Hip Pain: Causes, Symptoms, and Treatment

Hip pain can be frustrating because it doesn’t always feel like it’s coming from one simple structure. Some people feel it deep in the groin. Others feel it on the outer side of the hip, down the outer thigh, or into the buttock.

Sometimes, hip pain is actually referred from the lower back. That’s one reason hip pain can feel confusing at first.

Hip pain can also change how you walk. Once you start limping or avoiding certain movements, other areas can get irritated too, and the whole thing can feel more widespread than when it started.

At PhysioCentral, we assess and treat hip pain for people in Miranda and across the Sutherland Shire, including nearby areas like Caringbah, Gymea, Sylvania, Cronulla, and Jannali. The goal is simple: work out what’s driving your symptoms, calm the flare, then rebuild your hip’s capacity so it can handle daily life, work, the gym, and sport again.

Key takeaways

• Hip pain is often manageable, but it can come from the hip joint, outer hip tendons, muscles, or be referred from the lower back.
• Groin pain often points to the hip joint. Outer hip pain often relates to glute tendon irritation (often co-existing with bursitis). Buttock pain can be hip or back related.
• Early wins usually come from removing the main aggravators, then following a graduated plan to restore movement and build strength.
• If you can’t weight bear, pain followed a fall, or you feel unwell with a hot red area around your hip, get assessed urgently.

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Table of contents

Overview: hip pain and why it can be confusing
Quick self check: where is your hip pain?
Common causes of hip pain
Symptoms that matter (what your symptoms may suggest)
When to get it checked (red flags)
Do I need an X-ray or scan?
What helps in the first week (and what to avoid)
How we assess hip pain at PhysioCentral
Physiotherapy treatment that helps
Rehab plan: Mobility to Flexibility to Strength (our phased approach)
Return to running and sport (simple readiness checklist)
FAQs about hip pain
Book an appointment in Miranda (PhysioCentral)

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Overview: hip pain and why it can be confusing

Hip pain can come from a few common sources, and the symptoms often overlap. For example:

• Outer hip pain is often related to irritation of the glute tendons. This is called Greater Trochanteric Pain Syndrome (GTPS), and many people call it hip bursitis.
• Hip joint pain can be related to osteoarthritis (wear and tear changes) or joint irritation.
• Groin or front of hip pain can be related to hip impingement (Femoroacetabular Impingement – FAI) or irritation around the hip joint, including the labrum (the cartilage rim around the socket).
• Muscle and tendon overload can involve the hip flexors (front of hip pain) or the adductors (groin strain type pain).
• Pain can also be referred from the lower back or pelvis.

The best first step is identifying where you feel it most and what tends to make it worse.

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Quick self check: where is your hip pain?

1) Pain on the side of the hip (outer hip pain)

This is often GTPS, sometimes labelled bursitis. It commonly hurts with stairs, longer walks, standing on one leg, or lying on the sore side.

Clues:

• worse with side sleeping
• worse with stairs or single leg tasks
• tender to touch over the bony outer hip
• aching pain down the outer thigh

2) Pain in the groin or deep in the front of the hip

This pattern is more likely to involve the hip joint. Hip osteoarthritis and hip impingement (FAI) often show up as groin pain, stiffness, and pain with twisting, turning, squatting, or getting in and out of the car.

Clues:

• pinchy or sharp pain with twisting
• stiffness after sitting
• reduced comfortable hip rotation
• pain with deep squats or long strides

3) Pain in the buttock or upper outer buttock

This can be hip related, but it’s also a very common area for referred pain from the lower back.

Clues:

• symptoms change with prolonged sitting or bending
• you also have back pain
• symptoms sometimes move around (back, buttock, outer thigh)

4) Pain at the front of the hip (hip flexor region)

This can be hip flexor irritation, adductor overload – tendon or hip joint related pain. It often flares with sprinting, hills, long strides, or repeated getting in and out of the car.

Clues:

• pain with uphill walking or sprinting
• pain with long stride length
• sore with resisted lifting of the knee

It’s common to have symptom overlap. Hip pain often involves more than one area once you’ve been limping, avoiding movements, or changing how you load the leg. Even more so if you’ve had it for longer than 3 months

Summary of Common causes of Hip Pain

Greater trochanteric pain syndrome (GTPS), often called hip bursitis

GTPS causes pain on the outer side of the hip. It’s usually related to tendon irritation, and it often flares with compression and load, like side sleeping, stairs, hills, and standing on one leg.

Hip osteoarthritis (hip arthritis)

Hip OA commonly causes pain in the groin or buttock with walking, plus stiffness and reduced movement.

Hip impingement (FAI) and labral irritation

FAI is a common “pinchy groin pain” pattern. It often flares with twisting, turning, deep squats, and sitting into low chairs. Labral irritation can feel similar, and it’s often managed best by improving mobility, control, and load tolerance.

Muscle and tendon overload

Hip flexor irritation (front of hip pain), adductor strain (groin pain), and tendon overload are common after a training spike, more hills than usual, changes in sprinting volume, or a sudden shift in gym loads.

Referred pain from the lower back

Hip pain can be referred from the lower back (lumbar spine). This can mimic hip problems, especially when buttock pain is dominant or symptoms change with sitting and bending.

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Symptoms that matter (what your symptoms may suggest)

The timing of symptoms and the type of sensation you feel also guide our treatment and rehab plan.

These patterns don’t diagnose you, but they help point us in the right direction.

Symptom pattern	What it may suggest (not a diagnosis)
Night pain and pain when lying on your side	Outer hip tendon irritation (GTPS), often called bursitis
Morning stiffness	Joint-driven pain patterns and inflammatory conditions. Also tendon issues.
Groin pain and stiffness after sitting	Hip joint driven pattern (OA, impingement style irritation)
Buttock pain plus back stiffness	May be referred from the lower back
Clicking, catching, “Pinchy” pain with twisting or deep squat	Hip joint irritation or impingement style pattern
Sudden severe pain after a fall	Needs prompt assessment, especially if weight bearing is difficult

If you’re not sure where your symptoms fit, that’s normal. A proper assessment quickly clears this up.

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When to get it checked (red flags)

Get assessed promptly if:

• Pain is sudden or intense
• Pain followed an injury or fall
• You can’t put weight on the leg, or cannot move the hip normally
• There’s swelling, deformity, or significant bruising
• You got a fever, you feel unwell, or the area is hot and red – these can be signs of an infection, which should be treated as urgent.

If in doubt, get it checked out. It’s always safer to get checked.

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Do I need an X-ray or scan?

Not everyone needs imaging straight away. We may suggest imaging when:

• symptoms are severe, worsening, or not improving as expected
• there was trauma, or you cannot weight bear
• we’re concerned about fracture, significant joint issues, or infection

Depending on what we suspect, imaging may include X-ray, ultrasound, MRI, or CT. Sometimes imaging helps, and sometimes it finds “normal age related changes” that aren’t the main driver of pain. That’s why your symptoms and clinical exam matter most.

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What helps in the first week (and what to avoid)

Rest. Early wins usually come from reducing irritability without fully shutting down activity.

Rest doesn’t mean just lying on the lounge all day. It means rest from aggravating activities. Decrease the load for relief.

Helpful starting points:

• keep moving, but reduce the main triggers for 7 to 10 days (stairs volume, hills, long walks, deep squats)
• avoid long static positions that flare it (for many people, anything over 30 minutes can be “long”)
• if it’s outer hip pain, reduce compression positions like side sleeping on the sore side, sitting with legs crossed, or leaning into one hip
• try a pillow between the knees if you’re a side sleeper
• use pacing: aim for discomfort that settles within 24 hours, not spikes that lead to a 2 to 3 day flare

If you want a clear target, we usually aim for a “manageable discomfort” following exercise during rehab, not repeated flares.

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How we assess hip pain at PhysioCentral

A good hip assessment is not just “where does it hurt?” We look for what’s driving your pain pattern, what irritates it, and when.

This usually includes:

• your story and symptom behaviour (where it hurts, what sets it off, morning and night patterns)
• walking analysis and single leg control
• hip range of motion and strength testing
• tests that help separate outer hip tendon pain, hip joint patterns, muscle overload, and referred pain from the back
• a clear home exercise plan so you know exactly what to do between visits

If you’re looking for hip pain physiotherapy in Miranda, this assessment stage helps your rehab progress faster and be more targeted.

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Physiotherapy treatment that helps

Treatment depends on what we find, but commonly includes:

• guidance on the positions and loads that are currently flaring symptoms, and how to unload them without losing fitness
• hands on treatment when stiffness or protective muscle spasm is limiting movement
• progressive strengthening, especially glutes and hip control work
• a graded return to walking, stairs, running, or gym loads

The goal isn’t just pain relief. It’s rebuilding your hip’s strength and load tolerance to prevent it from returning.

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Rehab plan: Mobility → Flexibility → Strength (our 3-Phase approach)

Phase 1: Mobility

Goal: restore comfortable movement and reduce protective stiffness.

Common focus areas:

• settling protective spasm around the low back, glutes, and outer thigh when needed
• hip rotation and extension
• walking mechanics

Progress looks like:

• less of a limp
• walking up and down stairs gets easier
• symptoms settle within 24 hours of normal daily activity

Phase 2: Flexibility

Goal: further reduce tightness and restore full range without pain. This’ll set us up for the strengthening phase

Key points:

• you might do modified versions of common exercises so you load the right tissues without flaring them
• flexibility is targeted, not forced
• for outer hip pain, we avoid positions that compress the sore area while range and strength build

Progress looks like:

• better tolerance to sitting and getting out of the car
• less grabbing pain when turning in bed
• lessening pain with walking, and the ability to walk further before aching develops

Phase 3: Strength

Goal: rebuild load tolerance to wipe out the rest of the pain and reduce recurrence risk.

This phase builds:

• glute strength and endurance
• single leg control
• gradual tolerance to hills, longer walks, and impact where needed

Progress looks like:

• night pain settling and mornings feeling looser
• stairs and hills feel controlled again
• return to sport or gym loads without repeated flare ups

Important note for GTPS (outer hip tendon pain): it often improves steadily, but it can take longer than people expect. Many feel early improvement within a few weeks once the right triggers are removed and the right loading starts, but full settling commonly takes a few months. That’s normal, and it’s one reason pacing and progression matter.

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Return to running and sport (simple readiness checklist)

If your goal is running or sport, we keep it simple and measurable. A practical checklist we often use:

• brisk 30 minute walk without limping, and without a big next day flare
• stairs are comfortable with good control
• single leg balance for 30 seconds with reasonable steadiness
• strength tasks are improving week to week without symptom spikes

If your sport involves change of direction, we’ll also progress:

• acceleration and braking
• side stepping and cutting
• landing mechanics
• graded sprint exposures

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FAQs about hip pain

Why does my hip hurt at night?

Night pain is common with outer hip tendon pain (GTPS), especially when lying on the sore side. Adjusting your sleeping position helps in the short term, but rebuilding hip strength and load tolerance is what solves it long term.

Is hip pain always coming from the hip joint?

No. Hip pain can be referred from other areas, including the lower back.

What does groin pain usually mean?

Groin pain often fits a hip joint driven pattern, especially if twisting, squatting, or getting in and out of the car aggravates it. It can also trigger protective muscle spasm around the groin and hip, which makes it feel tighter and more uncomfortable.

How long does outer hip pain (GTPS or bursitis) take to improve?

Many people notice early improvement within a few weeks once the main triggers are removed and the right exercises start. Full settling of pain often takes a few months, especially if it’s been there a while or if you’ve had repeated flare ups. Fully recoverable if you follow the right rehab plan in a graduated manner.

Do I need a scan for hip pain?

Not always. Imaging may be suggested if symptoms are severe, traumatic, not improving as expected, or if serious causes need to be ruled out. If scans are needed, we’ll tell you why and what type is most appropriate. Your GP can also advise.

Can exercise help hip osteoarthritis?

Of course! Stiff joints cause pain. As mobility improves, pain lessens. Strength work also decreases joint stress. As strength goes up, pain goes down.

Can physio help if I have had this for months?

Yes. Persistent or chronic hip pain often reflects reduced load tolerance, stiffness, and movement compensatory movements – like limping or changing stride length. As well as avoidance of previously enjoyed activities.

A progressive treatment plan that restores mobility, improves flexibility, and builds strength is the answer. The longer you’ve had it, the longer it takes to get there. But we know the optimal program to follow based on your unique presentation of causes and symptoms.

You don’t need to put up with the degree of pain you’ve become used to, and the less active lifestyle you feel you’ve been forced to adopt.

Book in, get it thoroughly assessed, and we’ll put you on the path to pain relief.

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Book an appointment in Miranda

If hip pain is affecting your walking, sleep, work, gym training, sport, or confidence on stairs, we can help.

PhysioCentral is based in Miranda and supports patients across the Sutherland Shire. We’ll assess what’s driving your symptoms and guide you through a practical plan to settle it and keep it settled.

Graeme Curran, Physiotherapist
Founder. PhysioCentral. Miranda. Sutherland Shire.

Related reading

• Injury recovery phases explained: https://physiocentral.net.au/understanding-injury-recovery-a-simple-guide-to-healing-phases-and-treatment-timing/
• Physiotherapy in Miranda and the Sutherland Shire: https://physiocentral.net.au/service/physiotherapy-miranda-sutherland-shire/