Hip pain is not one diagnosis. Not every pain near your hip comes from your hip.
The hip is one of the strongest joints in the body, and pain around it can come from several different structures.
It may come from the hip joint itself, or the gluteal tendons, hip flexors, hamstrings, adductors, or a bursa. It may begin in the lower back or the sacroiliac joint, involve a nerve, or reflect a condition outside the musculoskeletal system.
Our first job is not treating the pain. It is determining where it actually begins, so the plan is aimed at the right problem.
The hip carries you through nearly everything you do. It lets you walk, climb stairs, squat, run, lift, sit, stand, and balance on one leg. Because it sits at the crossroads of the spine, the pelvis, and the leg, a lot of different structures can produce pain that is felt in and around the hip.
Some of that pain comes from the hip joint itself. Some comes from the tendons and muscles that move and stabilize it. Some comes from a bursa, some from the lower back or the sacroiliac joint, and some from an irritated nerve. Occasionally, pain felt near the hip reflects a medical condition that has nothing to do with the joint at all.
Because the location of pain does not reliably identify its source, the first step is never a standard treatment. It is a careful history and examination that determines where your pain is actually coming from.
This page is written to help you understand that pain felt around the hip is a symptom, not a diagnosis, and that the same complaint can come from very different sources. It walks through the structures that can be involved, the patterns that hint at where the pain is coming from, how a thorough evaluation sorts them out, and what conservative care can and cannot do. It is meant to inform rather than alarm. Most hip pain improves, and most of it is not dangerous, but the back, the nerves, and even conditions outside the musculoskeletal system can all be felt near the hip, so treating every hip the same way does a patient a disservice.
Our approach is consistent with the rest of our care. We take the time to understand what happened and what makes the pain better or worse, we screen for the concerns that fall outside a routine visit, and only then do we talk about treatment. When what we find belongs with another provider, we say so and help you get there.
Does this sound familiar?
Patients recognize experiences more than diagnoses. Different activities that provoke pain often point toward different structures, which is exactly why the evaluation matters.
Groin pain climbing stairs is a different clue than buttock pain that travels down the leg, and clicking is a different story than a deep ache that keeps you from sleeping on one side. Where the pain sits, when it happens, and what makes it better or worse are the first threads a careful examination follows.
It is worth paying attention to the specific movements that bother you, because they often map onto specific structures. Pain rising from a low seat or crossing the legs loads the joint in flexion and rotation. Pain lying on one side loads the tendons and bursa on the outside of the hip. Pain that flares after sitting and eases once you get moving behaves differently from pain that builds the longer you are on your feet. Noticing these details before your visit gives the examination a head start.
Hip pain limiting what you can do?
Schedule an evaluationIs it really your hip?
One of the most useful questions in the whole evaluation is whether the hip is the source of the pain or simply where it is felt. Where the pain sits gives real clues.
Pain in the groin
This is the pattern that most often points to the hip joint itself, including the labrum, the cartilage, arthritis, or the hip flexors. Groin pain with certain movements is one of the more reliable clues that the joint is involved.
Pain on the outside of the hip
Pain over the bony point on the side of the hip more often comes from the gluteal tendons or a bursa, a pattern sometimes called greater trochanteric pain syndrome, than from the joint itself.
Pain in the buttock
Buttock pain frequently is not a hip joint problem at all. It may come from the sacroiliac joint, the lumbar spine, the piriformis and gluteal muscles, or a nerve, which is why the back and pelvis are always part of a hip evaluation.
Pain in the front of the thigh
Pain across the front of the thigh can come from the hip, from a lumbar nerve, or from the muscles themselves. The pattern of what provokes it helps separate these.
Pain that travels below the knee
Pain that extends past the knee more often suggests the spine or a nerve than the hip joint. This single clue frequently redirects the whole examination.
The reason this distinction matters is practical. A hip that hurts because of an arthritic joint needs a very different plan from a hip that hurts because a nerve in the lower back is irritated, even though both may be felt in nearly the same region. Treating the visible symptom without asking where it comes from is how people end up doing months of hip work for a problem that was never in the hip. A careful look at where the pain sits, and how it behaves, usually points us in the right direction before a single image is ordered.
These are patterns, not proof, and none of them makes a diagnosis on its own. That is why the physical examination matters so much. Our sciatica, back pain, and disc injuries pages explain how back and nerve-related leg symptoms are sorted out.
Understanding the hip
A small amount of anatomy makes everything else easier to follow. The hip is a deep, stable ball-and-socket joint, surrounded by powerful muscles and tendons, and it never works in isolation.
The main structures include:
- Pelvis, the base the hip attaches to
- Femur, the thigh bone with its ball-shaped head
- A deep ball-and-socket joint
- Labrum, the rim that deepens the socket
- Cartilage that lines the joint surfaces
- Joint capsule, the sleeve around the joint
- Gluteal tendons on the outside
- Hip flexors at the front
- Hamstrings behind
- Adductors on the inside
Unlike the shoulder, the hip is built for stability. The socket is deep and the joint is held by strong ligaments and muscle. That design makes it powerful and reliable, but it also means the tissues around the hip, and the joints above and below it, can all contribute to pain.
This connectedness is the key to understanding hip pain. When the lower back is stiff or a nerve is irritated, the symptoms can show up around the hip. When the core or the gluteal muscles are not doing their share, the joint and its tendons can become overloaded. When the foot or knee changes how you walk, the hip absorbs the difference. That is why a thorough evaluation looks above and below the joint, not only at the hip itself, and why rehabilitation so often addresses the whole chain rather than a single spot.
Common causes of hip pain
These are among the most common sources of pain felt around the hip. The goal here is not to self-diagnose from a list. It is to see how different these are from one another, and why classification comes before care.
Hip osteoarthritis
Wear of the joint surfaces, most common with age. Groin pain, stiffness, and reduced rotation are typical, often worse with activity and after rest. Care focuses on movement, strength, and load, with referral when the joint is significantly affected.
Gluteal tendinopathy
Irritation or degeneration of the gluteal tendons on the outside of the hip. Pain over the bony point, worse lying on that side or with prolonged standing, is common. It responds well to graded loading.
Greater trochanteric pain syndrome
A broader term for pain over the outer hip that often involves the gluteal tendons and nearby bursa. Night pain on that side is a frequent complaint, and it is frequently mistaken for the joint itself.
Hip bursitis
Irritation of a bursa that cushions tissues around the hip. It can accompany tendon problems and produce tenderness and pain with pressure or certain movements.
Labral tear
Irritation or tearing of the rim that deepens the socket, sometimes with clicking, catching, or a sense of the hip giving way. It can occur with impingement or from repetitive load, and findings are interpreted alongside the examination.
Hip impingement
Also called femoroacetabular impingement, where the shapes of the ball and socket lead to pinching with certain movements. It can produce groin pain with deep flexion and rotation, often in active adults.
Hip flexor strain
A strain of the muscles at the front of the hip, common with sprinting, kicking, or sudden loading. Pain at the front with lifting the knee or stretching the hip is typical.
Adductor strain
A strain of the inner-thigh muscles, common in sports with cutting and pivoting. Pain along the inner thigh and groin with squeezing the legs together is characteristic.
Hamstring tendinopathy
Irritation of the hamstring tendons where they attach near the sitting bone. Deep buttock pain with sitting, driving, or loading the hamstring is common, and it responds to progressive strengthening.
Stress injury or fracture
Bone overload from repetitive impact, more common in runners and with certain risk factors. Pain that worsens with weight-bearing and does not settle deserves prompt evaluation, since some hip stress fractures need urgent care.
Lumbar referral
Pain around the hip and buttock that actually originates in the lower back. This is why a hip evaluation is never complete without a lumbar screen. See our back pain page for how we assess this.
Sacroiliac joint referral
Pain from the joint between the spine and the pelvis, often felt in the buttock and sometimes into the thigh. It has its own patterns and testing.
Sciatica and nerve pain
Pain, numbness, tingling, or weakness that travels down the leg from an irritated nerve, often from the lower back rather than the hip. Our sciatica page explains how this is evaluated.
Each of these has a different natural history and a different best approach. Some respond very well to conservative care and rehabilitation. Some need imaging or an orthopedic opinion, and a few need prompt medical attention. Telling them apart is the entire purpose of the first visit, and it is why two people with pain in nearly the same spot can leave with very different plans.
It is also common for more than one of these to be present at once. Someone can have mild arthritis in the joint and an irritated gluteal tendon, or a stiff hip alongside a contribution from the lower back. Age-related changes are common and do not automatically explain a person’s pain. The job of the evaluation is not to pin every symptom on a single label, but to build an accurate picture of what is driving your particular pain right now, and to weight the plan toward the parts that matter most.
Hip pain does not always mean arthritis
Many people assume hip pain must mean arthritis. It is one possible cause, but it is far from the only one, and the assumption can send care in the wrong direction.
Arthritis is a real and common cause of hip pain, and this is not an argument that it never matters. The point is simply that hip pain is not one thing, and assuming arthritis can lead people to accept stiffness and decline as inevitable when a treatable tendon, muscle, or back problem is actually driving their symptoms. Pain felt around the hip can come from any of these instead of, or alongside, arthritis:
- Gluteal tendinopathy
- A bursa
- A labral or joint-shape problem
- A muscle strain
- The lower back
- A nerve
- A stress injury
- Inflammation of soft tissue
The two ends of the age range make the point well. A young, active person can have real hip pain from a tendon, a labrum, or a stress injury, with no arthritis at all. An older adult can have age-related changes on an X-ray that are not the actual source of their pain, which may be coming from the back instead. This is exactly why an image is read alongside the examination rather than treated as the final word.
This matters because the label a person carries shapes what they expect and how they behave. Someone told they simply have an arthritic hip may stop moving it, when appropriate movement and strengthening are often part of what helps. Someone whose real problem is a tendon or the back may spend months focused on the joint. Getting the classification right is not about being technical for its own sake. It is what allows the plan, and your expectations, to match the actual problem.
Why hip pain often hurts at night
Night pain is one of the most common and most searched hip complaints. There are real reasons the hip can feel worse in bed, and most of them are not a sign of something dangerous.
Several factors tend to combine:
- Lying on the painful side compresses the gluteal tendons and a nearby bursa
- Lying on the other side can still tension those tissues across the top of the hip
- Inflammation tends to feel worse when you are still and unloaded
- The joint capsule can feel tighter in certain positions
- There is less natural distraction from activity and daylight
- Frequent position changes interrupt sleep, which lowers pain tolerance for the next night
Outer-hip and gluteal tendon problems are especially known for night pain on the affected side. Simple changes, such as a pillow between the knees or avoiding lying directly on the sore hip, often help while the underlying cause is addressed.
Night pain also tends to improve as the underlying problem improves, which is a useful thing to track. As the tendons calm down and tolerate load again, many people find they can lie on the hip for longer before it complains. That said, night pain that is severe, unrelenting, or paired with fever, weight loss, or a history of cancer is a different matter and belongs in the emergency and evaluation sections below.
Is it your hip or your back?
This is one of the most important questions in a hip evaluation, because the answer changes everything about the plan. Certain patterns point toward the spine, and others toward the hip.
Patterns that suggest the back or a nerve
- Pain in the buttock
- Pain that travels below the knee
- Numbness
- Tingling
- A burning quality
- Weakness in the leg
- Symptoms that change when you cough or strain
Patterns that suggest the hip joint
- Pain in the groin
- Difficulty putting on shoes or socks
- Pain with rotating the hip
- Pain with walking
- Stiffness
- Limited range of motion
- A deep ache in the joint
Neither list is perfect, and the two problems can coexist in the same person. Someone can have arthritis in the hip and an irritated nerve in the back at the same time. This is precisely why the examination matters. Testing the hip, the lower back, the sacroiliac joint, and the nervous system together is what separates a hip problem from a back problem, or tells us how much each is contributing.
There are a few quick clues worth knowing. Groin pain and difficulty putting on shoes and socks lean toward the hip joint, because both involve loading and rotating the joint. Pain that travels below the knee, or that changes when you cough or strain, leans toward the back or a nerve. A limp that eases when the joint is unloaded points one way, while numbness and tingling point another. None of these settles the question by itself, but together they help direct the examination, and the examination is what gives the answer.
Do you need X-rays or an MRI?
Imaging is not the first step. The examination usually tells us more about how the hip is working than a scan does, and it guides whether imaging is worth doing at all.
What informs the decision includes:
- Your history and how the pain started
- How the hip and lower back move
- Strength and single-leg testing
- Your walking pattern
- The neurological examination
- Whether trauma or an inability to bear weight is present
- Your age, activity, and general health
- Whether a result would actually change the plan
Movement and strength testing
The foundation of a hip assessment. How the hip moves, how you walk, and where you are weak often localizes the problem better than any single image.
X-ray
Useful for questions about the joint surfaces, arthritis, alignment, and bone. It does not show most soft-tissue problems such as tendinopathy.
MRI
Useful for selected soft-tissue, labral, tendon, and stress-injury questions, and for the lumbar spine when a nerve is suspected, when the result would change treatment.
Ultrasound or CT
Ultrasound can help evaluate certain tendons and bursae in real time. CT is used in specific situations, usually for detailed bone questions and typically through medical services.
Scans of the hip and lower back frequently show changes that are common with age and may have nothing to do with your current pain. Studies of people with no hip or back pain at all routinely find labral changes, mild arthritis, and disc changes on imaging, which is a good reminder that a finding on a scan is not the same as the cause of a symptom. That is exactly why imaging is interpreted alongside the examination, and why it is ordered when it will change what we do, not by default. An image answers a question. The examination is what tells us which question is worth asking.
How we evaluate hip pain
A hip evaluation is a structured process. It screens the hip, the lower back, the sacroiliac joint, and the nervous system before anyone talks about treatment.
History
- When and how the pain started
- Where you feel it and where it travels
- Which activities provoke it
- Night pain and sleep
- Any trauma or a fall
- Prior hip or back problems
- Your activity and goals
Walking and movement
- Your walking pattern
- Single-leg balance
- Hip range of motion
- How you stand up and sit down
- Comparison side to side
Hip, back, and SI examination
- Lower back examination
- Sacroiliac joint testing
- Hip-specific tests
- Palpation of tendons and bursae
Neurological screening
- Strength through the leg
- Reflexes
- Sensation
- Nerve-tension testing
Functional testing, imaging review, and diagnosis. We look at how the hip performs the tasks that matter to you, review any imaging you already have, and bring the findings together into a working diagnosis. When findings point to a significant labral or joint problem, advanced arthritis, a stress fracture, a possible non-musculoskeletal cause, or another concern outside our scope, we refer promptly.
The purpose of an evaluation this thorough is not to complicate a simple problem. It is to confirm that a simple problem really is simple before treating it as one, and to catch the less common situations that need a different kind of attention. Most people who come in with hip pain have something that responds well to conservative care. The evaluation is what lets us say that with confidence rather than assumption, and it is also what tells us early when someone needs an orthopedic opinion, imaging, or a medical workup instead.
Bring any imaging you already have.
Schedule a comprehensive hip evaluationWhat chiropractic care can and cannot do
Conservative care and rehabilitation help with many hip problems, especially those driven by mechanics, the tendons, the back, and how the hip is loaded. They are one part of a larger picture, and honesty about the limits matters.
It may help with
- Improve hip mechanics
- Address a sacroiliac joint contribution
- Address a lumbar contribution to the pain
- Improve mobility
- Guide strengthening and rehabilitation
- Rebuild movement confidence
- Support a graded return to activity
It cannot
- Repair a severe labral tear
- Replace a hip that needs replacement
- Reverse advanced arthritis
- Heal a fracture
- Treat every cause of hip pain
- Diagnose a soft-tissue problem with an X-ray alone
- Guarantee permanent relief
When hip pain requires emergency care
Most hip pain is not an emergency. But a few patterns need urgent or emergency medical evaluation rather than a routine appointment, including some that are not really about the hip at all.
Seek urgent or emergency medical care for:
- Inability to bear weight after an injury
- A suspected fracture
- Significant trauma such as a fall or collision
- An obvious dislocation or deformity
- Fever with a hot, red, swollen joint
- A history of cancer with new deep hip pain
- Night sweats or unexplained weight loss
- Loss of bowel or bladder control
- New saddle numbness
- Rapidly progressing leg weakness
- A cold, pale, or pulseless leg
Loss of bowel or bladder control, saddle numbness, or rapidly progressing leg weakness can signal a serious spinal problem. If any of these are present, seek emergency care first. A chiropractic evaluation can follow once you are medically stable.
How we treat hip pain
Treatment is chosen for the diagnosis in front of us and changes as you recover. Nothing is applied by default, and not every hip needs the same thing.
Education and reassurance
Understanding where your pain is coming from, and what it is not, reduces fear and helps you make good decisions. Reassurance here is grounded in the examination, not a substitute for it.
Activity modification
Clear guidance on what to keep doing and what to adjust, so you neither push into harmful territory nor shut the hip down completely.
Hip mobility work
Gentle, graded techniques to improve how the hip moves when stiffness is part of the problem.
Lumbar and pelvic mobility
Because the hip works with the spine and pelvis, improving how they move often improves how the hip loads and feels.
Sacroiliac joint care
Addressing a sacroiliac contribution when the examination points to it, as one part of the plan rather than an automatic step.
Soft-tissue treatment
Addressing guarded, overloaded, or sensitive muscles around the hip, buttock, and thigh to allow more comfortable movement.
Progressive strengthening
Rebuilding the strength the hip needs, targeted to the structures the examination identifies.
Gluteal strengthening
Restoring strength and control in the gluteal muscles, which are central to hip stability and to many outer-hip problems.
Core and pelvic control
Training the core and pelvis to support the hip during walking, lifting, and daily movement.
Balance and single-leg control
Rebuilding the single-leg stability that walking, stairs, and sport depend on.
Walking and loading progression
Gradually reintroducing walking distance and load at a pace the hip can tolerate.
Return to sport and activity
Building back toward running, golf, and the activities that matter to you, in stages.
Referral and co-management
Working with primary care, orthopedics, imaging, or physical therapy when the hip needs care beyond conservative management.
A good plan usually changes over time. Early on, the emphasis is often on calming an irritated hip, protecting it from the specific movements that provoke it, and restoring comfortable motion. As symptoms settle, the focus shifts toward rebuilding strength and control, especially in the glutes and core, and gradually reloading the activities that matter to you. The mix of tools is chosen for your diagnosis and adjusted based on how you respond, rather than followed from a fixed template.
Strength is often the part people underestimate. Many hip problems, especially those involving the gluteal tendons and the outer hip, improve most durably when the muscles that control the hip and pelvis are rebuilt in a graded way. It is not glamorous, and it takes patience, but it is frequently what turns short-term relief into a lasting result. Where a problem is beyond what conservative care can address, we say so early and help you get the right opinion rather than delaying it.
Recovery means more than less pain
The real measure of a hip recovery is what you can do again. Two people with the same pain rating can have very different limitations.
Because of that, progress should be tracked through returning function, not a pain score alone. Getting from a pain level of seven to a three matters, but walking farther, sleeping through the night, and getting out of the car without bracing is what recovery actually looks like.
Setting goals this way also keeps the plan honest. A treatment that eases pain for an afternoon but leaves you unable to climb stairs or walk the dog has not really solved the problem. When we measure recovery by what you can do again, it becomes clear whether the hip is genuinely improving or simply feeling briefly more comfortable, and the plan can be adjusted accordingly.
Hip pain, answered honestly
Is my hip pain arthritis?
It might be, but arthritis is only one of many causes. Tendons, muscles, a bursa, the labrum, the lower back, and nerves can all produce pain around the hip. The examination, and imaging when needed, help tell them apart.
Is it bursitis?
Bursitis can contribute to outer-hip pain, but pain over the side of the hip more often involves the gluteal tendons, sometimes together with a bursa. The distinction guides the rehabilitation.
Is it sciatica?
Pain that travels down the leg with numbness, tingling, or weakness often comes from an irritated nerve in the lower back rather than the hip. Our sciatica page explains how this is evaluated.
Is it my SI joint?
The sacroiliac joint, between the spine and the pelvis, can cause buttock pain that is sometimes felt near the hip. Specific testing helps identify whether it is involved.
Why does it hurt when I walk?
Walking loads the hip joint and the muscles around it. Pain with walking can come from the joint, the tendons, or a contribution from the back, which is why the walking pattern is part of the examination.
Why does it hurt at night?
Lying on the hip compresses irritated tendons and a bursa, and inflammation tends to feel worse when you are still. Outer-hip tendon problems are especially known for night pain.
Why does it hurt getting out of the car?
Rising from a low seat combines hip flexion and rotation with loading, which can provoke joint, labral, or tendon problems. It is a common and telling complaint.
Why is the pain in my groin?
Groin pain is the pattern most associated with the hip joint itself, including the labrum, cartilage, and hip flexors. It is one of the more useful clues that the joint is involved.
Why does my hip click?
Clicking can come from tendons moving over bone, from the labrum, or from the joint. On its own it is often harmless, but clicking with pain, catching, or a sense of giving way is worth examining.
Do I need an MRI?
Usually not right away. The examination guides whether imaging would change the plan. When it would, X-ray, MRI, or ultrasound may be appropriate for the specific question being asked.
Will I need surgery?
Many hip problems improve without surgery. Some, such as certain labral tears or advanced arthritis, may need an orthopedic opinion. The examination and, when needed, imaging help determine which situation you are in.
Can chiropractic help hip pain?
For selected causes, yes. Conservative care and rehabilitation can help hips driven by mechanics, the tendons, the sacroiliac joint, and the back. Some conditions need other care, and we refer when that is the case.
Can hip pain come from my back?
Yes, and it commonly does. Pain in the buttock, pain below the knee, and numbness or tingling often point to the lower back or a nerve rather than the hip joint. Screening the back is part of every hip evaluation.
Should I keep walking?
Usually some movement is better than complete rest, within the limits your symptoms allow. The right amount and type depend on the diagnosis, which is another reason classification comes first.
Why patients choose Family Health Chiropractic
We locate the source before we treat
A careful history and examination come first, because pain location alone does not identify the cause.
We look beyond the joint
The lower back, the sacroiliac joint, the nerves, and the muscles around the hip are all part of a complete evaluation.
We do not order imaging by default
Imaging is recommended when it answers a meaningful question and would change your plan.
We use adjustments thoughtfully
An adjustment is one possible tool, matched to the person and the diagnosis, never automatic.
We emphasize rehabilitation
Restoring strength, control, and function is how hip recovery lasts.
We refer when appropriate
When a significant joint problem, a stress fracture, or a non-musculoskeletal cause is likely, we coordinate with the right providers.
Hip pain care in Austin and Westlake
Hip pain touches almost everything: walking, sleeping, stairs, sitting, exercise, and simple tasks like getting out of the car or putting on shoes. When it lingers, guessing at the cause rarely helps.
Many people assume hip pain must be arthritis and simply wait it out, while others are told it is the joint when the real source is the back or a tendon. A careful evaluation replaces that uncertainty with a clear picture: what is involved, what is not, and what the plan should be.
We serve patients from Austin, Westlake, Rollingwood, Bee Cave, Lakeway, and the surrounding communities. We take the time to watch how you walk, examine the hip along with the lower back and sacroiliac joint, screen for nerve involvement and the less common causes that are not really about the hip, review any imaging you already have, and build a plan focused on restoring function, referring when your hip needs another type of care.
Whether your hip pain started after a run, crept in over months, or has been keeping you from sleeping on one side, a thorough evaluation is a reasonable next step. Being told it is just arthritis, or just aging, is not the same as understanding what is actually driving your symptoms and what can be done about it.
Family Health Chiropractic · 3736 Bee Caves Road, Suite 9, Austin, Texas 78746 · (512) 347-8881
Your hip is part of a much bigger movement system.
Hip pain can begin in the joint, the tendons, the muscles, the lower back, the sacroiliac joint, or the nervous system. Our goal is not to guess. It is to determine where your pain begins so treatment is directed at the right problem.