Ouch! Why Does My Hip Hurt?

As a physical therapist, I frequently see patients who ask, “Why does my hip hurt?” Hip pain is a common issue, and it can have a range of causes. Whether the pain is sharp or achy, constant or only with certain movements, understanding what’s causing it is key to finding the right treatment.

Several common conditions could be the culprit. One of the most frequent causes is bursitis, which occurs when the bursae — small, fluid-filled sacs that cushion your hip joint — become inflamed. This is often due to overuse or repetitive activities like running, cycling, or an impact to the side of your hip, like a fall. Bursitis typically causes pain on the outer side of the hip, and it can be aggravated by lying or sleeping on the affected side.

Another cause is tendinopathy, or damage to the tendons that attach muscles to the hip. Tendon injuries result from overuse or improper movement patterns, leading to pain and stiffness in the front or side of the hip. Athletes, especially runners, are prone to this condition, but it can affect anyone who engages in repetitive activities.

Iliotibial band (ITB) syndrome, often called Runner’s Knee, is another potential cause. The ITB is a thick band of connective tissue that runs along the outside of the thigh, from the hip to the knee. When this band becomes irritated or loses extensibility, it can cause pain in the outer hip and thigh, particularly with activities like running, cycling, or walking.

Sometimes, hip pain isn’t caused by the hip at all — it can be referred pain from the lower back. Conditions like a herniated disc or spinal stenosis can irritate the nerves in the lumbar spine, leading to pain that travels down to the hip area. This type of pain often feels like an ache or tightness in the hip and may be accompanied by numbness or tingling in the leg. If you’ve attempted to treat your hip and haven’t responded, be sure to see a physical therapist to get an accurate evaluation of your spine. Research shows that 70% of the time, hip pain comes from the spine — even if you’re not experiencing back pain at all.

Treatment Options

Treatment will vary depending on the root cause of your hip pain. A physical therapist will evaluate your movement, joints, strength, and flexibility to identify the source of your discomfort. For bursitis, treatment may include reducing inflammation through modalities and targeted stretching. If you’re dealing with tendinopathy or ITB syndrome, strengthening exercises to improve muscle balance and correct movement patterns will be key. For lumbar spine-related hip pain, treatment may focus on addressing the underlying mechanical issues in the back and nerve mobilization techniques.

A correct diagnosis is critical to successful recovery. Physical therapy can help you manage pain, restore mobility, and prevent future issues. A tailored exercise program, along with orthopedic manual therapy and patient education, will help you return to your daily activities with less discomfort and better movement.