Causes and Treatment for Outer, Side, and Inner Hip Pain

Hip pain is a common symptom that can be described as aching, sharp, or burning. It can range in intensity from mild to severe.

There are many possible causes of hip pain. They include serious ones, like a fracture or joint infection, and less serious causes, like bursitis. Your healthcare provider can diagnose the cause and help to plan your treatment.

This article presents information about the potential causes of hip pain. It will help you to learn more about these conditions and the measures used to achieve the best outcomes possible.

Note: Hip pain in children is assessed differently than in adults. This article focuses on hip pain in adults.

Overview of Hip Pain

The hip is a large "ball-and-socket" joint. The "socket" is a bone in your pelvis called the acetabulum and the "ball" is the head of your femur. It is the upper part of the long bone in your leg.

The hip joint is held in place by ligaments and covered in cartilage, a smooth, white tissue that allows the hip to move with ease. Fluid-filled sacs called bursae provide cushioning to prevent friction between muscles, tendons, and bones in the hip joint.

The hip also contains a network of muscles that enable movement and support. These include:

• Gluteals: Buttocks muscles on the back of the hip
• Adductors: Inner thigh muscles that pull the leg inward
• Iliopsoas: Runs from the lower back to the upper femur
• Quadriceps: Front thigh muscles that run from the hip to the knee
• Hamstrings: Muscles on the back of the thighs that run from the hip to below the knee

Problems with any of these structures can contribute to hip pain.

Hip Pain Patterns

There are common patterns of hip pain. The location of your hip pain—anterior, lateral, or posterior—and how the pain feels can help your healthcare provider pinpoint the problem.

• When the problem is within the hip joint, the pain tends to be on the inside of the hip (anterior hip pain).
• When the pain is on the side of the hip (lateral hip pain), or on the outside of the hip closer to your buttocks (posterior hip pain), the problem tends to be with muscles, ligaments, tendons, and/or nerves that surround the hip joint.

Hip pain while walking can be caused by conditions that affect the muscles, tendons, or the hip bone's blood supply. For example, snapping hip syndrome can be caused by tendons getting caught on a prominent area of bone in the hip area.

When to See a Healthcare Provider

Seek immediate medical care for hip pain that is:

• Caused by an accident, serious fall, or other injury
• Deformed, badly bruised, or bleeding
• Sudden, severe, or worsening
• Unable to move your hip or bear any weight on your leg

Moderate hip pain should be evaluated by a healthcare provider if accompanied by:

• Bruising or bleeding
• Fever
• Lasts longer than a week
• Leg or foot weakness
  
• Swelling
• Trouble bearing weight or walking
  
• Warmth over the hip

Mild hip pain that lasts longer than six weeks should also be evaluated.

Causes of Inner Hip Pain

Anterior hip pain affects the inside of your hip and groin area.

Common causes may include:

• Inflammation
• Infection
• Bone fracture

Osteoarthritis

Osteoarthritis of the hip occurs when the cartilage in the hip joint slowly wears away over time. The cartilage can break down due to advancing age or because of a prior hip injury. This can cause bones of the joint to begin to rub on each other.

With hip osteoarthritis, pain may be dull, aching, or sharp, and the pain and stiffness can get worse with activity and improve with rest.

The main symptom of hip arthritis is mild to severe pain in or around the hip. It can be described as aching, sharp, burning, throbbing, or dull.

Other symptoms include:

• Limited range of motion
• Hip area stiffness
• Pain that spreads to the groin area, buttocks, lower back, thigh, or knee
• Walking with a limp

Inflammatory Arthritis

Inflammatory arthritis may affect the hip, resulting in dull, aching pain.

These conditions include:

• Rheumatoid arthritis (a chronic autoimmune disorder affecting joints)
• Ankylosing spondylitis (a chronic inflammatory condition of the spine and joints)
• Systemic lupus erythematosus (an autoimmune disorder affecting the whole body)
  

This type of hip pain often will ease with activity.

Fracture

A hip fracture, which is a break in the upper quarter of the thigh bone, causes deep pain. You feel it in the outer part of the upper thigh or groin area. These breaks can happen after a fall or a direct blow to the hip.

Stress fractures of the hip can develop due to recurrent physical pressure, and are most common in female athletes who have the "female athlete triad."

This triad includes three health conditions:

• Eating disorders
• Menstrual irregularities
• Bone weakening
  

Steroid drug use, a history of smoking, and other medical conditions that can weaken the bone, like cancer or osteoporosis, are also risk factors for hip stress fractures.

Iliopsoas Bursitis

Bursitis is an irritation or inflammation of the bursa. These are small, fluid-filled sacs that serve as a cushion between joints, muscles, and tendons. The iliopsoas bursa, located on the inner or groin side of your hip, causes anterior hip pain if inflamed.

Iliopsoas bursitis is most common in runners or soccer players. It causes anterior hip pain that may spread to the front of the thigh or into the buttock. Sometimes, you may feel a snapping, catching, or popping in the hip with this type of bursitis.

Hip Flexor Strain

A hip strain refers to a stretch or tear of a muscle, its nearby tendon, or both. Hip flexor muscles, such as the iliopsoas muscle or rectus femoris muscle, are often involved in a hip strain.

A hip flexor strain can be caused by overuse, as is the case with cyclists or soccer players. It also may result from trauma, such as a direct hit during a contact sport. In addition to anterior hip pain, these strains can cause swelling, limited movement, and muscle weakness.

Osteonecrosis of the Hip

Osteonecrosis of the hip is the death of bone cells, and it can cause destruction of the hip joint. It may occur due to insufficient blood supply to the hip bone. Many cases are due to corticosteroid drug use and excessive alcohol use.

Though rare, it can cause hip pain and groin pain that gets worse with walking, pain in the thighs, buttocks, and/or knees.

Hip Labrum Tear

Your hip labrum is a band of cartilage-like tissue that runs around the outer rim of your hip socket. It helps to support the joint and deepen the socket. Overuse or an injury to your hip can cause a tear in your labrum, with pain that gets worse with weight-bearing.

Femoroacetabular Impingement (FAI)

In femoroacetabular impingement (FAI), bony growths develop around the hip joint. These growths can limit hip motion and eventually cause hip osteoarthritis and tears of the labrum.

The symptoms include an aching or sharp pain in the groin area that moves toward the outside of the hip. Often, you can feel the pain when you stand up after sitting for a long time. Stiffness and limping are also common.

Infected Hip Joint

It's uncommon, but sometimes the hip joint can be infected. This is called a septic joint.

Symptoms include:

• Severe anterior hip and/or groin pain
• Swelling
• Warmth
• Limited hip motion
• Fever (people who have a weak immune system might not have a fever)

Bone Cancer

Rarely, bone cancer that begins in the bone (primary cancer) or has spread from somewhere else in the body (metastatic) can cause bone pain.

Usually, the pain starts off being worse at night, and as the tumor grows, the pain often becomes constant. It can cause swelling around the hip, along with weight loss and fatigue. A hip fracture may occur because the bones are weakened.

Causes of Side Hip Pain

Lateral hip pain refers to pain on the side of the hip.

Trochanteric Bursitis

Trochanteric bursitis causes sharp lateral hip pain that often spreads down into the thigh and knee. The pain is usually worse at night when sleeping on the affected hip. It also gets worse with activity, like walking or running.

Over time, the pain may evolve into a deep aching pain that spreads over a larger area of the hip. You may notice swelling or you might start to limp with the affected leg.

Snapping Hip Syndrome

Snapping hip syndrome causes a snapping or popping sensation, possibly with lateral hip pain when walking or getting up from a chair. The actual "snapping" is due to one or more tight muscles, tendons, or other soft tissue moving over a bony structure within your hip.

One commonly affected "tight" or irritated tissue is the iliotibial band (IT band). This thick collection of connective tissue starts at the hip and runs along the outer thigh. The snapping sound comes from where the IT band passes over the upper part of the thigh bone.

This condition is most common in people who engage in sports or activities that involve frequently bending at the hip. For this reason, it also is known as "dancer's hip."

Causes of Outside Hip Pain

Posterior hip pain affects the outside of the hip or buttock area, usually due to a problem with the muscles, tendons, or ligaments that surround the hip joint, rather than the actual joint itself.

Hamstring Muscle Strain

Muscle strains are small tears that are usually caused by a quick twist or pull to the muscle. When this affects the hamstring muscles around the hip joint, it causes buttock pain and/or pain in the back of the hip.

Sacroiliac Joint Problem

The sacroiliac (SI) joints on each side of the body connect the lower spine to the pelvis.

Various problems with the SI joint, including arthritis of the joint, infection of the joint, and injury to the joint ligaments, may cause posterior hip pain that may spread out from the hip and down the back of the leg. The sharp or burning pain is often worse with standing and walking.

Piriformis Syndrome

Piriformis syndrome, also called deep gluteal syndrome, occurs when the sciatic nerve (a large nerve that branches off from your lower back into your hip, buttock, and leg) becomes irritated or compressed by the piriformis muscle. This muscle is deep within the buttock, near the top of the hip joint.

The burning or aching pain of this syndrome usually begins in the posterior hip and buttock region and moves down the back of the thigh.

Diagnosis

A medical history and physical exam by a healthcare provider are essential for a proper diagnosis. Your healthcare provider will likely order imaging tests or blood tests.

Medical History

A healthcare provider will ask you questions about your pain.

Questions may include:

• Is your hip pain better with rest or exercise?
• Do you have any other symptoms, like fever, swelling, or joint pain?
• Do you or any family members have arthritis or a history of joint problems?
• Have you experienced any recent trauma to your hip?

Physical Exam

Your healthcare provider will view and press on a few "landmark" sites within your hip, leg, lower back, and abdomen. They may also perform a neurological exam to assess muscle weakness and reflexes.

It's likely they will move your hip around to evaluate its range of motion, look at the way you walk (your gait), and check your overall posture and ability to bear weight.

They may also perform more specific tests, such as the FABER test, straight leg test, leg roll test, or Trendelenburg test.

FABER Test

The FABER test (its name stands for flexion, abduction, and external rotation) is used to diagnose some hip problems, such as hip osteoarthritis or hip labrum tear.

You'll be lying flat on your back for this test while the provider flexes your leg and then puts your ankle from the same side as the affected hip just above the kneecap on the opposite leg. They'll press down on the knee from the affected side in order to lower the leg.

The test is positive if pain occurs at the hip joint, or if the knee and leg from the affected side cannot be lowered into a parallel position with the opposite leg.

Imaging

Imaging tests may be needed to confirm or support a diagnosis for your hip pain.

• An X-ray is the standard test in diagnosing a hip fracture and it can also show bony growths or other changes associated with hip osteoarthritis.
• Magnetic resonance imaging (MRI) may be used to evaluate a hip fracture, as well as other conditions, like hip osteonecrosis or an infected hip joint.
• Magnetic resonance arthrography is the preferred test when a hip labral tear is suspected.
• Ultrasound may be used to confirm a diagnosis of bursitis.

Blood or Other Tests

Blood tests may be ordered in some specific circumstances. For instance, your healthcare provider will likely order a white blood cell count, blood cultures, and a test for inflammatory markers in the blood if an infected joint is suspected.

A hip aspiration, which uses a needle to remove synovial fluid from the hip joint, is usually taken to both diagnose and treat septic arthritis.

Differential Diagnoses

Some conditions that don't involve the hip can cause hip pain and may be considered during an evaluation of hip pain.

Kidney Stone

A kidney stone can cause severe pain in the flank area between the top of your hip and the bottom of your ribcage in your back. The pain may spread out to your groin or inner thigh.

Meralgia Paresthetica

Meralgia paresthetica refers to compression of the lateral femoral cutaneous nerve, a sensory nerve that passes under the inguinal ligament in the groin area. Besides a burning pain in the upper-outer thigh, it can cause numbness and tingling.

This condition is most common in older adults and people who have diabetes. Obesity, pregnancy, and wearing tight pants or belts will also increase the risk of developing this condition.

Aortoiliac Occlusive Disease

Aortoiliac occlusive disease refers to a blockage of the aorta, the main blood vessel in your body, and the iliac arteries, which branch off from the aorta near your belly button. A blockage causes aching, cramping pain in the buttock, hip, and/or thigh.

This pain gets worse with exercise and will ease with rest. The condition is most often caused by atherosclerosis when plaque builds up in the blood vessel walls, causing them to narrow so much that blood flow to the legs and groin is impaired.

Lumbar Radiculopathy

An irritated nerve in the lower spine can cause pain that feels like burning or tingling in or around the hip joint. This condition, called lumbar radiculopathy, can be diagnosed with an MRI of the lower spine.

Treatment

The treatment of hip pain depends on the diagnosis. Common elements of a treatment plan include self-care, medication, physical therapy, and surgery.

Self-Care Strategies

Your healthcare provider may recommend a number of self-care strategies.

A few examples of these strategies include:

• Limiting or avoiding activities that make your hip pain worse, like climbing stairs
• Using an aid, like a cane or walker, to improve independence and mobility
• The R.I.C.E. protocol: If you experience hip pain while performing a sport or other activity, follow the steps of rest, ice, compression, and elevation until you can get in to see your healthcare provider.

Medications

Medications, such as Tylenol (acetaminophen) or an over-the-counter nonsteroidal anti-inflammatory (NSAID), are used to ease hip pain related to osteoarthritis and femoroacetabular impingement.

Opioids, which are stronger drugs for pain, may be needed to treat pain from a hip fracture or an infected hip joint.

Other drugs may be needed, depending on your diagnosis. A disease-modifying anti-rheumatic drug (DMARD) can be used to treat rheumatoid arthritis. Intravenous (IV) antibiotics can be used to treat an infected joint.

Physical Therapy

Physical therapy is a cornerstone of the treatment for many causes of hip pain. It is meant to improve strength, flexibility, and mobility in your hip.

A physical therapist may use massage, ultrasound, heat, and ice to soothe inflammation. They may also offer guidance on returning to sports or other activities.

Surgery

Surgery may be required for the treatment of a hip fracture. Sometimes worsening osteoarthritis may be treated with a total hip replacement. A hip arthroscopy may be used to repair a torn hip labrum.

Prevention

You may not be able to prevent all causes of hip pain, but there are several things you can do to be proactive about it:

• Lose weight if you are overweight.
• Eat a healthy diet that contains enough vitamin D and calcium for bone health.
• Choose low-impact activities like swimming or biking.
• Stretch before and after exercise.
• Get a special shoe insert if you have leg-length differences.
• Wear the right running shoes and avoid hard surfaces like asphalt.
• Talk with your healthcare provider about daily strength exercise routines.
• Consider yoga or tai chi to improve balance and help prevent falls.

Summary

Hip pain is usually described by a location: anterior (front), lateral (side), or posterior (back). The site may help point to the cause.

Common causes include muscle strain or osteoarthritis, and less common reasons may specifically affect athletes or dancers, such as the snapping hip syndrome. Your healthcare provider will need to diagnose the condition to ensure the right treatment.

See a healthcare provider promptly if your hip pain is severe, comes on suddenly, or is associated with other symptoms, like a fever or swelling.