Specializing in Pain Management and Sports Medicine

Causes of Hip Pain

Hip pain is actually a common complaint among individuals 60 years or older. In a survey of over 6500 adults who were 60 years and older, 14.3% of them reported significant hip pain on the majority of days over the prior six weeks. That is a lot of people with painful hips.

The most common causes of hip pain include bursitis, tendinitis, cartilage tears (labral tears), osteoarthritis and femoral fractures. The location and character of the pain, i.e. sharp, dull, burning etc, activities and positions that aggravate and alleviate the pain and whether it is painful with walking can be used to differentiate the various causes of hip pain. Many times pain felt in the hip is referred from a pinched nerve in the lower back.

The hip joint is a ball-and socket joint comprised of the femoral head (ball) and the acetabulum (socket) which is part of the pelvis. The joint is relatively fixed to the body by the pelvis which results in a relative immobility and therefore, a primary hip issue can cause pain in the lower back or knee. Furthermore, a primary abnormality in the lower back or knee can cause problems with the hip. In some instances more than one issue is going on such as knee and hip osteoarthritis or a bursitis and sciatica.

An uncommon occurrence is a condition known as osteonecrosis or avascular necrosis of the femoral head (ball). A fracture of the femoral neck which sits just below the ball, can disrupt the blood supply to the ball and with this the bone starts to die. This is usually a very painful condition and one that can lead to a hip replacement.

The dictionary defines a bursa as a fluid-filled sac or saclike cavity, especially one countering friction at a joint.


There are about 18 bursae in the hip region. Of these 18 bursae two cause the most problems. The first and by far the most commonly painful bursa is the one over the pointy bone on the outside of the hip know as the greater trochanter. There are actually 2 bursae in this area a deep trochanteric bursa and a more superficial one that is directly over the bony prominence. The other one is in the front of the hip and it reduces the friction of the iliopsoas tendon (the Iliopsoas muscles flexes the hip) as it passes over the front of the hip joint.

Pain is the most common complaint in patients with hip problems. A thorough evaluation including a careful history and physical examination can often times determine the cause. The location of the pain as well as the activities and positions that aggravate and alleviate the pain give the physician clues as the possible causes of hip pain. For example, pain that worsens with or after walking and improves with rest is the hallmark of hip joint problems like arthritis.


X-ray images of a normal hip joint on the left showing space between the femoral head (ball) and socket (acetabulum). On the right the space between the ball and socket have disappeared and the ball and socket are in contact with each other instead of gliding over smooth cartilage.

Pain on the outside of the hip that is aggravated by pressure over the bone is usually related to bursitis or tendinitis. Difficulty sleeping on the painful side is often described as is pain when getting out of bed, a chair or car.

Pain located in the posterior aspect of the hip or the buttock is the least common pain pattern associated with hip issues but is probably the most common when there is a problem in the lower back or sacroiliac joint. Sciatica can sometimes present with only pain in this area and without pain radiating further down into the thigh or leg.


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