"Hip pain" is a symptom, not a diagnosis — and where you feel it is the biggest clue to why. Pain in the groin or front usually points to the hip joint itself; pain on the outer side points to the tendons and bursa; pain at the back is often referred from the lower back or deep gluteal structures.
Persistent hip pain that hasn't responded to generic treatment is almost always a case of the wrong structure being treated. This guide explains what each pain location tends to mean — and when to seek specialist assessment.
What the location of your hip pain reveals
Hip pain location chart — front / side / back
Pain location is the primary diagnostic clue. Groin/front = joint; outer side = tendon/bursa; back = referred.
| Where it hurts | Likely sources | Read more |
|---|---|---|
| Groin / front of hip | Hip joint: FAI, labral tear, osteoarthritis; iliopsoas | FAI / labral tear → Groin pain → |
| Outer side (lateral) | Gluteal tendinopathy / GTPS ("bursitis") | Hip bursitis → Gluteal tendinopathy → |
| Back of hip / buttock | Referred from lower back; deep gluteal / proximal hamstring | See assessment → |
| Deep, with catching | Labral tear / intra-articular | FAI / labral tear → |
| Diffuse, worse with stiffness after rest | Hip osteoarthritis | OA & replacement rehab → |
The key principle: Treating the area ("your hip hurts") without identifying the structure driving it ("why it hurts") is why many people get better briefly — then flare again. Correct diagnosis comes first.
Hip pain when walking — mechanical vs referred
Pain that comes on with walking can come from several places. Distinguishing them is the difference between treating the hip and treating the back — and a common reason "hip" treatment fails.
Mechanical (from the hip joint)
Conditions like osteoarthritis or FAI often cause pain with walking — typically with stiffness and reduced range, worse on hills and stairs. Pain tends to be consistent with activity.
Referred (from the lower back)
The hip feels sore but the driver is the lumbar spine. Back-referred hip pain often changes with back position, may spread into the buttock or outer thigh, and often comes with nerve-type symptoms (pins and needles, numbness).
Tendon or bursa related (lateral)
Worse with single-leg loading — going up stairs, on slopes, or standing on one leg to get dressed. Typically also provoked by lying on that side.
A proper assessment always screens the back — and treating one without checking the other is why so many people get stuck with persistent "hip" pain that isn't actually from the hip.
When hip pain is actually coming from your lower back
A large share of stubborn "hip" pain is referred from the lumbar spine. Several clues help distinguish them:
Pain spreads or shifts
Referred pain often moves between the buttock, outer thigh and hip rather than staying in one localised spot.
Changes with back position
If bending, sitting, or rotating your spine changes the hip pain — that's a strong sign the lumbar spine is involved.
Nerve-type symptoms
Pins and needles, numbness, or pain extending into the leg suggest nerve involvement from the spine.
Why it matters: Local hip tests don't reproduce the pain, but back movements do — that's the key finding that redirects assessment away from the hip and toward the lumbar spine as the driver.
Red flags — when hip pain needs prompt attention
Inability to bear weight or pain after a significant fall — possible fracture
Fever, feeling unwell, or a hot swollen joint — possible infection
Unexplained weight loss or pain that's constant and worse at night
New numbness, weakness, or bladder/bowel changes
These symptoms point away from routine musculoskeletal causes. If you have any of these, see your GP or a medical professional — not just a physiotherapist.
Why generic physio fails complex hip pain
Generic care treats the area — "your hip hurts, here are some hip exercises." Complex, persistent hip pain needs the mechanism identified: joint vs tendon vs referred — and the load matched to the tissue.
The diagnostic-led difference is:
- Movement testing beyond "does this hurt?" — specific, structured tests that isolate individual structures
- Screening the whole kinetic chain — hip, back, pelvis, and lower limb assessed together
- A plan with a timeline — not another generic exercise sheet, but a structured progression based on what the assessment found
For more on why generic exercise often fails, see our article on why hip pain needs more than generic exercise.
Get to the actual cause of your hip pain
John Gravenall offers specialist hip and groin assessments in London, the Midlands, and online.
Book a specialist hip assessment →Frequently Asked Questions
Why does my hip hurt when I walk?
It depends on location. Joint causes (osteoarthritis, FAI) typically bring stiffness and reduced range, worse on hills and stairs. Lateral pain suggests tendon or bursa. Back-referred pain changes with spine position and may include nerve symptoms.
Can hip pain come from your back?
Yes — a large share of "hip" pain is referred from the lumbar spine. Clues: pain spreads or shifts, changes with back position, or comes with pins and needles, numbness or leg pain.
Where is hip pain felt for each cause?
Groin or front of hip typically points to the hip joint (FAI, labral tear, osteoarthritis). Outer side points to gluteal tendinopathy or bursitis. Back of hip or buttock is often referred from the lower back or deep gluteal structures.
When should I worry about hip pain?
Seek prompt medical attention if you cannot bear weight after a fall, have fever with a hot swollen joint, unexplained weight loss, constant pain worse at night, or new numbness, weakness or bladder/bowel changes.
How long should hip pain last before seeing someone?
If hip pain has persisted beyond a few weeks or isn't improving with generic treatment, a specialist assessment is worthwhile — especially if it's disrupting sleep, walking, or training.