Hip Pain: Hip, Back or Somewhere Else?

Part 6 of our Move Better, Feel Better: Pain & Movement Explained series

Written by Jessica Brown, Osteopath and Owner of One Health Osteopathy Clinic, Tunbridge Wells

Hip pain can be surprisingly difficult to pinpoint.

You may feel pain in the groin, on the outside of your hip, deep in your buttock or travelling down your thigh. Sometimes the hip itself is responsible. At other times, pain felt around the hip may actually be coming from the lower back, nerves, muscles, tendons or other surrounding structures.

One of the most useful questions we can therefore ask is not simply:

“Where does it hurt?”

but:

“Where is the pain actually coming from?”

At One Health Osteopathy Clinic in Tunbridge Wells, we regularly assess people with hip, groin, buttock and lateral hip pain from Tunbridge Wells, Tonbridge, Sevenoaks and surrounding areas of Kent.

In this guide, I explain some of the most common causes of hip pain, how the location and behaviour of your symptoms can give us useful clues, what treatment and rehabilitation may involve and when it is sensible to have your hip assessed.

Hip pain at a glance

Not all hip pain comes from the hip joint. The lower back, nerves, muscles, tendons and other structures can all produce pain around the hip and buttock.

Where you feel the pain can provide useful clues. Groin pain is more commonly associated with the hip joint, while pain over the outside of the hip may be related to the gluteal tendons. Buttock pain may arise from the hip, lower back, muscles or nerves.

Hip osteoarthritis does not simply mean your hip is “worn out”. Many people remain active with osteoarthritis, and exercise and strengthening are central parts of management.

Lateral hip pain is often tendon-related. What used to be routinely labelled “trochanteric bursitis” is now more often recognised as greater trochanteric pain syndrome, frequently involving the gluteal tendons.

Women in midlife are particularly affected by lateral hip pain. Gluteal tendinopathy is especially common among middle-aged and postmenopausal women, and researchers are investigating the potential influence of hormonal changes on tendon health.

Movement and strengthening are usually important. The right amount and type will depend on what is causing your symptoms.

The first step is understanding what you are dealing with.

Where is hip pain usually felt?

The word “hip” can mean very different things to different people. Some people point to the groin. Others point to the outside of the pelvis. Others describe pain deep in the buttock.

These areas can suggest different possible sources.

Pain in the groin or front of the hip

Pain felt deep in the groin or towards the front of the hip is more likely to involve the hip joint itself.

Possible causes include:

hip osteoarthritis;
irritation within the joint;
labral problems;
hip impingement;
muscular or tendon problems around the front of the hip.

You may notice difficulty getting your shoes and socks on, getting in and out of a car, crossing your legs or moving the hip through certain positions.

Pain on the outside of the hip

Pain around the bony prominence on the outside of the hip is extremely common. It is often described as greater trochanteric pain syndrome, or GTPS.

You might notice pain:

lying on the affected side;
walking;
climbing stairs;
standing on one leg;
getting out of a chair;
running;
walking uphill;
after increasing exercise.

This is one of the most important types of hip pain to diagnose correctly because it is frequently described simply as bursitis when the gluteal tendons may actually be an important source of symptoms. Recent reviews describe gluteus medius and minimus tendinopathy as central features of many cases of GTPS.

Pain in the buttock

Buttock pain has several possible causes.

It may relate to:

the lower back;
sacroiliac region;
gluteal muscles;
gluteal tendons;
hamstring tendons;
the hip joint;
nerves;
other surrounding tissues.

This is why location alone cannot always provide the answer.

A careful history and clinical assessment help us understand how your symptoms behave and which structures are most likely to be contributing.

How can you tell if hip pain is actually coming from your back?

The lower back frequently produces symptoms around the buttock and hip.

Sometimes there is obvious back pain alongside it.

At other times, somebody may describe their problem entirely as “hip pain” even though the lumbar spine is contributing significantly.

Signs that make us consider the back include:

pain extending from the lower back into the buttock;
symptoms travelling further down the leg;
tingling or numbness;
symptoms that change significantly when you move your spine;
pain associated with prolonged sitting or particular spinal positions;
previous episodes of lower back pain or sciatica.

However, the distinction is not always straightforward.

A person can also have both hip and lower-back problems at the same time.

This is one reason we normally assess both regions where appropriate rather than assuming that pain felt over the hip must originate from the hip joint.

Can sciatica feel like hip pain?

Yes.

Sciatica can cause pain in the buttock and sometimes around the outer hip before travelling further down the leg.

If a nerve root in the lower back becomes irritated, symptoms may include:

pain;
burning;
tingling;
pins and needles;
numbness;
weakness.

Not everyone with sciatica experiences all of these symptoms. Someone may initially think they have a muscular problem in the hip or buttock when the symptoms are actually nerve-related. This is where neurological assessment, including sensation, strength and reflex testing where appropriate, can help distinguish between different possibilities.

We explore sciatica in more detail in Part 2 of this series: Sciatica: What Does It Feel Like and When Should You Get Help?

What is greater trochanteric pain syndrome?

Greater trochanteric pain syndrome, or GTPS, describes pain around the outside of the hip. Historically, many cases were labelled trochanteric bursitis, meaning inflammation of a small fluid-filled sac over the side of the hip. We now understand that this description is often too simplistic. The tendons of the gluteus medius and gluteus minimus muscles, which attach around the outside of the hip, frequently play an important role.

For this reason, you may also hear the terms:

gluteal tendinopathy

lateral hip pain.

Symptoms commonly include pain when lying on the affected side, tenderness when pressing over the outside of the hip and discomfort with walking, stairs or prolonged standing.

Pain can also extend down the outside of the thigh.

Why does the outside of my hip hurt when I sleep on it?

This is one of the classic complaints associated with gluteal tendinopathy and greater trochanteric pain syndrome.

When you lie directly on the painful side, the gluteal tendons and surrounding tissues can become compressed against the outside of the hip.

Even lying on the opposite side can sometimes aggravate symptoms if the upper leg drops across the body and places the tendons in a compressed position.

You may find it more comfortable temporarily to:

avoid spending long periods directly on the painful side;
place a pillow between your knees when lying on the opposite side;
vary your sleeping position where possible.

The aim is not to protect the tendon forever.

It is to reduce repeated irritation while symptoms are particularly sensitive and then progressively rebuild the tendon’s ability to tolerate load.

Why is lateral hip pain common in women around menopause?

Greater trochanteric pain syndrome and gluteal tendinopathy are particularly common in middle-aged and postmenopausal women.

Researchers are increasingly interested in whether changing oestrogen levels during and after menopause may influence tendon structure and its response to load.

Oestrogen appears to have effects on collagen and other aspects of musculoskeletal health, so declining hormone levels are one possible factor being investigated.

However, menopause should not be viewed as the sole cause of lateral hip pain.

Strength, tendon loading, activity changes, biomechanics, general health, previous injury and other factors may also contribute.

Research specifically examining menopausal hormone therapy and exercise for greater trochanteric pain syndrome is still developing. This is another example of why better research into women’s musculoskeletal health throughout perimenopause and menopause remains important.

What is hip osteoarthritis?

Hip osteoarthritis is another common cause of hip pain, particularly as we get older.

It involves changes within the whole joint, including the cartilage, bone and surrounding tissues.

Typical symptoms may include:

pain around the groin or front of the hip;
pain extending into the thigh;
stiffness;
reduced hip movement;
difficulty getting shoes or socks on;
discomfort getting in and out of a car;
pain walking longer distances;
difficulty with stairs.

Occasionally, hip-joint pain may even be felt primarily around the knee. This is another example of why the location of pain does not always tell us exactly where it originates.

Does hip osteoarthritis mean the joint is worn out?

No.

Although the phrase “wear and tear” is commonly used, it can give the impression that an arthritic joint is simply wearing away every time you use it.

That is not an accurate or particularly helpful way to think about osteoarthritis.

Osteoarthritis involves biological changes throughout the joint and occurs alongside changes in muscle strength, movement and the surrounding tissues.

The amount of osteoarthritis visible on an X-ray also does not perfectly predict how much pain someone will experience. The important message is that movement and exercise remain beneficial rather than harmful for most people with hip osteoarthritis. NICE recommends tailored therapeutic exercise, including strengthening and aerobic exercise, as a core treatment for osteoarthritis.

Does hip arthritis always need an X-ray?

No.

Typical osteoarthritis can often be diagnosed clinically without imaging.

NICE recommends that osteoarthritis can usually be diagnosed without an X-ray or MRI in someone aged 45 or over who has activity-related joint pain and either no morning stiffness or stiffness lasting no longer than 30 minutes, providing there are no unusual features suggesting another condition.

Imaging may still be appropriate when:

symptoms are unusual;
the diagnosis is uncertain;
significant trauma has occurred;
another condition needs to be ruled out;
symptoms are not progressing as expected;
surgical referral is being considered.

A scan should therefore answer a clinical question rather than simply being ordered because something hurts.

Does hip arthritis always lead to a hip replacement?

No.

Many people manage hip osteoarthritis for years without surgery.

Management may involve:

strengthening;
general exercise;
maintaining mobility;
adjusting activity during flare-ups;
weight management where relevant;
pain-management strategies;
maintaining overall health and fitness.

Hip replacement can be extremely effective when osteoarthritis is substantially affecting quality of life and appropriate non-surgical management is no longer sufficient.

NICE recommends considering referral for joint replacement when pain, stiffness or loss of function significantly affects quality of life and non-surgical treatment has been ineffective or is unsuitable.

An X-ray showing arthritis therefore does not automatically mean surgery is inevitable.

Can tendons cause hip pain?

Absolutely. Tendons attach muscles to bone and transmit force when we move.

Around the hip, the gluteal tendons are particularly important in controlling the pelvis and supporting us during walking, running and standing on one leg.

Tendon pain can develop when the amount of load placed on a tendon becomes greater than its current capacity.

That might follow:

suddenly increasing your walking;
taking up running;
increasing hill walking;
returning to sport after a break;
a change in gym training;
doing considerably more activity on holiday;
or sometimes a period of reduced activity followed by a sudden increase.

This does not mean the tendon is weak or permanently damaged. Tendons are adaptable tissues. Rehabilitation involves finding an appropriate level of load and then progressively increasing the tendon’s capacity.

What is the best treatment for gluteal tendinopathy?

One of the best-studied approaches combines education about tendon loading with targeted exercise.

A well-known randomised clinical trial of people with persistent gluteal tendinopathy found that an education and exercise programme produced better overall improvement than either a corticosteroid injection or waiting for the problem to settle. Benefits were still evident at 52 weeks.

Rehabilitation may include:

temporarily reducing positions that strongly compress the painful tendon;
managing walking or exercise load;
progressive gluteal strengthening;
hip and pelvic control exercises;
gradually increasing walking;
progressively returning to running or sport;
improving general lower-limb strength.

The important word is progressive.

Doing too little indefinitely does not build tendon capacity, but repeatedly doing far more than the tendon currently tolerates may keep it irritated.

Finding the right middle ground is often an important part of successful rehabilitation.

Can shockwave therapy help lateral hip pain?

For some people with persistent gluteal tendinopathy or greater trochanteric pain syndrome, extracorporeal shockwave therapy may be considered as part of a wider rehabilitation programme.

Shockwave therapy uses acoustic pressure waves applied to the affected area.

Research into shockwave for lateral hip pain is encouraging, although results across studies are variable. A 2024 systematic review involving more than 1,100 participants found clinical improvements favouring shockwave in several studies, while also noting variation in study quality and treatment protocols and calling for further high-quality research.

More recent reviews also include shockwave among the non-surgical treatments that may be useful for selected people with persistent greater trochanteric pain syndrome.

At One Health Osteopathy Clinic, we offer shockwave therapy for appropriate tendon conditions, including selected cases of persistent gluteal tendinopathy.

It is not normally used as a stand-alone treatment.

Where appropriate, we combine shockwave with:

education about tendon loading;
activity modification;
progressive strengthening;
mobility work;
hands-on treatment where useful;
gradual return to walking, running or sport.

Whether shockwave is suitable will depend on your diagnosis, how long the problem has been present, your medical history and how your symptoms have responded to previous treatment and rehabilitation.

Should you stretch a painful hip?

Stretching can be helpful for some types of hip pain, but the answer depends on what is causing the symptoms.

If muscles around the hips, thighs or lower back feel stiff, comfortable stretching and mobility exercises may help restore movement, improve normal circulation through active tissues and reduce the feeling of tightness.

However, more stretching is not always better. With an irritable gluteal tendon, for example, repeatedly stretching the leg strongly across the body can increase compression of the tendon and may aggravate lateral hip pain. This is why an individual assessment can be useful. The aim is not simply to stretch every structure that feels tight. It is to choose movements that help your particular presentation.

Are mobility exercises useful for hip pain?

Yes.

The hip is designed to move in several directions, and comfortable mobility work can be particularly helpful if pain, sitting or reduced activity has led to stiffness.

Depending on your presentation, mobility work might include:

hip flexion and extension;
gentle rotations;
controlled hip circles;
spinal and pelvic mobility;
comfortable squatting;
walking;
cycling.

Movement encourages normal circulation and fluid exchange through the muscles and surrounding tissues while regularly taking joints through comfortable ranges can help maintain mobility.

As symptoms improve, mobility work is usually most useful alongside strengthening and normal physical activity rather than being the only form of rehabilitation.

Why is strengthening important for hip pain?

Strong muscles around the hips and legs help us walk, climb stairs, run, balance and transfer load effectively through the lower body.

Your gluteal muscles are particularly important when you stand on one leg, which happens repeatedly during normal walking.

Depending on the condition, rehabilitation might include:

gluteal strengthening;
hip abductor exercises;
squats;
bridges;
step-ups;
single-leg exercises;
resistance-band work;
progressive weights;
balance and control exercises;
walking or running progression.

Someone with hip osteoarthritis may initially need very different exercises from a runner with gluteal tendinopathy.

The principle is the same. We want to gradually build the strength and physical capacity required for your life and your goals.

Should you rest if your hip hurts?

Sometimes temporarily doing less can be very helpful.

If your hip has become painful after suddenly increasing running, walking, gym training or another activity, continuing at exactly the same level may repeatedly aggravate sensitive tissues.

This is where relative rest can be useful.

You might temporarily:

reduce walking distance;
reduce hills;
shorten running sessions;
modify certain exercises;
avoid repeatedly lying on an irritable lateral hip;
allow more recovery between sessions.

At the same time, comfortable movement can usually continue.

The aim is not complete inactivity.

It is to reduce what is clearly aggravating symptoms while maintaining movement and gradually rebuilding capacity.

When should hip pain be assessed?

Consider having your hip assessed if:

pain has persisted for several weeks;
the problem keeps returning;
symptoms are affecting walking or stairs;
you are having difficulty getting shoes and socks on;
lying on your side has become painful;
exercise or running is becoming increasingly difficult;
your hip movement feels increasingly restricted;
pain travels down your leg;
you experience tingling, numbness or weakness;
you have started avoiding normal activities because of pain;
or you are unsure whether your symptoms are coming from your hip or your back.

A good assessment can help distinguish between a problem arising from the hip joint, tendons, muscles, lower back, nerves or a combination of factors.

Having symptoms assessed earlier can also be helpful when they are not settling as expected. Identifying contributing factors and starting appropriate treatment or rehabilitation may help prevent a relatively straightforward problem becoming more persistent.

When is hip pain more urgent?

Most hip pain is musculoskeletal and is not an emergency.

However, seek urgent medical help if:

you have severe hip pain following a fall or injury;
you cannot walk or put weight through the leg;
the hip or leg appears deformed;
you experience sudden severe pain;
the hip becomes significantly swollen or hot;
you feel feverish, shivery or generally unwell alongside severe hip pain.

A hot, swollen joint accompanied by fever or feeling unwell needs urgent assessment because infection must be ruled out.

The NHS also advises urgent assessment following significant hip injury, particularly when someone cannot walk or bear weight.

Can an osteopath help with hip pain?

Osteopaths are regulated healthcare professionals trained to assess and manage musculoskeletal conditions, including many common causes of hip and lower-back pain.

At One Health, we start by understanding exactly where your pain is felt and how it behaves.

We may ask about:

when the symptoms started;
whether there was an injury;
where the pain travels;
what movements aggravate it;
whether lying on your side is painful;
whether walking or stairs are affected;
your exercise and activity levels;
changes in training;
previous hip or back problems;
your medical history;
what the pain is preventing you from doing.

Your assessment may include your hip, lower back and pelvis together with relevant muscles, tendons, joints and nerves.

Depending on your presentation, we may assess:

hip range of movement;
spinal movement;
muscle and tendon tenderness;
strength;
balance;
gait;
neurological function;
squatting or stepping;
movements relevant to your sport or everyday activities.

Our osteopathic approach to hip pain

The hip does not function in isolation. It works alongside the pelvis, lower back, knee, ankle and the muscles and fascia throughout the lower body. That does not mean that every painful hip requires treatment everywhere. It means we assess the areas that appear relevant to your individual presentation.

Where appropriate, osteopathic care may include:

joint mobilisation and articulation;
soft-tissue treatment and massage techniques;
myofascial techniques;
stretching and mobility work;
muscle energy techniques;
treatment of relevant lower-back or pelvic restrictions;
neuromuscular and movement retraining;
progressive hip and gluteal strengthening;
tendon rehabilitation;
balance and control exercises;
walking or running rehabilitation;
advice about activity and load management;
shockwave therapy for appropriate persistent tendon problems.

Osteopathic manual approaches aim to improve comfortable mobility and function, reduce muscle tension and support normal blood and nerve supply to tissues. Exercise and self-management are also important parts of osteopathic care.

Our aim is not simply to reduce pain temporarily.

We want you to understand what may be contributing, improve movement and strength and feel confident returning to the activities that matter to you.

For hip osteoarthritis, NICE recommends therapeutic exercise tailored to the individual, including local muscle strengthening and general aerobic activity.

People should also be advised that introducing exercise may initially cause some discomfort, but consistent exercise can improve pain, function and quality of life over time.

Routine imaging is not required for a typical clinical presentation of osteoarthritis and is not recommended simply to monitor the condition.

This supports an active approach to hip health rather than assuming that an arthritic hip should be protected from movement.

Hip pain treatment in Tunbridge Wells

If hip pain is affecting your walking, sleep, exercise, running or everyday activities, an assessment can help establish what may be contributing and what you can do about it.

One Health Osteopathy Clinic is based in central Tunbridge Wells and welcomes patients from Tunbridge Wells, Tonbridge, Sevenoaks and surrounding areas of Kent.

Our registered osteopaths assess people with a range of musculoskeletal hip problems, including:

hip and groin pain;
lateral hip pain;
greater trochanteric pain syndrome;
gluteal tendinopathy;
hip osteoarthritis;
buttock pain;
hip pain associated with lower-back problems;
nerve-related leg symptoms;
running and exercise-related hip pain;
difficulty returning to normal activity following pain or injury.

We also offer shockwave therapy at One Health Osteopathy Clinic for appropriate persistent tendon problems, including selected cases of gluteal tendinopathy.

Our approach combines careful clinical assessment with hands-on osteopathic treatment where appropriate, together with mobility work, strengthening, rehabilitation and practical advice about activity.

We want you to understand where your symptoms may be coming from, know what you can safely do and feel confident getting back to the things you enjoy.

Frequently asked questions about hip pain

How do I know if my pain is coming from my hip or my back?

Hip-joint pain is commonly felt around the groin or front of the hip, while lower-back problems may produce pain around the buttock or outer hip and sometimes further down the leg. However, there is considerable overlap, so clinical assessment is often needed to distinguish between them.

Why does the outside of my hip hurt?

Pain on the outside of the hip is commonly associated with greater trochanteric pain syndrome, often involving the gluteal tendons. Symptoms may be particularly noticeable when lying on the affected side, walking, climbing stairs or standing on one leg.

Is lateral hip pain always bursitis?

No. Although the term trochanteric bursitis is still commonly used, research suggests that the gluteal tendons frequently contribute to persistent lateral hip pain. The broader term greater trochanteric pain syndrome is therefore often more appropriate.

Why does my hip hurt when I sleep on my side?

Side lying can compress sensitive gluteal tendons and surrounding tissues against the outside of the hip. Temporarily changing sleeping position or placing a pillow between the knees can sometimes reduce irritation while the underlying problem is rehabilitated.

Is walking good for hip pain?

For many hip conditions, walking is beneficial. If symptoms are particularly irritable, you may temporarily need to reduce distance, hills or speed before gradually building back up.

Should I exercise with hip osteoarthritis?

Yes, in most cases. Strengthening and aerobic exercise are central to osteoarthritis management and can improve pain and function when appropriately tailored and progressed.

Can hip arthritis cause knee pain?

Yes. Pain originating from the hip can sometimes be referred into the thigh or knee. This is why the hip may need to be examined when knee pain does not behave as expected.

Can menopause affect hip tendon pain?

Gluteal tendinopathy is particularly common in middle-aged and postmenopausal women, and researchers are investigating whether changes in oestrogen may influence tendon health. However, hormonal changes are only one potential factor, and strength, activity, tendon loading and other health factors may also contribute.

Can shockwave help gluteal tendinopathy?

Shockwave therapy may be useful for selected people with persistent gluteal tendinopathy or greater trochanteric pain syndrome, particularly when symptoms have not responded sufficiently to initial rehabilitation. Current evidence is encouraging but variable, so shockwave should usually form part of a wider programme that includes progressive strengthening and load management.

Should I stretch lateral hip pain?

It depends. Gentle mobility can be useful, but strong stretches that pull the leg across the body may increase compression of an already sensitive gluteal tendon in some people. An individual assessment can help determine which movements are most appropriate.

Does hip osteoarthritis mean I will eventually need a hip replacement?

No. Many people manage hip osteoarthritis successfully without surgery. Joint replacement may be considered if symptoms substantially affect quality of life and appropriate non-surgical management is no longer providing sufficient benefit.

Should I see an osteopath for hip pain?

An osteopath can assess whether your symptoms appear to be arising from the hip joint, muscles, tendons, lower back, nerves or a combination of factors. Where appropriate, care may include hands-on osteopathic treatment together with mobility work, strengthening, activity advice and rehabilitation.

Coming next

This completes our first Move Better, Feel Better: Pain & Movement Explained series.

Next, we will move into our Active for Life: Sports Injury, Recovery & Rehabilitation series, looking at persistent pain, sports injuries, running problems, tendon pain and how to return confidently to exercise after injury.

The Move Better, Feel Better: Pain & Movement Explained series

Lower Back Pain: What Causes It and When Should You Get It Checked?
Sciatica: What Does It Feel Like and When Should You Get Help?
Is Sitting Really Bad for Your Back?
Neck and Shoulder Pain: What Could Be Causing It and What Actually Helps?
Knee Pain: Common Causes and When Should You Get It Assessed?
Hip Pain: Is It Coming From Your Hip, Back or Somewhere Else? (you are here)

About the author

Jessica Brown is a registered osteopath and owner of One Health Osteopathy Clinic in Tunbridge Wells.

Jessica holds a Master’s degree in Osteopathy from the University College of Osteopathy, where she received awards for academic achievement and her dissertation. She also has postgraduate training in women’s health osteopathy.

Her clinical approach combines careful assessment, hands-on osteopathic treatment where appropriate, movement, rehabilitation and clear, evidence-informed advice. She is particularly interested in helping people understand their symptoms, regain confidence in their bodies and return to the activities that matter to them.

Evidence and further reading

This article is informed by current UK health guidance and contemporary research relating to hip pain, hip osteoarthritis and gluteal tendinopathy.

The NHS provides guidance on common causes of adult hip pain and symptoms requiring urgent assessment.

NICE recommends tailored therapeutic exercise as a core treatment for osteoarthritis and advises that typical hip osteoarthritis can often be diagnosed clinically without routine imaging.

A randomised clinical trial in gluteal tendinopathy found that education about tendon loading combined with targeted exercise produced better overall improvement than corticosteroid injection or a wait-and-see approach, with benefits maintained at 52 weeks.

A 2024 systematic review of shockwave therapy for greater trochanteric pain syndrome found encouraging clinical improvements in several studies but also highlighted variation in the evidence and the need for further robust trials.

Clinical evidence continues to evolve and this article should be reviewed periodically as new research becomes available.

One Health Osteopathy Clinic
Oxford House, 15–17 Mount Ephraim Road
Tunbridge Wells, Kent TN1 1EN

This article provides general health information and does not replace an individual medical assessment.

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Hip Pain: Is It Coming From Your Hip, Back or Somewhere Else?