it hurts and what that tells you
The division is rough, but it holds in most cases.
- The groin and the front of the thigh, sometimes as far as the knee. That is the joint itself: osteoarthritis, inflammation, a tear of the cartilage rim, death of bone in the femoral head. The giveaway is difficulty putting on a sock, getting out of a car or crossing the legs.
- The outer side, the "bone" you lie on. That is the soft tissue over the greater trochanter: the bursa and the tendons of the buttock muscles. Lying on that side and climbing stairs hurt, and a tender spot can be found with a finger.
- The buttock and the back of the thigh, especially with pain shooting below the knee. That is most often not the hip at all but the lower back: a trapped nerve root or a problem in the sacroiliac joint.
The reverse also happens: the joint is worn out and the only thing that hurts is the knee. Pain referred to the knee is a well-known trap, and if the knee is clear on examination and on X-ray but still hurts, the hip is worth checking.
Osteoarthritis, the commonest cause
Osteoarthritis of the hip is the gradual thinning of cartilage. It usually starts after forty-five, more often in people with a family history, in those carrying extra weight, after old injuries and in people whose work has loaded the joint for years.
You recognise it by its rhythm. Groin pain comes on with movement and settles at rest; in the morning or after sitting a long time the joint seizes up for a few minutes and then loosens as you walk. Bit by bit the distance a person can cover without stopping shortens and the range of movement narrows: first the hip stops turning inwards, then bending down to the foot becomes hard. Night pain arrives late, once the disease is well advanced.
Morning stiffness that does not clear in half an hour and lasts an hour or more, especially with several joints affected on both sides equally, is no longer osteoarthritis: it is a reason to look for inflammatory joint disease and to have blood tests.
Outer-side pain that stops you lying on that side
The second commonest story is inflammation and wear of the buttock tendons and the bursa over the greater trochanter. This used to be called simply trochanteric bursitis; these days it is more often described as greater trochanteric pain syndrome, because the bursa alone is rarely the whole story.
The picture is very recognisable: the outer side of the thigh hurts, the sore spot can be found with one finger, sleeping on that side is impossible, and stairs, getting up from a chair and standing with the weight on one leg are all painful. The pain may travel down the outer thigh, but it usually stops above the knee and does not come with numbness.
It turns up mostly in middle-aged and older women, after a step up in activity, where the legs are of different lengths and where the buttock muscles are weak. It is not dangerous in itself, but it drags on and ruins sleep. The mainstays are offloading the area, pain relief, and muscle work along the lines a professional sets out; at the appointment the doctor decides whether imaging and other tests are needed.
When it is not the joint at all
Some of the pain in this area has nothing to do with the joint, and treating it as arthritis achieves nothing.
- The lower back. A trapped nerve root gives pain that starts in the buttock and runs down the leg, often below the knee, with numbness, pins and needles or weakness in the foot. It changes with position and worsens on coughing and sneezing. Movement of the hip itself, by contrast, is free and painless, and that is the key difference.
- The sacroiliac joint. Deep pain in one buttock, more often after childbirth, with inflammatory disease of the spine, or after a heavy load.
- Inguinal hernia and groin muscle problems. Pain strictly in the groin, worse on straining and on bringing the leg inwards.
- Compression of the skin nerve of the thigh. Burning and numbness over the outer thigh with no weakness; often linked to a tight belt or waistband, or to weight gain.
- The blood vessels. Pain in the buttock and thigh that comes on reliably after a certain walking distance and clears after standing still for a couple of minutes points to narrowed leg arteries. That is a subject of its own and a reason to have the circulation assessed.
Fracture after a fall: the thing that must not be missed
A fracture of the top of the thigh bone in an older person is the most dangerous cause of pain in this area. With osteoporosis, a fall from standing height is enough, and sometimes just an awkward turn in bed.
The danger is that the fracture does not always look like one. The classic picture — sudden pain, a shortened leg turned outwards, no ability to stand — is not universal. In an impacted fracture, where the fragments are wedged into each other, the person may stand and even walk a few steps, complaining only of groin pain. Those are exactly the ones that get missed: an older person fell, got up, made it to the sofa, and everyone assumed there was no harm done. A plain X-ray does not always show the crack either, and if the suspicion persists a further scan is arranged.
Call an ambulance on the single European number 112 or take the person to hospital if, after a fall or a blow:
- the groin or hip pain is severe and they cannot put weight on the leg;
- the leg has become shorter, turned outwards or is lying at an unnatural angle;
- the joint is deformed, or swelling or a large bruise is spreading quickly;
- numbness, coldness or weakness appears in the leg or foot.
See a doctor the same day even if the person is walking, whenever an older person has fallen and afterwards limps, complains of the groin or cannot lift the straight leg while lying down. All the more so if they take osteoporosis medication or steroids, or have already broken a bone after a minor knock. Driving yourself in that situation is a bad idea: let someone else take you.
Signs that change the conversation
There are a few combinations that turn hip pain from a mechanical problem into something else.
- Pain with fever. A hot, swollen hip, a high temperature, shivering and being unable to move the leg mean infection in the joint or the bone, and help is needed immediately, within the hour. It is particularly dangerous in people with diabetes, after joint surgery, with a joint replacement in place, in anyone on medicines that suppress the immune system, and in people who inject drugs.
- Pain at rest and at night together with weight loss. Pain that does not depend on movement, wakes you at night and comes with weight loss, night sweats or unexplained weakness needs investigating without delay. The bones of the pelvis and thigh are among the commonest sites of secondary cancer, and in anyone ever treated for cancer of the breast, prostate, lung, kidney or thyroid such pain counts as tumour pain until proved otherwise. Pain appearing for the first time in old age and worsening quickly is just as concerning.
- Pain in someone who has taken steroids long term. Avascular necrosis of the femoral head is death of an area of bone from loss of its blood supply. The main risk factors are long courses of steroids at high dose and heavy drinking; it also occurs in sickle cell disease, after radiotherapy and after injury to the joint. It begins as groin pain on loading in a relatively young person, the early X-ray is often normal, and MRI settles the question. Diagnosing it early has a concrete point: in the early stages the joint can still be saved.
- Sudden weakness in the leg, trouble passing urine or numbness around the back passage and genitals together with back and leg pain: that is a spinal emergency and needs hospital straight away.
What you can do yourself
Until the cause is known, a few simple measures make sense and harm nobody.
- Do not retreat into complete rest. A joint that stops moving loses range and hurts more. Find the level of activity at which pain is bearable and no worse the next day.
- Remove the obvious provocations: long flights of stairs, standing for long periods, sitting in low soft armchairs, sleeping on the painful side.
- Comfortable shock-absorbing shoes and a walking stick both help. The stick is held in the hand on the good side, which is what actually takes the load off.
- Losing weight noticeably eases the load on the joint, and it is one of the few measures with proven benefit in osteoarthritis.
- For pain, paracetamol or non-steroidal anti-inflammatory drugs, including as a gel rubbed into the outer thigh. Follow the leaflet, and check with your doctor if you have stomach, kidney or heart problems or take other medicines.
- Warmth usually eases stiffness and cold eases fresh pain after exertion. But if the joint is hot and there is a fever, do not apply heat — infection has to be ruled out first.
What the doctor will suggest
The doctor will examine the hip, check the range of movement and the way you walk, and will always look at the lower back and the knee so that referred pain is not mistaken for joint pain. After that, depending on the findings: X-ray, blood tests where inflammation or infection is suspected, ultrasound of the soft tissues, and MRI where the plain film showed nothing. Treatment usually offered is prescribed exercise and work with a physiotherapist, painkillers, sometimes an injection into the joint or into the trochanteric area, and, in advanced osteoarthritis where pain prevents sleeping and walking, a discussion about hip replacement. The specific exercises, how many and over what timescale, are set by a professional after examining you: there is no single programme here that suits everybody.
If it is a child whose hip hurts
In children and teenagers everything works differently, and none of the above transfers to them. Osteoarthritis and trochanteric bursitis barely exist at those ages, while there is a set of causes all of their own: temporary inflammation of the joint after an infection, Perthes' disease, a slipped femoral head in a teenager and, most urgent of all, a pus-forming infection of the joint. A child who starts limping for no reason or complains of a knee needs examining, not waiting. There is a separate page on this site about hip pain in children: if the person in question is a child or a teenager, read that one.
Online consultation
Hip pain is a subject where half the work is done by talking: where exactly it hurts, when it began, what makes it worse and what helps, how it behaves at night, what you have already taken and what the scans showed. In an online consultation an Oladoctor doctor will help you separate the joint from the lower back and from soft-tissue pain on the outside, go through any X-rays and MRI scans you already have, explain which further tests are worth adding, and point you to the right person: orthopaedic surgeon, rheumatologist, neurologist or rehabilitation specialist. They will separately check the signs that cannot wait, and if what you describe sounds like a fracture, an infection or tumour pain, you will be told plainly and directed to face-to-face care.
This material is for information only and does not replace medical advice.
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