Hip Pain: What Is Actually Causing It and What Helps
Where the pain sits tells you most of what you need to know. A guide to groin pain, outer hip pain, buttock pain — and why "hip bursitis" is usually the wrong label.
Published 6 August 2026 · 9 min read · By the Platinum Physiotherapy Clinical Team
Hip pain is one of the most commonly mislabelled problems we see. Patients arrive having been told they have "bursitis" when the tissue involved is a tendon; others have been treated for a hip problem for months when the pain is actually referred from the lower back. The hip is a large joint surrounded by some of the strongest muscles in the body, and pain around it can originate in the joint itself, the tendons and muscles around it, or the lumbar spine above it. The single most useful diagnostic clue costs nothing: where exactly does it hurt? This guide walks through what each location typically means and what genuinely helps.
Where the pain sits usually identifies the source. Groin pain typically means the hip joint itself (osteoarthritis or a labral or impingement problem). Pain on the outer hip, tender to touch and worse lying on that side, is almost always gluteal tendinopathy — not bursitis. Buttock pain that travels down the leg is usually referred from the lower back.
Start With the Location
Point to the spot with one finger. This simple test narrows the possibilities more effectively than most imaging.
| Where it hurts | Most likely source | Typical pattern |
|---|---|---|
| Groin, front of hip | The hip joint itself — osteoarthritis, impingement, labral irritation | Worse with deep bending, putting on socks, getting out of a car; stiff after rest |
| Outer hip, over the bony point | Gluteal tendinopathy (commonly mislabelled "bursitis") | Tender to touch, painful lying on that side at night, worse on stairs |
| Buttock, sometimes into the leg | Usually referred from the lumbar spine | Varies with back position; may include numbness or tingling |
| Deep at the sit bone | Proximal hamstring tendinopathy | Worst sitting on hard surfaces, uphill walking, accelerating |
| Front of thigh to the knee | Often the hip joint referring pain | Hip pathology commonly refers to the knee — a classic trap |
That last row matters and is frequently missed: hip joint problems refer pain to the knee surprisingly often. If knee treatment is not helping, the hip deserves examination — particularly in older adults and in children, where hip conditions presenting as knee pain is a well-recognised pitfall.
Why "Hip Bursitis" Is Usually the Wrong Diagnosis
For decades, pain on the outer hip was routinely diagnosed as trochanteric bursitis — inflammation of a fluid-filled sac over the bony prominence. Imaging and surgical studies have since shown that in the large majority of these cases, the bursa is not the primary problem. The actual pathology is gluteal tendinopathy: degenerative change and irritation in the gluteus medius and minimus tendons where they attach to the femur.
This is not pedantry, because the treatment differs substantially. If you believe the problem is inflammation of a bursa, the logical treatments are rest, ice, and repeated cortisone injections. If it is a tendinopathy, the evidence-based treatment is progressive loading — carefully graded strengthening of the gluteal muscles — combined with removing the compressive positions that irritate the tendon. Injections may relieve pain short-term but do not address the tendon, and repeated injections into tendon tissue are generally best avoided. See our hip bursitis and gluteal tendinopathy page.
The Positions That Keep Gluteal Tendinopathy Going
Gluteal tendons are irritated by compression, which happens whenever the affected leg crosses the midline of your body. Three everyday habits do this constantly, and stopping them is often the fastest source of relief.
Sleeping on the painful side compresses the tendon directly — and sleeping on the good side with the top leg dropped forward across the body compresses it too, which is why many people hurt on both sides. Sleep with a pillow between your knees so the top leg stays in line with your hip. Standing hanging on one hip, with your weight shifted and the hip pushed out sideways, is the second. Sitting cross-legged or with knees together and feet apart is the third. Also stop the classic "IT band stretch" where you cross one leg behind the other and lean away — that position maximally compresses the tendon, which is why it often feels like it should help and reliably makes things worse.
Hip Osteoarthritis
Hip osteoarthritis typically causes groin pain, morning stiffness that eases within about half an hour of moving, and progressive loss of rotation — patients often notice difficulty putting on socks or getting in and out of a car before they notice pain. It is more common after 50 but not exclusive to older adults.
The most important message is that osteoarthritis is not a reason to stop moving. Exercise therapy is recommended as a first-line treatment in every major clinical guideline, and strengthening the muscles around the hip reliably reduces pain and improves function even though the joint changes themselves do not reverse. X-ray severity correlates poorly with symptoms: plenty of people with significant radiographic changes have minimal pain, and vice versa. For most people, a structured strengthening program, activity modification, and weight management where relevant meaningfully delay or avoid surgery. When a hip replacement does become appropriate, going into surgery stronger produces better outcomes afterwards — so the rehabilitation is not wasted either way.
Impingement and Labral Problems in Younger Adults
Femoroacetabular impingement is a shape mismatch between the ball and socket that causes them to make contact earlier than they should during deep hip flexion and rotation. It typically affects active adults in their twenties to forties, and often shows up in athletes in sports requiring deep squatting, kicking, or rapid direction changes.
The classic presentation is groin pain with deep squatting, prolonged sitting, or pivoting, sometimes with clicking or catching, and patients frequently make a C-shape with the thumb and forefinger around the side of the hip when describing where it hurts. Labral tears often accompany it. Encouragingly, a large proportion of these patients improve substantially with physiotherapy focused on hip and trunk strength, movement modification, and avoiding the specific end-range positions that provoke symptoms — surgery is usually considered only when a well-executed conservative program has been given a genuine trial.
When Hip Pain Is Really Back Pain
Buttock pain, pain that travels down the back of the leg, and pain accompanied by numbness, pins and needles, or weakness usually point to the lumbar spine rather than the hip joint. The sciatic nerve refers pain into the buttock and leg, and lumbar facet joints refer into the buttock and outer thigh.
A few clues help distinguish them. Hip joint pain is generally worse with hip movement and load — walking, stairs, deep bending — and better lying down. Referred back pain typically changes with your back position, may be worse sitting or after prolonged standing, and often includes nerve symptoms. A proper physiotherapy assessment tests both regions, because assuming the wrong source is the single most common reason hip treatment fails.
What Treatment Works
Across almost every cause of hip pain, progressive strengthening is the core treatment, and it is consistently under-dosed. Gluteal and deep hip muscle strengthening, loaded gradually over eight to twelve weeks, is what changes tendon capacity and joint tolerance. Stretching alone rarely resolves hip pain and, in gluteal tendinopathy, commonly aggravates it.
Hands-on manual therapy helps with stiffness and gives short-term relief that makes exercise more tolerable. Acupuncture and shockwave therapy are useful adjuncts for stubborn tendinopathy. Load management — temporarily reducing hills, stairs, and long walks while capacity is rebuilt — is essential and often overlooked. Expect meaningful improvement in six to twelve weeks for tendinopathy and ongoing gains over several months for osteoarthritis; the timeline is longer than most people hope, but the outcomes are good when the program is followed properly. At Platinum Physiotherapy, every hip assessment is one-on-one in a private room, includes screening of the lumbar spine, and produces a specific loading program rather than a generic exercise sheet.
Frequently Asked Questions
Why does my hip hurt when I lie on my side at night?
That is the classic sign of gluteal tendinopathy. Lying on the painful side compresses the tendon against the bone, and lying on the other side with the top leg dropped across the body does the same. A pillow between the knees to keep the top leg in line with the hip usually helps substantially.
Is hip bursitis a real diagnosis?
True bursitis exists but is far less common than the label suggests. Most outer hip pain is gluteal tendinopathy — irritation of the gluteal tendons — which matters because tendinopathy responds to progressive strengthening rather than rest and repeated injections.
Can hip problems cause knee pain?
Yes, and it is a common trap. Hip joint pathology frequently refers pain to the front of the thigh and knee. If knee treatment is not working, the hip should be examined — this is especially important in older adults and in children.
Should I stretch a painful hip?
It depends on the cause. With gluteal tendinopathy, common stretches that bring the leg across the body compress the tendon and typically make it worse. With hip osteoarthritis, gentle mobility work helps. Strengthening is the more reliable treatment in almost every case.
Do I need an X-ray or MRI for hip pain?
Usually not initially. A physiotherapy assessment can identify the likely source in most cases, and imaging findings correlate poorly with symptoms — many people with significant X-ray changes have little pain. Imaging becomes useful when symptoms do not respond as expected or surgery is being considered.
Can physiotherapy help me avoid a hip replacement?
For many people with hip osteoarthritis, exercise therapy meaningfully reduces pain and improves function, and is recommended as first-line treatment in clinical guidelines. It can delay or avoid surgery, and if a replacement is eventually needed, going in stronger produces better outcomes afterwards.
Find Out What Is Actually Causing Your Hip Pain
One-on-one assessment including lumbar screening, plus a specific loading program — not a generic exercise sheet. Platinum Physiotherapy, College Plaza, Brampton. Direct billing, open 7 days a week.
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