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Hip pain causes

Hip pain has a number of possible causes

In older adults, hip joint degenerative changes (known as hip osteoarthritis) cause the majority of arthritis hip pain.

Osteoarthritis is a gradual process which leads to the thinning and eventual loss of the smooth joint surfaces (known as the cartilage). It also has other effects, such as creating scarring and adhesions to the soft tissue joint capsule, as well as weakness to the muscles and tendons supporting the joint.

The hips are one of the most common joints to suffer with disabling osteoarthritis. Although the disease process is usually gradual, in many cases individuals suffer with a rapid onset of groin pain and significant stiffness, which does not often coincide with any changes in activity.

Hip pain when sitting for long periods of time can be caused by hip osteoarthritis, or initial rising from a seated position, squatting movements and getting in and out of a vehicle, where hip pain after sitting goes away after walking.

Although degenerative osteoarthritis of the hip is normally seen in those over sixty, this is one of the forms of arthritis that can be seen in younger and middle-aged individuals.

In these cases there will often be a strong genetic predisposition, previous hip joint trauma, other medical problems such as inflammatory arthritis or a developmental defect to the hip/s such as Perthes disease or hip dysplasia. A sore hip in younger adults may also be the result of a bony prominence to the ball part of the hip joint (femoral neck/ head) or a hip socket (acetabulum) which becomes too deep.

This has become known as hip impingement, or femoroacetabular impingement syndrome. Another cause of hip pain in middle-aged adults is a condition known as greater trochanteric pain syndrome.

This condition causes joint pain on the outside of the hip and is due to a combination of inflammation in a protective fluid filled sac (called the hip bursa) as well as pain from the tendons of the gluteal muscles.

Other tendon problems which manifest disproportionality in younger and middle-aged adults include ischial and hamstring tendon pain.

Both, greater trochanteric pain syndrome and ischial and hamstring tendon pain may result from a combination of degenerative changes within the tendons and/ or stiffness in some of the adjacent soft tissue.

This problem may be compounded in those who still attempt to push past their limits with regular sporting activity, causing pain and stiffness.

When hip pain is suspected or felt in babies and children, this should always be assessed by a qualified healthcare clinician.

This will allow for the screening of certain hip conditions which, if left untreated, may cause problems with the hip joints in later life. One such hip joint problem is termed developmental dysplasia of the hip. This condition refers to when the ball (femoral head) part of the hip joint does not sit properly in the hip socket (acetabulum).

In some cases, it may be entirely dislocated from the joint. This condition is caused by childbirth and is more common with breech births. In later childhood, a condition known as Perthes disease may develop. It is not known exactly why this condition develops, but it involves an interruption of the blood supply to the ball (femoral head) part of the hip joint.

In many cases this is temporary and with monitoring will resolve. However, in some cases a specialist may recommend a brace, or in rare cases surgery, to encourage healing. Far rarer are cases when children get a hip joint infection.

In the event of a suspected hip joint infection, then medical treatment will be required. Often this will involve a small operation to wash out the infection with sterile fluid and several days of intravenous antibiotics.

In spite of these more serious causes of hip pain in children, the majority of hip pain in children will be related to mechanical problems such as small rotational abnormalities in the lower limbs as they develop.

This is also known as trochanteric bursitis and is more commonly referred to nowadays as Greater Trochanteric Pain Syndrome.

Bursae are fluid-filled sacs in the body that sit between moving tissues. They act as cushions between the bones and tissues, preventing the build-up of friction as they move against one another.

If a bursa becomes inflamed it produces more fluid, causing it to swell up into a lump. This inflammation is known as bursitis.

More commonly, this condition is caused by repetitive small tears to the powerful walking tendons. Both conditions are felt on the outside (lateral) of the upper thigh-bone (femur), at a bony prominence known as the greater trochanter. Sleeping on the affected side can be very painful.


The heavier you are, the more load is placed on your hip, your back, your knees and the muscles, tendons and ligaments associated with them. These can become overloaded and painful.

Prolonged overload will result in excessive wear and tear but in the early stages, weight loss to a healthy level will completely eradicate the symptoms.


Patients who develop arthritis can have a genetic predisposition to it. Some people's collagen fibres are more susceptible to damage, meaning their articular cartilage is more susceptible to wearing out. Some people are born with unusually shaped joints that can wear out more quickly. 


An accident such as falling off a ladder from a height or slipping on an icy pavement and falling on your side can damage the hip. High impact/force injuries can cause a hip fracture.

Referred pain

Back problems can commonly cause referred pain in the hip. A trapped nerve in the spine may cause sciatica hip pain, pain in the hip or pain down towards and below the knee.

Knee problems may affect the way you walk, exacerbating hip issues. For this reason, at your initial appointment your Consultant will carry out a clinical examination of your hips, back and knees, to rule out referred pain being the cause of your hip pain.


Doing too much physical activity before our bodies have adapted to the increased loads and stresses on your hip flexors can cause sudden hip pain. From torn ligaments and tendons to sore muscles, it can be easy to damage the soft tissues around the hip with overactivity. It is always best to increase activity levels steadily over a period of time. This could lead to outside hip pain after running or hip pain when walking.

Our physiotherapists can help develop a suitable exercise programme at a level suitable for you.

Specialists offering Hip pain causes

Mr Jeya Palan

Orthopaedic Consultant Surgeon

BSc (Hons), MB BS, PhD, FRCS (Tr & Orth)

The Huddersfield Hospital

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Mr David Wood

Consultant Orthopaedic Surgeon

MB ChB, MRCS, FRCS (Tr and Orth)

Thornbury Hospital

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Mr Robert Metcalf

Orthopaedic Surgeon

MB ChB ; FRCS (Tr. and Ortho) ; FRCS (Eng)

The Huddersfield Hospital

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