Hip Pain Causes: What's Actually Going On and Why It's Not Just 'Getting Older'
- Jessica Pace
- Feb 23
- 5 min read
Updated: Apr 28
Hip pain is one of the most common complaints I see — and also one of the most misunderstood. Patients come in having been told to "just take it easy" or having assumed it was an inevitable part of getting older. In most cases, neither of those things is true.
The good news: the majority of hip pain has a specific, identifiable cause. And most of those causes respond exceptionally well to targeted rehab when they're properly assessed and addressed.
Common Hip Pain Causes Are More Complex Than People Realize
The hip joint is a ball-and-socket joint designed for significant range of motion and load bearing. It's one of the most mechanically demanding joints in the body — absorbing forces several times your body weight with every step, stair, and squat. But surrounding that joint is an intricate system of muscles, tendons, bursae, nerves, and connective tissue — any of which can become a primary source of pain.
This is why "hip pain" is really an umbrella term, not a diagnosis. Where it hurts, when it hurts, what makes it better or worse, and how it behaves with loading and rest all point toward very different structures — and very different treatment approaches.
When someone says "my hip hurts," what they actually have could be any of the following:
Hip flexor tendinopathy — typically felt in the front of the hip or groin, often provoked by activities like stair climbing, getting up from a chair, or hip flexion against resistance. Common in runners and people who sit for long periods.
Gluteal tendinopathy — outer hip pain, frequently mistaken for IT band syndrome or trochanteric bursitis. Often worse with sustained single-leg loading, crossing the legs, or lying on the affected side. Research has significantly shifted the understanding of this condition in the last decade — compressive load management, not rest, is the cornerstone of rehab.¹
Hip labral tear — presents as deep aching, clicking, catching, or a sense of giving way in the hip. Common in active adults and overhead athletes, and more conservatively manageable than most people assume when properly diagnosed and loaded appropriately.
Hip impingement / FAI (femoroacetabular impingement) — pain at end ranges of motion, especially with flexion and internal rotation. Often described as a pinching sensation at the front of the hip. FAI is increasingly recognized as a structural variant that becomes symptomatic due to movement and loading factors that can be modified — surgery is far less commonly necessary than it once was thought to be.²
Referred pain from the lumbar spine — this one catches people off guard. The hip and lumbar spine share neurological territory, and L2–L4 referral patterns can produce pain that feels exactly like hip joint pain but originates entirely in the spine. Treating the hip when the lumbar spine is the driver produces exactly zero results — which is why a thorough assessment that rules this in or out is essential.
Trochanteric bursitis — lateral hip pain, often worse lying on that side at night. Now understood to frequently overlap with gluteal tendinopathy rather than representing pure bursal inflammation, which changes the rehab approach significantly.
"Getting Older" Is Not a Diagnosis
This is one I feel strongly about. Hip pain is not a personality trait of aging — it's usually a mobility or strength deficit that has a very addressable cause.
Age is a factor in tissue resilience and recovery timeline. It is not a reason to accept pain as permanent. Exercise-based rehabilitation produces meaningful improvements in pain and function across all age groups — research supports this even in older adults with hip osteoarthritis, one of the most commonly undertreated conditions in this population.³ Getting older changes how quickly you recover. It doesn't change whether recovery is possible.
I've worked with many patients who came in having been told they were 'bone on bone,' convinced surgery was their only option. What they hadn't had was a thorough functional assessment — one that looked at how they were actually moving, what muscles had stopped doing their job, and what the joint was being asked to compensate for. In most cases, there was meaningful progress to be made. Not every patient avoids surgery — but far more can than the imaging alone would suggest.
No one should be heading into an operating room without first finding out what a well-designed rehab program can do for them.
Imaging findings also deserve a mention here. Degenerative changes, labral fraying, and joint space narrowing on imaging are common findings in people with zero pain — and their presence on an MRI or X-ray does not mean they are the source of your symptoms. Treating an image instead of a person is one of the most common reasons people don't get better.
What a Proper Assessment Actually Looks Like
Here's what surprises most people about a virtual PT evaluation: it's not a lesser version of in-person care. It's a different delivery of the same clinical reasoning.
I can watch how you load your hip, where your movement strategy breaks down, and what your body has quietly learned to compensate around — all through your screen. I'm looking at single-leg loading, hip hinge mechanics, range of motion in all planes, and the subtle asymmetries that tell the story of how this developed over time.
What I'm looking for isn't just where it hurts. It's why it started, why it's staying, and what it's going to take to change it. That means understanding the full picture — your activity history, your movement patterns, your prior treatment, and your goals — before building anything.
That's exactly what the initial evaluation at Pace Tailored Virtual PT delivers. Root cause, not just symptom management.
Ready to Feel Better Without Leaving Home?
If you've been managing hip pain on your own — stretching the same hip flexor, icing the same spot, waiting for it to resolve — there's a smarter path. At Pace Tailored Virtual PT, you get board-certified orthopedic expertise, a program built specifically for you, and care that fits your real life. No waitlists. No commute. No generic exercise sheets.
👉 Book your initial evaluation at Pace Tailored Virtual PT and find out what's actually going on.
About the Author
Jessica Pace is a Doctor of Physical Therapy and board-certified orthopedic clinical specialist with over 10 years of experience treating musculoskeletal conditions. She is the founder of Pace Tailored Virtual PT, a concierge virtual orthopedic PT practice. She specializes in helping active adults identify and correct the movement patterns that lead to pain — before they become injuries.
References
Mellor R, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. https://doi.org/10.1136/bmj.k1662
Heerey JJ, et al. Prevalence of radiological features of femoroacetabular impingement in a population-based study. Br J Sports Med. 2018;52(19):1213–1221. https://doi.org/10.1136/bjsports-2017-097901
Fransen M, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;4:CD007912. https://doi.org/10.1002/14651858.CD007912.pub2
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