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Hip pain that won't go away.

Most hip pain is not what you fear. Seeing what's actually happening — before you see a surgeon — is the value. Four questions map your pattern. A physician attests your next step.

Hip pain pattern screener

Four questions. Your pattern routes you to the right next step — PT, surgeon, or home care.

Where exactly does it hurt?

Location is the single most useful piece of information.

Try it right now

Which movement reproduces your pain?

The motion that brings on your pain points to the structure behind it. Mirror each cue, then tap the one that reproduces it most clearly.

Four conditions, four different treatments

Hip pain is not one diagnosis. The location and character of your pain are the most useful diagnostic clues.

1

Hip Osteoarthritis

Deep groin pain

Weight-bearing, morning stiffness, over age 50

Cartilage wear that develops gradually. The hip socket loses its smooth gliding surface. Pain typically worsens with loading — walking, stairs, getting out of a car. X-ray confirms the degree of joint space narrowing.

Affects 1 in 4 adults over 60

Orthopedic surgeon
2

Greater Trochanteric Bursitis

Outer hip / lateral thigh

Worse lying on the side, climbing stairs, hip abduction

Inflammation of the fluid sac over the bony prominence of the outer hip. Common in runners, walkers, and middle-aged women. Does not typically cause groin pain. PT and a cortisone injection resolve most cases.

PT resolves 70% of bursitis cases without injection

Physical therapy first
3

Hip Labral Tear

Deep groin or anterior hip

Clicking, catching, or locking — often in active adults under 50

A tear in the fibrocartilage ring around the socket. Often caused by hip impingement (FAI) or sports-related stress. MRI arthrogram is the definitive diagnostic test. PT is first line; arthroscopy for refractory cases.

MRI arthrogram: 90% sensitivity for labral tears

Orthopedic evaluation
4

Referred Pain from the Spine

Posterior hip / buttock / leg

Pain travels down the leg, may follow a dermatomal pattern

The lumbar spine and hip share nerve pathways that make referral common and confusing. L3-L4 nerve root irritation mimics hip OA. A physical therapist can perform provocation tests — FABER, FADIR — to distinguish hip from spine.

Up to 40% of "hip pain" is actually spine-referred

Physical therapy evaluation
2024 AAOS Guidelines

Three treatment paths — how they compare

Treatment is matched to severity, not chosen arbitrarily. Knowing what each path delivers — and when it applies — is the most useful thing to know before your first appointment.

First-line for most

Physical Therapy

When it applies: Pain limiting activity but not disabling. Strength preserved. No bone-on-bone on X-ray.
  • Evidence-based PT (3–5 sessions/week) reduces pain comparably to injections at 12 months
  • Aquatic exercise reduces hip OA pain 20–30% in clinical trials
  • Gluteus medius + quadriceps strengthening are the most effective target muscle groups
  • Each 10 lbs lost reduces hip-loading force significantly — PT + weight loss outperforms either alone

Strong evidence · 2024 AAOS CPG (Moderate Recommendation)

Start PT
Bridge, not solution

Corticosteroid Injection

When it applies: Acute flare, moderate-to-severe pain, or need to participate in PT. Single-joint involvement.
  • Relief in approximately 60–70% of patients
  • Meaningful pain reduction lasting 4–12 weeks in most responders
  • Guideline limit: 3–4 injections per joint per year (excess risks cartilage damage)
  • Does not slow disease progression — pairs best with PT and weight management

Moderate evidence · 2024 AAOS CPG (Moderate Recommendation)

Talk to Sage about injections
End-stage OA

Hip Replacement (THA)

When it applies: Bone-on-bone arthritis on X-ray. Pain at rest or night. Conservative measures failed over 3–6 months.
  • Implant survival above 85% at 15–20 years (NJR 2023 registry data)
  • Most patients return home within 1–2 days; walk the day of surgery
  • 80% report dramatic pain improvement by 3 months
  • Hyaluronic acid injections NOT recommended (strong evidence against, 2024 AAOS CPG)

Strong evidence · 2024 AAOS CPG · NJR Annual Report 2023

See a surgeon

Treatment decisions require individual clinical evaluation. This comparison is educational, not prescriptive. Always discuss options with a qualified healthcare provider.

Validated PROM · HOOS-12

Score your hip in 60 seconds

The same Hip disability and Osteoarthritis Outcome Score your orthopedic surgeon would use. 12 questions, three subscales, one number that means something.

Pre-loaded with a sample patient so you can see what the result looks like. Edit any answer to make it yours.

Pain

19

/ 100

Function

25

/ 100

Quality of Life

19

/ 100

HOOS-12 Total

21/ 100Severe
Connect with a hip replacement surgeon

Your HOOS-12 score is consistent with end-stage hip disease. Patients with scores in this range often qualify for hip replacement (THA) and report dramatic improvement after surgery.

Edit your answers (12 items)tap to expand

pain

How often is your hip painful?

Pain straightening your hip fully

Pain walking on a flat surface

Pain at night while in bed

function

Difficulty descending stairs

Difficulty rising from sitting

Difficulty putting on socks/stockings

Difficulty getting in/out of a car

Quality of Life

How often are you aware of your hip problem?

Have you modified your lifestyle to avoid hip-damaging activity?

How troubled are you by lack of confidence in your hip?

In general, how much difficulty do you have with your hip?

HOOS-12 © Klassbo, Larsson, Mannevik 2003. This widget is for education, not diagnosis. Subscale scoring follows the published HOOS user guide (0 = extreme problems, 100 = no problems).

Talk to Sage

Ask anything about hip pain. Sage knows the evidence and routes you to the right care.

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Real people who have been where you are. Real words. Real stories.

These are peer-to-peer stories, not medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.

Hip pain in depth

Evidence-based articles for patients who want to understand more.

When to Worry

Hip pain red flags: when to seek care immediately

Not all hip pain is equal. Most hip pain is musculoskeletal and can be managed with rest, physical therapy, and time. But certain presentations require urgent evaluation.

Seek emergency care immediately for: hip pain after a fall in a person over 65, especially with inability to bear weight (possible hip fracture); sudden severe pain with fever or chills (possible septic arthritis — a joint infection that destroys cartilage within hours and requires emergency surgery); hip pain with a known cancer history (possible metastatic disease); and any loss of bladder or bowel control accompanying back or hip pain (cauda equina syndrome — a surgical emergency).

See your doctor within 1–2 days for: a hip that clicks, locks, or gives way; progressive limping that has developed over weeks; hip pain waking you consistently at night; or pain that was mild and has become severe without explanation.

"Red flag" symptoms that warrant same-week evaluation include unexplained weight loss with hip pain, fever of any degree, or pain in a child or teenager — avascular necrosis and Legg-Calve-Perthes disease require early recognition in young patients.

Source: AAOS OrthoInfo; NHS Hip Pain Guidelines; BMJ Clinical Review 2023.

Frequently asked questions

Real questions patients ask about hip pain. Answers reviewed by Josh Emdur, DO, board-certified internal medicine physician.

This information is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare provider for diagnosis and treatment.

JE

Reviewed by Josh Emdur, DO

Board-certified internal medicine. Licensed in all 50 states. altru.care

Last reviewed: April 2025

Medical disclaimer: The information on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It does not replace a consultation with a qualified healthcare provider. If you are experiencing a medical emergency, call 911 immediately. Always consult your physician or another qualified health provider with questions about a medical condition or before starting, stopping, or changing any treatment.

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