Condition
Hip Pain
Where it hurts tells us most of what we need to know.
1 finger
if you can point to it precisely, it is usually tendon, not joint
Groin pain, lateral pain, and buttock pain come from three different structures. That one distinction narrows the diagnosis faster than any imaging does.
What it feels like
- Deep groin ache, worse with rotation and prolonged sitting
- Sharp pain on the outside of the hip, painful to lie on
- Buttock pain that may travel down the back of the thigh
- Stiffness after sitting that eases within a few minutes of walking
- Clicking or catching with certain movements
- Reduced range, particularly internal rotation
What tends to cause it
- Hip osteoarthritis, typically producing groin pain and lost internal rotation
- Gluteal tendinopathy — the actual cause of most lateral hip pain
- Femoroacetabular impingement, more common in younger active adults
- Labral tear, often alongside impingement
- Sacroiliac joint dysfunction referring into the buttock
- Lumbar spine referral, which mimics hip pain convincingly
Ask someone with hip pain to point at it and you have narrowed the diagnosis before touching them. Three locations, three different structures, three different plans.
Groin
This is the hip joint itself. Osteoarthritis, femoroacetabular impingement, labral pathology. The characteristic gesture is the “C sign” — patients cup the hand around the side and front of the hip rather than pointing.
Look for reduced internal rotation, pain at end range flexion combined with rotation, and stiffness after sitting that eases with the first few minutes of walking.
Outside of the hip
This is gluteal tendinopathy, and it is worth being emphatic: this is not bursitis in most cases. For decades lateral hip pain was labelled trochanteric bursitis and treated with rest and injection. Imaging studies later showed the bursa is often uninvolved, and the actual pathology is degenerative change in the gluteus medius and minimus tendons where they attach to the greater trochanter.
That reclassification changes treatment completely. Tendinopathy needs progressive loading, not rest — and it needs the compressive positions removed.
The compressive positions are the ones people adopt constantly: lying on that side, crossing the legs, and standing with the weight slung onto one hip. Addressing those three habits often produces more change in the first two weeks than anything we do in the clinic.
Buttock
Usually the sacroiliac joint or the lumbar spine, occasionally deep gluteal involvement of the sciatic nerve. SI pain is typically one-sided, low, and pointed to with one finger just inside the posterior pelvis. It is provoked by single-leg loading — stairs, getting out of a car, rolling over in bed.
Lumbar referral tends to be broader and comes with a back history.
The test worth knowing about
Internal rotation of the hip. It is quick, it is objective, and it declines early in hip joint pathology, often before pain is severe or radiographic change is impressive.
If your internal rotation is symmetrical and full, hip joint disease is unlikely to be your problem — and we should be looking somewhere else.
How we treat it here
Locate it precisely
Groin points at the joint. Outside of the hip points at the gluteal tendons. Buttock points at the SI joint or the lumbar spine. Pain you can cover with one finger is usually tendon; pain you have to describe with a whole hand is usually joint or referred.
Measure internal rotation
Loss of internal rotation is one of the earliest and most reliable signs of hip joint pathology. It is quick to test, it is objective, and it is frequently the finding that separates a hip problem from a back problem.
Load the tendon, unload the joint
Gluteal tendinopathy needs progressive loading and, importantly, avoidance of the compressive positions that irritate it. Arthritic hips need controlled loading and range work. Same region, opposite emphasis.
Address the neighbours
Hip pain frequently travels with lumbar and SI involvement. Treating one and ignoring the other two is why hip complaints recur.
Hip pain
Questions we get about this.
Why does the outside of my hip hurt when I lie on it?
Almost certainly gluteal tendinopathy, which is what most cases historically labelled bursitis actually are. Lying on your side compresses the gluteal tendons against the greater trochanter. So does crossing your legs and standing with your weight hung onto one hip. The single most useful change most people can make is putting a pillow between the knees at night, and it often helps within days.
Is my hip pain actually coming from my back?
Frequently. Lumbar spine and SI joint problems refer into the buttock and lateral hip convincingly. The distinguishing features are that true hip joint pain is usually felt in the groin, is worse with rotation, and comes with measurably reduced internal rotation. Buttock pain with normal hip rotation is usually not the hip.
I have arthritis on X-ray. Do I need a replacement?
Not based on the image. Radiographic hip arthritis correlates only loosely with pain and function — plenty of people have significant changes on film and manage well for years. Replacement is a decision driven by your pain, your function, and your quality of life, not by the grade on a report. Conservative care buys many people a long time, and exercise therapy has good evidence in hip osteoarthritis.
What is hip impingement?
Femoroacetabular impingement is a shape mismatch where extra bone on the femoral head, the socket rim, or both causes contact at end range. It typically produces groin pain with deep flexion and rotation — squatting, getting out of a low car, sitting for long periods — in younger, active people. It is often associated with labral tearing. Conservative management is a reasonable first line for many cases.
New patient special — $59 New Patient Visit
Get your hip pain properly examined.
One visit, a real diagnosis, and a plan with a visit count and an end date. If it turns out we are not the right provider, we will say so and point you to who is.
Columbus, OH · Same-week appointments · Most insurance accepted