Hip Pain: Non-Arthritic Causes
Overview
Not all pain around the hip is arthritis. Symptoms can arise from the gluteal tendons, bursae, hip joint, muscles, lower back or nerves. Pain location is helpful, but it does not prove the diagnosis. A careful history and examination usually guide the first steps; scans are used when they are likely to change management. Treatment depends on the underlying cause rather than the label on a scan report.
Common patterns of hip pain
- Lateral hip pain: commonly related to gluteal tendinopathy, with or without irritation of the trochanteric bursa. This is often called greater trochanteric pain syndrome.
- Groin or front-of-hip pain: may arise from the hip joint, hip flexor tendons, the labrum (the rim of cartilage around the socket), impingement, stress injury or referred pain.
- Buttock or posterior pain: may come from the lower back, sacroiliac region, hamstring origin, deep gluteal structures or nerves.
- Pain after a fall or sudden load: may represent fracture, tendon injury, muscle injury or joint damage and warrants assessment according to severity.
Greater trochanteric pain syndrome
Greater trochanteric pain syndrome describes pain over the outer side of the hip. It most commonly involves the gluteus medius or minimus tendons. The nearby bursa may also be irritated, but isolated ‘bursitis’ is less common than the older label suggests.
Pain is often worse when lying on the affected side, climbing stairs, standing on one leg, walking on slopes or after an increase in activity. Weakness, altered gait, lumbar problems and rapid changes in training load may contribute.
Assessment and imaging
Assessment includes pain location, onset, activity pattern, night symptoms, back symptoms, previous injury and general health. Examination reviews gait, hip and back movement, strength, tenderness and tests that load specific tendons or the hip joint.
X-rays may be used to assess joint shape and arthritis. Ultrasound or MRI may help when a significant tendon tear is suspected, symptoms are persistent despite appropriate treatment, or surgery is being considered. Imaging findings must be matched to symptoms because tendon changes and labral abnormalities can occur without pain.
Non-surgical treatment
- Modify aggravating loads while maintaining tolerable activity.
- A structured strengthening program, often focusing on the gluteal muscles, pelvis and trunk.
- Avoid sustained compression of a painful lateral hip, such as crossing legs or sleeping directly on that side; a pillow between the knees may help.
- Review walking, work and sport loads and increase them gradually.
- Pain-relieving or anti-inflammatory medicine may be considered after checking that it is suitable for your health and current medicines.
- A targeted, usually image-guided injection may be considered in selected cases. It is mainly used for short-term symptom control or diagnostic clarification and should not replace an appropriate rehabilitation program.
When might surgery be considered?
Surgery is uncommon for most non-arthritic hip pain. It may be considered when a clearly defined structural problem continues to cause major symptoms despite an appropriate rehabilitation program. Examples include selected full-thickness gluteal tendon tears, symptomatic impingement from a specific structure or persistent snapping with a confirmed treatable cause. Bursectomy alone is rarely a complete answer when tendon or referred pain is present.
The operation must match the pain generator. MRI findings alone are not an indication for surgery.
When to seek prompt review
- Inability to bear weight after injury.
- Fever, a hot swollen joint or rapidly increasing pain.
- Severe night pain, unexplained weight loss or a history of cancer.
- New weakness, numbness or bladder/bowel symptoms.
- Significant or persistent hip pain in a child or adolescent, or new severe pain during or after pregnancy.
Frequently asked questions
Is lateral hip pain always bursitis?
No. The gluteal tendons are frequently involved, and the bursa may be only one part of greater trochanteric pain syndrome.
Do I need an MRI?
Not always. Many causes can be assessed clinically and treated initially without MRI. Imaging is useful when the diagnosis is unclear, a significant tear is suspected or treatment has not progressed as expected.
Should I stop all exercise?
Usually not. Complete rest can reduce conditioning. The aim is to reduce provocative loading temporarily and then rebuild capacity gradually.
Can hip pain come from the back?
Yes. Lumbar spine and nerve problems can refer pain to the hip, thigh or groin and may coexist with local hip pathology.
General information
This page provides general information only. It cannot diagnose your condition or replace advice from a clinician who has assessed you. Your treatment and recovery plan may differ from the examples described here. Follow the instructions from your treating team. In an emergency, call 000 or attend the nearest emergency department.