Hip pain

Hip pain will often be accompanied by the related problems of stiffness or swelling in your hip joint. Whether you suffer from one or all of these symptoms, they can really impact the mobility and flexibility of your joint (i.e. how well you can use it), which in turn affects your overall mobility.

Depending on the causes of your hip pain and how it presents, you might find your hip problems are constant or you may have times where you feel better and times when you feel worse. This could be over the course of a day, a week or even longer. For example, some people's hip pain will be worst at night or at the end of a long day, while others can feel fine for days on end but will have what's sometimes called a 'flare-up' and their hip pain will be consistently bad for a number of days or weeks.

How joint pain affects your life: the findings of our Joint Pain Matters survey

Hip pain can significantly impact many areas of your life. Our Joint Pain Matters report found that 50% of people with joint pain feel it significantly reduces their quality of life and 39% rated their quality of life as 'poor' as a result of joint pain.

The same report found that 44% of people had missed work because of their joint pain, 37% of people felt it affected their sleep every night, and 49% had felt the impact of joint pain on their romantic relationships.

69% of our respondents felt that joint pain had negatively affected their mental health, with women tending to report a greater impact.

When you speak to a specialist, they'll ask you questions about where you feel your hip pain, asking about common symptoms such as outside hip pain or hip and thigh pain.

Hip pain can be felt in various locations and depending on the exact nature of your hip problems you might feel pain in one or more of these. For example, because the surfaces of your hip joint are located deep within the groin region, people with hip problems often experience both hip and groin pain. You might also have pain from your hip down to your knee, hip pain that spreads to your back (lower back and hip pain), or hip pain that presents as buttock pain.

Sometimes people have knee pain that turns out to be the result of a hip problem, or you might experience hip and leg pain together. You might feel that your hip pain is radiating down your leg, or you might experience your hip joint clicking or popping. Some people feel pain from hip to foot, or hip and knee pain together.

Getting a specialist opinion

As you can see, hip problems can present in various ways and can affect us all differently. If you are experiencing any of the above symptoms, do speak to a specialist. An orthopaedic consultant is a specialist in the treatment of bones and joints and can help you to identify the cause of your hip pain and develop a treatment plan to manage and reduce it.

As well as where your hip pain affects you, your orthopaedic consultant will want to know if there are any times your hip pain is particularly bad, if it started at any particular time, or if it seems to be linked to certain activities or occurrences.

Many people with hip problems find their sleep is very disrupted by their pain and stiffness, which can prevent them falling asleep and can also wake people in the night.

The majority of cases of hip pain at night occur as a result of lying directly on the painful soft tissue structures to the side or back of the hip.

Alternatively, when lying on the other side, these same soft tissue structures may be placed in a stretched position, causing hip pain when lying down. In more severe cases of hip osteoarthritis, or in the rare case of inflammatory joint disease affecting the hip, the night pain may be due to the buildup of inflammation within the joint.

In rare circumstances, hip pain through the night or hip pain when sleeping may be a sign of an underlying medical problem. As such, if individuals suffer significant hip pain at night and have any more systemic symptoms such as fever, sweats or widespread pain, it is advised that they seek an urgent assessment.

How to alleviate hip pain at night

When you have significant pain at night, it may feel like your hip is always painful, no matter the position. However, some adaptations may alleviate your symptoms. Ideas for how to relieve hip pain while sleeping include:

• If you prefer a side lying position, a cushion or pillow can be placed between the knees to prevent any stretching of the soft tissue structures
• A specialist memory foam mattress topper may also help matters if the pain arises when lying on the painful side. If possible, it may be advisable to sleep on your back. In which case, a pillow or blanket under the knees can also place the hip joints in a more neutral position, thereby relieving pain
• Over-the-counter pain-relief medication like paracetamol or ibuprofen may help to take the edge off your pain as you go to bed. There are certain tablets that are a bit more effective at helping with sleep as well as pain, and your pharmacist will be able to advise you on these where appropriate
• Gentle, appropriate exercise and stretching may help to relax the hip and ease your pain. A physiotherapist will be able to show you specific exercises, stretches and movements that would be best for you

Always remember: do whatever is comfortable. You know your body better than anybody, and you'll know which positions are best for you. You won't be damaging the joint any further by lying on one side in particular, for example.

Hip pain during pregnancy is very common, because your hips are put under a lot of strain. Although bodyweight may vary over different parts of your life, this almost always occurs gradually, whether gaining or losing weight. This means that your joints, along with the stabilising soft tissues around your joints and muscles, all have time to adapt to these different stresses.

On average during pregnancy, women may gain as much as eleven to eighteen kilograms. Furthermore, the majority of this weight gain is over the second and third trimester. This signifies very rapid weight gain and due to this, the hip joints may struggle to adapt to these increased stresses.

Factors that can make you more at risk of hip pain in pregnancy include:

• A history of lower back or pelvic girdle pain
• Previous injury to the pelvis (for example, from a fall or accident)
• Having pelvic girdle pain (PGP) in a previous pregnancy
• A physically demanding job
• Being overweight
• Having a multiple birth pregnancy

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. This can cause hip flexor pain or lower back and hip pain on one side.

The second cause for an increase in hip and pelvic pain during pregnancy is that a hormone known as relaxin is released in significant quantities. Relaxin relaxes and softens the ligaments and joint capsules around the pelvis, allowing for an easier passage of the baby in childbirth. In spite of this obvious advantage, lower back and hip pain during your pregnancy may be related to this weakening of the pelvis and hip joint capsule and ligaments.

In order to maintain appropriate balance with the baby bump, pregnant women will either tilt their pelvic forwards (anterior pelvic tilt) or backwards (posterior pelvic tilt) and flex their knees. These adaptations place the hip joints and hip flexors in an abnormal posture for the majority of the pregnancy and is, therefore, a third possible contributory factor.

The pain can be worse when you're:

• Walking
• Going up or down stairs
• Standing on one leg (for example, when you're getting dressed)
• Turning over in bed
• Moving your legs apart (for example, when you get out of a car)

In very rare circumstances when women are unable to weight bear due to hip pain or instability, they are advised to offload their weight and seek an urgent healthcare consultation.

Most hip pain causes can be categorised as either an injury or a degenerative joint condition.

Hip osteoarthritis

Osteoarthritis is the most common form of arthritis. It happens when the cartilage in our joints wears down over time, which is why it's often referred to as wear and tear arthritis. Cartilage is a smooth and flexible tissue that protects our joints; without it, our bones start to rub together.

Osteoarthritis can also lead to 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, and this is one of the most common causes of painful hips. 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 osteoarthritis is most commonly seen in people over sixty, as it is a disease that happens over time. However, it is possible to get osteoarthritis in your hip as a younger person. Risk factors include a family history of the condition, previous trauma to the joint (for example a fracture when you were younger), or another hip condition such as hip dysplasia.

Athletes and manual workers may also be more likely to develop osteoarthritis, in which case the joint may have worn down more quickly due to overuse.

Rheumatoid arthritis

Rheumatoid arthritis (RA) currently affects more than 400,000 people in the UK. It is caused by an autoimmune process, which happens when your body attacks its healthy cells by mistake. This often causes pain, swelling, and inflammation in your joints.

Joints affected by RA are commonly surrounded by inflamed tissue, which often results in chronic pain. Unlike osteoarthritis, rheumatoid arthritis often affects two or more joints. The condition causes other challenging symptoms too, including fatigue.

Hip impingement

A sore hip in younger adults may be the result of a bony prominence to the ball part of the hip joint (the femoral neck or head) or a hip socket (acetabulum) which becomes too deep. This means your ball and socket don't fit together properly, which restricts movement and causes pain.

This has become known as hip impingement, or femoroacetabular impingement syndrome.

Hip bursitis

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.

Greater trochanteric pain 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.

This was previously known as trochanteric bursitis but is more commonly referred to nowadays as greater trochanteric pain syndrome, because these days we understand that the causes are multiple and not just related to the bursae.

Accidents and injuries

An accident such as falling off a ladder from a height or slipping on an icy pavement and falling on your side can damage your hip. Common hip injuries include hip dislocation and a hip labrum tears.

If your hip pain is happening after an accident, you should speak to a specialist as soon as possible.

Fractures

A hip fracture is when a crack occurs at the top of your thigh bone (femur). Hip fractures are usually caused by a traumatic injury such as an injury during contact sports, but they can sometimes happen because of a condition that weakens your hip bone, for example osteoporosis.

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.

Overactivity

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 hip flexor pain, outside hip pain after running or hip pain when walking.

If you want to increase your activity levels without risking damage to your hips, our physiotherapists can help develop a suitable exercise programme at a level suitable for you.

When hip pain is suspected or felt in babies and children, this should always be assessed by a specialist. This will allow for the screening of certain hip conditions which, if left untreated, may cause problems with the hip joints in later life. Most hip pain in children is not serious, but it's good to rule out the few problems that are.

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.

It’s important to appreciate that everybody's perception and tolerance of pain is different, and people may feel pain in different areas. Some people might not complain of much pain despite having very stiff hips and quite a bit of disability as a result of damage to the joint.

A good rule of thumb is to see a doctor if your symptoms are impacting on your quality of your life or your ability to carry out your normal everyday tasks.

When you visit one of our consultants for help with hip pain, they will want to learn as much as possible about your symptoms. They may ask you questions like:

• How long have you had the hip pain?
• Was there an obvious cause, such as a hip fracture?
• Has the pain stayed the same, or has it been getting progressively worse over time?
• Where exactly is the joint pain?
• Do any specific movements, positions or activities make the pain worse?
• Have you tried any treatments for your hip pain? If so, have they helped?

They will also take a detailed medical history, perform a short physical examination, and possibly arrange for tests or scans to help make a diagnosis of the cause of your hip pain.

Most cases of hip pain are reliably diagnosed by an experienced clinician by undertaking a history of the condition and completing a physical examination. This will focus on examining your range of motion, analysing the extent of any stiffness and pain as well as when they happen, and looking for redness or swelling.

X-rays may be useful in determining the extent of any degenerative changes to the hips joint/s. However, using specialist angles hip surgeons often find X-rays a useful method of evaluating the shape, contour and angles of the hip joints in younger patients.

These specialist X-rays may provide information as to whether there are any developmental defects to the hip/s or whether there is any obvious bone related cause for hip impingement symptoms.

CT scans, which provide a very detailed 3D perspective on the bone anatomy, may be requested in certain cases to provide additional detail for planning certain forms of hip surgery.

MRI scans can also be used for this additional detail and are also requested in cases where a hip cartilage (labral) tear is suspected or where the hip pain is suspected to be caused by soft tissue outside of the joint itself.

Ultrasound technology has increased significantly in recent years and in the diagnosis of muscle and tendon pathology, such as that often found in greater trochanteric pain, will normally be used instead of MRI scans.

Which methods your consultant uses to diagnose the cause of your hip pain will depend on the specifics of your pain and other symptoms, as well as the information you give them about the history of your hip pain and any other medical conditions you have experienced.

Hip pain treatment options range from the conservative and non-invasive to the surgical. Typically, we will recommend conservative treatments first before recommending hip surgery. If these don't work well enough to improve your quality of life, then an operation on your hip might be the best choice for you.

In some instances, for example if your hip pain is caused by a fracture, surgery will be the first point of call.

Hip pain exercises

Exercise for hip pain can help tackle stiffness in your hip joint and strengthen the muscles around your hip. Many people recommend yoga for hip pain, as certain yoga poses can help strengthen and stretch muscles that are important in supporting aching joints.

As well as keeping your joint healthy, keeping active can assist with weight loss and maintain your overall health by reducing your risk of developing particular health conditions, such as type 2 diabetes and stroke.

To find specific exercises that can help to strengthen your hip, speak to a physiotherapist.

Physiotherapy for hip pain

When someone sees one of our chartered physiotherapists about how to ease hip pain, the first thing to determine is which biomechanical problems may have contributed to the hip pain.

These problems may be local to the hip region, for example poor strength or inflexibility of the hip joint itself. Problems such as excessive knee, ankle or foot rotation may also be contributing factors to your joint pain.

Once determined, physiotherapists are able to advise on a series of hip pain exercises designed to correct the movement pattern. Hip strengthening programs are often prescribed to gradually increase the load on muscles and tendons.

This has two advantages in that it may improve problematic biomechanics, but also loading soft tissue increases the likelihood of optimal muscle and tendon healing following injury. Common examples are rotational hip exercises known as side lying clam exercises and pelvic bridging exercises.

Stretching programs for muscles may also improve mechanical efficiency of movements as well as release tension in muscles, which can be a contributory factor in causing hip pain. Common muscle groups targeted in patients with hip pain include the calf muscles, hamstrings and hip flexor stretches for pain.

Certain manual techniques may also be employed by physiotherapists to improve hip pain. Depending on the cause of hip stiffness (such as tight hip flexors), physiotherapists are able to provide hip joint mobilisation techniques, sometimes referred to as mobilisations with movement.

These techniques may be done using a belt or strap to increase leverage. If the hip stiffness is thought to be due to muscular and soft tissue restriction around the hip, then physiotherapists can work on deep soft tissue release techniques to reduce any overactivity to these tissues.

Your physiotherapist will also be able to advise you on what hip pain exercises to avoid, and can give you stretches for lower back and hip pain too.

Medication for hip pain

Various types of medication can be used to treat hip problems. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) ease pain and inflammation in your hip joint, while analgesics such as opioids just target pain. These might be ingested, or they might be topical.

Some medications are available that can slow the progress of certain degenerative conditions, but you'll need to speak to your consultant about whether these are suitable for you personally.

Hip injections

Sometimes, standard pain relief may not be as effective as desired. In these situations, your consultant may advise an injection of a corticosteroid into the hip joint.

This steroid injection helps relieve pain and acts as an anti-inflammatory within the joint. Many people find it helps relieve their pain and stiffness, although the effects will wear off over time.

Repeat injections tend to become less effective. This type of injection can be helpful when you need a period of good pain relief but is not usually a long-term strategy.

Surgery for hip pain

If the damage to your hip joint is too extensive, or you don't respond to conservative treatment methods such as physiotherapy, you might need to have hip surgery.

The most common type of hip surgery is hip replacement surgery, which is a highly effective treatment for hip pain. Most people find it allows them to get back to living life to the full again. 

We answer your most commonly asked questions about hip pain.

How common is hip pain?

Chronic hip pain is thought to affect 12-15% of people over 60, with 1 in 9 people in the UK thought to have arthritis in their hip.

What causes hip pain that radiates down the leg?

Pain that radiates down your leg is often caused by sciatica, a condition commonly caused by a slipped disc in your spine. However, there are many other reasons you could be having hip pain that radiates down the leg, so you should always get it checked out by a doctor.

What can cause hip pain in a woman?

Most of the causes of hip pain in men and women are the same, however hip pain does become more prevalent in pregnancy.

Where is hip arthritis pain felt?

Hip arthritis pain can be felt in the hip itself but might also be felt in your groin, back, legs or knees. When you speak to a specialist, they will examine all these areas to deduce what is causing your pain.

Why is hip pain worse at night?

Many conditions can cause hip pain at night, and if your hip pan is worse at night it might be because you are lying on your hip, because you are lying in one position for a long time, or because your hip is tired after a long day.

If you only experience hip pain at night, it might be that you sleep in the wrong position.

How painful is a hip replacement?

Although you will feel some pain after a hip replacement operation, the pain you experienced before surgery should be gone immediately. The pain you feel when you wake up is called postoperative pain. It should not be too severe, and your care team will give you painkillers if you need them. Within a few weeks you'll find that the pain recedes significantly, and it should go completely within 6 weeks.

When you choose to go private with Circle, you can expect:

• Flexible appointment times to suit your schedule
• The choice of which consultant and hospital are best for you
• Bespoke treatment plans, built around you
• Consultant-led treatment from start to finish
• Private ensuite rooms as standard with delicious, healthy meals to suit all dietary needs
• Affordable, fixed-price packages with aftercare included
• Flexible payment options so you can spread the cost of your care

If you want to learn more about treatment for your hip pain, book an appointment with one of our consultants below, or give us a call directly to speak to one of our advisors.

Content reviewed by Circle in-house team in February 2023. Next review due February 2026.

1. Hip pain in adults, NHS
2. Hip pain, Mayo Clinic
3. Hip bursitis, OrthoInfo
4. When hip pain may mean arthritis, Arthritis Foundation
5. Hip pain, Versus Arthritis
6. Osteoarthritis of the hip, OrthoInfo
7. Pelvic pain in pregnancy, NHS
8. Hip replacement recovery, NHS