Overview: What Are the Most Common Causes of Hip Pain?
The hip is our second-largest joint after the knee and faces enormous daily stress. Surprisingly, in about half of all cases, the source of pain isn't in the joint itself, but in the surrounding muscles, tendons, and ligaments.
The Most Common Causes at a Glance:
Hip Arthritis (Coxarthrosis) – Age-related cartilage wear is by far the most common cause of hip pain. About 1-3% of women and 2.5-8.5% of men between 45 and 75 years are affected. The cartilage between the femoral head and socket wears away, causing bone-on-bone friction.
Tendon Irritation and Muscular Problems – Long labeled as "bursitis," we now know that in 90% of cases of lateral hip pain, the tendons of the gluteal muscles (gluteus medius/minimus) are irritated or overloaded. This gluteal tendon tendinopathy often develops from one-sided strain or lack of movement.
Hip Impingement (FAI) – A structural abnormality where the femoral head and socket don't fit together optimally. Bone spurs cause "pinching" during certain movements, which can damage cartilage over time.
Referred Pain – Problems in the lumbar spine, such as a herniated disc, can project pain into the hip region. Piriformis syndrome (a tight buttock muscle pressing on the sciatic nerve) also causes hip discomfort.
Additional Possible Causes:
Avascular necrosis (blood supply disruption to the femoral head)
Rheumatic diseases
Hip dysplasia (congenital malformation)
Injuries (bruises, strains, fractures)
Infections (rare but dangerous)
Did You Know? 2% of all newborns have a hip maturation disorder. Thanks to ultrasound examination during routine checkups, this is detected early and can heal completely.
Symptoms: Where Does It Hurt Exactly? – What Pain Location Reveals About the Cause
The exact location of your pain provides important clues about the cause. Doctors use this information as a first guide to the correct diagnosis.
Pain in the Groin or Front of the Hip
This usually indicates a problem in the hip joint itself – typical of arthritis or hip impingement. The pain can radiate to the knee, which confuses many people ("My knee hurts, but the cause is in my hip").
Pain on the Outside of the Hip
This is where the greater trochanter is located, where important tendons attach. Pain in this area usually comes from:
Overload of the gluteal tendons
Irritation of the bursa (trochanteric bursitis)
Tension in the lateral hip muscles
Pain in the Buttock with Radiation to the Leg
This symptom pattern suggests involvement of the sciatic nerve:
Piriformis syndrome (tight muscle pressing on nerve)
Lumbar spine disc problems
Rarely: true sciatica
Diffuse Pain Throughout the Hip Area
May indicate systemic diseases:
Rheumatoid arthritis
Fibromyalgia
Metabolic disorders
Symptoms and Possible Causes Table
Symptom/Pain Character | Possible Cause(s) |
Groin pain, worse with walking | Hip arthritis, hip impingement |
Lateral hip pain, tender to pressure | Tendon irritation, bursitis |
Morning stiffness, improves with movement | Early-stage arthritis |
Nighttime pain when lying on side | Bursitis, activated arthritis |
Radiating pain to buttock/leg | Piriformis syndrome, disc herniation |
Sudden, sharp pain after exertion | Muscle injury, tendon tear |
Why Does Hip Pain Often Occur at Night or at Rest?
Nighttime hip pain is particularly troublesome and robs you of sleep. It has specific causes that differ from activity-related pain.
Typical Causes of Night and Rest Pain:
Inflammatory Processes – With activated arthritis or rheumatic diseases, inflammatory fluid accumulates in the joint at night. Pressure increases, pain intensifies.
Bursitis – The bursa at the trochanter gets compressed when lying on your side. With inflammation, this leads to stabbing pain that wakes you from sleep.
Advanced Avascular Necrosis – Blood supply disruption to the femoral head typically causes nighttime groin pain, often accompanied by a dull, boring sensation.
Poor Sleep Position – A mattress that's too firm or lack of support can cause pressure pain even in healthy hips. This effect is amplified with pre-existing problems.
What You Can Do Immediately:
Change sleep positions (back sleeping often provides relief)
Place a pillow between your knees (when side sleeping)
Use a softer mattress topper
For acute inflammation: Ice the area before bedtime
Important: Nighttime rest pain lasting weeks should always be evaluated by a doctor!
Hip Pain After Sitting or Extended Breaks – What Does This Mean?
The typical "start-up pain" – you stand up after sitting for a while and the first steps hurt, then it gets better. Many people know this phenomenon and it has clear medical reasons.
Why Do Start-Up Pains Occur?
During movement breaks, the joint produces less synovial fluid. This "lubricant" is essential for smooth movement. After rest periods, a lubricating film must first reform – the initial movements are therefore painful.
Typical Causes of Start-Up Pain:
Beginning Hip Arthritis – The cartilage is already damaged but not completely worn away. The joint fluid doesn't distribute well on rough surfaces after rest.
Muscular Shortening – Long sitting leads to shortened hip flexors. When standing up, these must suddenly be stretched, causing pain.
Hip Impingement – The narrow spot between femoral head and socket becomes particularly noticeable after flexed positions (sitting).
What Helps Against Start-Up Pain?
Stand up slowly and move carefully at first
Do small movement exercises regularly while sitting
Stretch your hip flexors daily (see exercise section)
Use ergonomic seating with frequent position changes
Causes: What Role Do Muscles and Fascia Play in Hip Pain?
Modern research shows: Many hip pains don't arise from joint damage, but from problems in the muscular-fascial system. This good news means: with targeted exercises, you can often achieve significant improvements.
Common Muscular Causes:
Shortened Hip Flexors – From lots of sitting, the iliopsoas muscle shortens. This pulls on the pelvis and changes the entire posture, leading to pain in the hip and lower back.
Weak Gluteal Muscles – The gluteus medius stabilizes the pelvis while walking. If it's too weak, other structures compensate – overload and pain follow.
Tight Fascia – The connective tissue around muscles can stick together and harden. The fascia lata on the outside of the thigh is often affected.
Muscular Imbalances – One-sided loads lead to imbalances. Example: Strong front thigh with weak back side destabilizes the hip joint.
Piriformis syndrome deserves special mention: This small muscle in the buttock can pinch the sciatic nerve when tight. Result: Pain from buttock to leg, often incorrectly called "sciatica."
The Good News: Muscular-fascial problems respond excellently to targeted therapy:
Stretching exercises resolve shortening
Strengthening exercises correct weaknesses
Fascial training improves elasticity
Regular movement prevents adhesions
Special Case: Hip Pain During Pregnancy – What Are the Causes and What Helps?
About 50% of all pregnant women suffer from hip and pelvic pain. The causes are varied and usually harmless, but can significantly affect daily life.
Why Does Hip Pain Occur During Pregnancy?
Hormonal Changes – The hormone relaxin loosens ligaments and connective tissue to prepare for birth. This leads to more mobility but also instability in the pelvic area.
Weight Gain and Center of Gravity Shift – The growing belly shifts the body's center of gravity forward. The lumbar spine compensates with increased lordosis, stressing the hip and back.
Symphysis Loosening – The pubic symphysis widens. In some women, this leads to pain in the front pelvic area with radiation to the hips.
Nerve Pressure – The additional weight can compress the sciatic nerve or lateral femoral cutaneous nerve (meralgia paresthetica).
What Helps with Pregnancy Hip Pain?
Prenatal yoga – Special exercises gently strengthen the pelvic muscles
Pelvic belt – Stabilizes the pelvis and relieves joints
Side sleeping with pregnancy pillow – Relieves hip pressure while sleeping
Warm baths – Relax muscles (not too hot!)
Physical therapy – Specialized therapists know pregnancy-appropriate exercises
Swimming/aqua fitness – Relieves joints through buoyancy
Important: Severe, sudden pain or pain with bleeding is always an emergency! Contact your doctor or midwife immediately.
Can the Wrong Mattress Trigger Hip Pain?
The short answer: Yes, definitely! Especially when there's already mild irritation or pre-existing damage, an unsuitable mattress can significantly worsen symptoms.
How Your Mattress Influences Hip Pain:
With Too-Hard Support:
Pressure points at hip and shoulder for side sleepers
Bursa at trochanter gets compressed
Blood circulation is impeded
Muscles can't relax
With Too-Soft Support:
Hip sinks too deep
Spine curves unnaturally
Muscles must stabilize at night instead of resting
The Ideal Mattress for Hip Problems:
Point-elastic – gives way at hip and shoulder, supports the waist
Medium firmness – not too hard, not too soft
Zone division – different firmness levels for different body regions
Good ventilation – prevents heat buildup and promotes relaxation
Practical Tips:
A high-quality topper (5-8 cm) can soften a too-hard mattress
Side sleepers benefit from a pillow between the knees
Try different sleep positions
Mattresses should be replaced every 8-10 years
Attention: A new mattress isn't a miracle cure! With persistent symptoms, medical evaluation is important.
Red Flags: When Should I See a Doctor for Hip Pain?
Most hip pain is harmless and improves with conservative treatment. However, there are clear warning signs where you should seek medical help immediately.
Warning Signs for Hip Pain – See a Doctor Immediately!
Emergency - Go to ER immediately for:
Severe pain after fall or accident (suspected fracture)
Hip is hot, swollen and you have fever (joint infection!)
Sudden inability to move the leg
Numbness or paralysis in the leg
See doctor promptly (within a few days) for:
Nighttime rest pain over several weeks
Pain with unexplained weight loss
Morning stiffness over 30 minutes
Pain that worsens despite rest
Movement restriction that impairs daily life
See family doctor or orthopedist for:
Chronic pain over 6 weeks
Recurring symptoms after activity
Uncertainty about the cause
When self-treatment doesn't help
Which Doctor Is Right?
Family doctor – First point of contact, referral if needed
Orthopedist – Joint problem specialist
Rheumatologist – For suspected inflammatory diseases
Sports medicine doctor – For sports-related overuse
Treatment: What Can I Do Myself for Hip Pain?
Many hip problems can be successfully self-treated. The key is finding the right balance between rest and movement.
Immediate Measures for Acute Pain:
1. The RICE Protocol (for injuries):
Rest – Stop activity immediately
Ice – Cool for 15-20 minutes (wrapped in cloth)
Compression – Light compression with elastic bandage
Elevation – Relieves and reduces swelling
2. Heat or Cold?
Cold for: Acute inflammation, swelling, stabbing pain
Heat for: Muscle tension, chronic pain, stiffness
3. Pain Medication – Short-term and Targeted:
Ibuprofen (400-600mg) – anti-inflammatory
Diclofenac – as tablet or gel
Acetaminophen – for NSAID intolerance Important: Maximum 7-10 days without medical consultation!
4. Movement – The Foundation:
With acute pain: Gentle movement within pain-free range
No complete immobilization (except after injury)
Prefer joint-friendly activities
5. Daily Life Relief:
Walking aids for severe pain
Ergonomic workplace adjustments
Weight reduction (every pound counts!)
Appropriate footwear with cushioning
Home Remedies That Really Help:
Cottage cheese wraps – Cools and reduces swelling
Arnica ointment – For bruises and swelling
Ginger tea – Natural anti-inflammatory
Epsom salt bath – Relaxes muscles
Which Exercises and Sports Help with Hip Pain?
Movement is the best medicine for your hips! The right activity can relieve pain, improve mobility, and prevent further wear. Important: You don't have to do everything alone – professional support can make the crucial difference.
Best Sports for Hip Problems:
Strength Training – Properly Dosed
Targeted muscle building stabilizes the hip joint
Improves force distribution and relieves cartilage
Especially important: Training gluteal and core muscles
Recommendation: Machine training instead of free weights if unsure
Focus on controlled movements with moderate weight
Swimming and Aqua Fitness
Joints relieved by buoyancy
Smooth movements without impact loading
Strengthens entire musculature
Especially recommended: Backstroke and aqua jogging
Yoga and Pilates
Improves mobility and balance
Strengthens deep muscles
Reduces stress and tension
Choose gentle variations (Yin yoga, therapeutic Pilates)
Sports You Should Avoid:
Jogging on hard surfaces (especially with advanced arthritis)
Stop-and-go sports (tennis, squash, soccer)
Sports with strong rotational stress (golf during acute symptoms)
High-impact aerobics
Extreme strength training with very heavy weights
Professional Support – Your Key to Success
Why professional guidance is so important: Many people are unsure which movements are good for them and which could cause harm. This is completely normal! Wrong training can worsen symptoms, while properly guided exercises can work wonders.
Personal Training for Hip Problems
Individually adapted training program
Correct movement execution under supervision
Motivation and regular progress monitoring
Adjustment for pain or problems Tip: Look for a trainer with additional health sports qualifications
Physical Therapy – The Medical Perspective
Precise analysis of your movement patterns
Identification of muscular imbalances
Manual therapy for pain relief
Creation of home exercise program
Close collaboration with your doctor
Rehabilitation Sports and Functional Training
Group courses subsidized by health insurance
Specifically for people with joint problems
Guidance by trained exercise leaders
Motivation through group community
Usually 50 sessions over 18 months possible
The Right Start to Training
For acute pain:
First medical evaluation
Start with physical therapy
Slow transition to active training
Accompaniment by professionals
For chronic symptoms:
Consultation with physiotherapist or qualified trainer
Functional analysis and mobility tests
Individual training plan
Regular adjustment based on progress
The Most Important Training Principles:
Quality over quantity – Better less, but correct
Progression – Slow increase in load
Recovery – Rest is part of training
Holistic approach – Don't just train the hip
Pain-free – Training should challenge, not hurt
Prevention: How Can I Prevent Hip Pain?
Prevention is better than cure – this old saying especially applies to hip health. With simple measures, you can significantly reduce the risk of hip problems.
Checklist: Keeping Your Hips Healthy Long-term
Movement as Foundation:
At least 30 minutes moderate movement daily
Variety: Train strength, endurance, and mobility
Prefer joint-friendly sports
"Sitting is the new smoking" – stand up hourly!
Weight Control:
Every pound less relieves hips by 3-4 times
Balanced nutrition
Drink enough for joint lubrication
Everyday Ergonomics:
Set up workplace correctly (chair, desk, monitor)
Change position every 30 minutes
When lifting: Squat down, keep back straight
Carry heavy loads close to body
The Right Shoes:
No high heels as permanent solution
For misalignments: Orthopedic insoles
Barefoot walking on soft surfaces trains foot muscles
Consider minimalist shoes
Minimize Risk Factors:
Avoid one-sided stresses
Reduce stress (increases muscle tension)
Get enough sleep for recovery
Special Prevention Exercises:
Daily 5-10 minutes hip mobilization
Regular hip flexor stretching
Core training for stable center
Balance exercises for better coordination
Does Hip Arthritis Always Require Surgery?
The diagnosis "hip arthritis" triggers fear in many people: "Do I need an artificial joint now?" The reassuring answer: In most cases, no!
Facts About Hip Surgery:
A hip prosthesis (total hip replacement) is always the last option when conservative measures are exhausted. Modern studies show: With the right therapy, many patients can avoid surgery or at least postpone it for years.
When Is Surgery Really Necessary?
Severe pain despite intensive conservative therapy
Significant movement restriction in daily life
Markedly reduced quality of life
X-ray shows advanced cartilage loss
Patient is psychologically and physically ready for surgery and rehab
What Should Definitely Be Tried First:
1. Multimodal Pain Therapy Combination of medications, physical therapy, and psychological support
2. Targeted Physical Therapy
Muscle building around the joint
Mobility improvement
Gait training for relief
3. Weight Reduction Every pound less means 3-4 pounds less stress on the hip
4. Injection Therapy
Hyaluronic acid to improve joint lubrication
Cortisone for acute inflammation
5. Alternative Methods
Acupuncture (often covered by insurance)
Nutritional changes and weight reduction
Supplements (glucosamine, chondroitin)
Modern Hip Surgery – When It's Really Needed:
Minimally invasive techniques reduce trauma
Modern prostheses last 15-25 years
Quick mobilization (often same day as surgery)
Remember: Never rush the decision for surgery! A second opinion is always wise. Many orthopedists tend to operate too quickly – conservative specialists often see alternatives.
Optimizing Collaboration with Therapists
Preparing for Your Doctor Visit
Checklist for the Medical Consultation: □ Pain diary from the last 2 weeks □ List of all medications □ Previous test results/images □ Concrete questions noted □ Companion if uncertain
Important Information:
When exactly does pain occur?
What improves/worsens it?
What treatments have been tried?
Family history (arthritis, rheumatism?)
Finding the Right Physical Therapy
Quality Markers:
Specialization in hip/orthopedics
Time for assessment (min. 30 minutes)
Large training room with modern equipment
Holistic approach
Red Flags with Therapists:
Only passive treatment and massage
No exercise instruction
Promises of quick healing
Pressure for many appointments
No progress monitoring
Conclusion: Your Path to Pain-Free Hips
Hip pain isn't a fate you must accept. With the right knowledge about causes, targeted exercises, and adapted lifestyle, you can achieve a lot. The most important points:
Movement is medicine – but the right kind!
Early treatment prevents worsening
Muscular causes are often curable
Take red flags seriously and get them checked
Surgery only as last option after exhausting all alternatives
Remember: Every person is unique, and what helps others doesn't necessarily have to work for you. Listen to your body and work together with your doctor or therapist on the best solution for you.
Frequently Asked Questions About Hip Pain
Can stress cause hip pain?
Yes, indirectly. Stress leads to increased muscle tension, especially in the back and hip area. Chronic stress can also promote inflammatory processes in the body and intensify pain perception. Relaxation techniques like progressive muscle relaxation or meditation can help.
Are hip pains normal in young people?
Hip pain under age 40 is not "normal" and should be evaluated. Common causes in younger people include hip impingement, sports overuse, muscular imbalances, or rarely rheumatic diseases. Early treatment can prevent late complications.
Can hip pain come from the intestines?
Actually, yes. The hip flexor (psoas muscle) lies directly next to the intestines. Chronic intestinal inflammation, adhesions after surgery, or irritable bowel syndrome can lead to tension in this area and thus hip pain.
What role does nutrition play in hip pain?
An anti-inflammatory diet can positively influence hip pain. Recommended:
Omega-3 rich foods (salmon, walnuts, flaxseed oil)
Antioxidants (colorful vegetables, berries)
Spices like turmeric and ginger
Less red meat and sugar
Does heat or cold help better?
That depends on the cause:
Heat for: Muscle tension, chronic pain, arthritis (except during acute flare)
Cold for: Acute inflammation, swelling, fresh injuries, activated arthritis
This article is for informational purposes only and does not replace professional medical advice. Always consult with healthcare providers for proper diagnosis and treatment of hip pain.
