You notice it on the way to the mailbox. The first twenty steps are fine. Then something in the hip starts to complain, and by the time you turn around it is loud enough that you are thinking about it instead of about your day.
Or it is the second flight of stairs. Or it is two in the morning, you have rolled onto that side, and the sharp ache has woken you up again.
Hip pain after 50 rarely announces itself with an injury. It creeps in over months. Because it creeps in, most people never get a clear answer about what is actually causing it.
Here is the fact that makes this solvable. Where the pain sits tells you a great deal, and a lot of what people call hip pain is not the hip joint at all. Pain in the groin usually points at the joint. Pain on the bony outer side usually points at a tendon. Pain in the buttock very often points at the lower back.
This article sorts you toward one of four likely causes. It uses two things: where you can point to the pain, and what a few simple home movements do to it. Then it explains what the evidence says helps each one.
It is a sorter, not a diagnosis. The caveat section partway down matters as much as the test does.
Most hip pain that builds up slowly is mechanical, and mechanical problems respond to the right kind of loading. A small number of presentations are different. Read these before anything else.
Hip or groin pain after a fall, especially if your bones are thin. The American Academy of Orthopaedic Surgeons states that most hip fractures result from low energy falls in older people with weakened or osteoporotic bone.
The part people get wrong: a fracture does not always stop you walking. AAOS says that with some fractures "it may be possible to bear part of your weight on the leg," and that with a nondisplaced femoral neck fracture "you may still be able to move your leg and bear weight even though it is painful."
If you fell and the hip has hurt in a new way since, get imaging. Walking is not proof that nothing is broken.
Fever with a hot, painful, swollen hip. StatPearls describes septic arthritis as an orthopedic emergency. It presents with sudden pain in a single joint, fever, swelling, and a reluctance to move the joint at all. In adults it most often affects the knee, then the hip. That is an emergency room problem, not a clinic appointment.
A sudden inability to put weight on the leg. If the leg will not carry you, that needs urgent assessment whatever came before it.
Night pain that does not change with position. Mechanical hip pain almost always responds to something. Rolling over, straightening the leg, a pillow between the knees. Pain that stays identical no matter what you do deserves a look.
A history of cancer, or new unexplained weight loss. AAOS lists the pelvis among the skeletal sites where cancer most commonly spreads, with breast, lung, thyroid, kidney and prostate cancers the most common origins. It also notes that "pain that occurs without heavy activity is particularly concerning."
If you have a cancer history and a new deep ache in the hip or pelvis, tell your doctor before you start any exercise program. None of the items above is a diagnosis. Each one is a reason to get checked rather than to manage it yourself.
Point at your hip with one finger. Not a vague wave at the whole area. One finger, on the spot that hurts most. Where that finger lands narrows the field faster than almost anything else you can do at home.
| Where your finger lands | What usually sits underneath | Classic trigger |
|---|---|---|
| The groin, or the crease at the front | The hip joint itself | Walking distance, standing up from a low chair, putting on socks and shoes |
| The bony point on the outer side | The gluteal tendons where they attach | Lying on that side at night, stairs, standing on one leg |
| The buttock, behind and to the side | Very often the lower back, not the hip | Walking upright, standing still, easing when you lean forward |
| High in the front crease, with a catching feeling | The hip flexors or the labrum | Deep bending, twisting, getting out of a car |
The American Academy of Family Physicians organizes adult hip pain the same way, into anterior, lateral and posterior. Its 2021 review states that anterior joint pain "is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults."
It also states that "the most common cause of lateral hip pain is greater trochanteric pain syndrome," and that posterior hip pain includes referred lumbar spine problems.
Read that middle line twice. The most common cause of pain on the outer side of your hip is not the hip joint. It is a tendon problem. That one sentence redirects a great many people who have spent a year worrying about arthritis.
Five steps. Do them where you have a firm surface and something solid to hold. Stop any step at once if you feel a sharp pain. Do not force any position. If you have had a fall recently, skip this and read the red flag section again.
Step 1. The one finger test. Stand up. Put one finger on the exact spot that hurts most. Note which row of the location map that matches. If you honestly cannot narrow it to one spot, write that down too, because more than one thing is often going on.
Step 2. Press the bony point, then lie on it. Find the bony bump on the outer side of your hip, roughly level with a side pants pocket. Press it firmly with your thumb.
Then lie on that side on a bed, head on a pillow, for up to 30 seconds. Get up sooner if it turns sharp. Note two things: whether the bony point was tender to press, and whether lying on it reproduced your usual pain.
Step 3. The figure four. Lie flat on your back. Bend the painful side knee, then rest that ankle across the opposite thigh just above the knee. Let the bent knee fall out to the side under its own weight.
Do not push it down with your hand. Hold about 20 seconds. Note where you feel it: deep in the groin, on the outer side, in the buttock, or nowhere at all.
Step 4. Stand on that leg. Stand beside a kitchen counter with one hand resting on it. Lift the other foot just clear of the floor and hold for up to 30 seconds. Keep your hand on the counter the whole time.
Note whether pain appears, where it appears, and roughly how many seconds it took to show up.
Step 5. The shopping cart question. You do not need to do this one right now. You probably already know the answer. When you walk, does leaning forward onto a shopping cart or a walker handle make the pain and any leg symptoms noticeably better? Does standing up straight bring them back?
Write down five short answers. That is your test.
| Your pattern | Most likely driver |
|---|---|
| Finger in the groin, the figure four pulls deep in the groin, walking distance is the main limit, stiff first thing in the morning | The hip joint |
| Finger on the bony outer point, tender to press, lying on it hurts within 30 seconds, standing on that leg hurts within 30 seconds | The gluteal tendons |
| Finger in the buttock, symptoms travel down the leg, leaning on a cart clearly helps, standing tall makes it worse | The lower back |
| Finger high in the front crease, a sharp catch on deep bending or twisting, an ache after driving | The front of the hip |
These four causes overlap constantly, and the overlap is common rather than rare.
Hip osteoarthritis and gluteal tendinopathy frequently sit in the same hip. StatPearls reports that people with greater trochanteric pain syndrome who also have osteoarthritis are 4.8 times more likely to still have symptoms a year after treatment. Two problems in one joint is a normal finding.
The best home test in this article shows exactly how far a home test can take you. Grimaldi and colleagues, writing in the British Journal of Sports Medicine in 2017, tested 65 patients who came in with outer hip pain against MRI findings. Pain within 30 seconds of standing on the affected leg had 100 percent specificity in that group. That is why step 4 is on the list.
The same study found that 20 of those 65 patients, 31 percent, had gluteal tendinopathy visible on MRI while testing clinically negative. Roughly one in three people with the condition were missed by the clinical tests.
So a clear match on one row raises the odds. It does not close the case, and it does not rule the other three out.
The figure four tells the same story from the other direction. AAFP reports sensitivity of 42% to 81% but specificity of only 18% to 25% for problems inside the hip joint. In plain terms: it catches a lot, and it also lights up for plenty of things that are not the joint.
We take the same approach with shoulders, with the same honesty attached. If you want to see how the method works on a different joint, read our two minute self test for trouble lifting your arm overhead.
What it is. The cartilage lining the ball and socket thins over years. The joint gets stiffer, and the surfaces stop gliding as smoothly as they once did.
Where it hurts. AAOS describes the pain as being "in your groin (most common) or thigh that radiates (spreads out) to your buttocks or your knee." It also lists stiffness that makes walking or bending difficult, plus locking, sticking, or a grinding noise. Some people arrive at a clinic convinced they have a knee problem when the source is the hip.
Why after 50. AAOS states plainly that hip osteoarthritis "occurs most often in people 50 years of age and older." Morning stiffness that eases as you move is a typical part of the picture.
What the evidence says helps. A 2014 Cochrane review of land based exercise for hip osteoarthritis pooled 10 randomized trials. Nine of them, covering 549 participants, provided what the authors graded as high quality evidence.
Pain fell by about 8 points on a 0 to 100 scale, and physical function improved by about 7 points, with benefits sustained for 3 to 6 months after treatment ended. The evidence for quality of life was rated low quality.
Be clear about what that means. Eight points out of a hundred is real and reproducible, and it is not a cure. Exercise does not regrow cartilage, and no honest therapist will tell you it does. What it does is make the muscles around a worn joint far better at protecting it.
How long people work at it. The Danish GLA:D program, one of the largest structured osteoarthritis programs anywhere, runs three education sessions over two weeks plus 12 supervised neuromuscular exercise sessions, twice weekly for six weeks. It covers hip as well as knee.
Its published results come from a registry rather than a controlled trial, and the authors say the absence of a control group "most probably results in an overestimation of the specific treatment effects." Use the eight week structure as the anchor, not the reported numbers.
For a deeper look at managing this one, read our guide to hip therapy for arthritis pain relief and mobility.
What it is. The tendons of the gluteus medius and minimus attach to that bony point on the side of your hip. They become irritated and intolerant of compression. This is what most people mean when they say bursitis. AAFP notes that while the syndrome may involve bursitis, "gluteus medius tendinopathy or tears are now thought to be more common."
Where it hurts. Directly over the bony point, sometimes spreading down the outer thigh. StatPearls describes difficulty lying on the affected side, and pain that worsens with lying on that side or with walking and stair climbing, which load the abductors. Crossing the legs often provokes it too.
Why after 50. This one falls hardest on women. The LEAP trial authors, citing earlier work, describe gluteal tendinopathy as having "a prevalence of 10-25%" and being "experienced by one in four women aged over 50 years." StatPearls separately puts it at approximately 15% of women and 8% of men.
What the evidence says helps. This is the strongest evidence in the article. The LEAP trial, published in the BMJ in 2018, was a prospective, three arm, single blinded randomized clinical trial run in Brisbane and Melbourne.
It enrolled 204 adults aged 35 to 70, mean age 54.8, with outer hip pain lasting more than three months. Every participant had gluteal tendinopathy confirmed by clinical examination and by MRI. 167 of the 204, about 82 percent, were women. 189 completed the full 52 week follow up.
Three groups: education plus exercise across 14 physiotherapy sessions in eight weeks, a single corticosteroid injection, or wait and see. At eight weeks, 51 of 66 in the education and exercise group reported success, against 38 of 65 in the injection group and 20 of 68 in the wait and see group.
Education plus exercise beat the injection by 19.9 percentage points at eight weeks (95% CI 4.7 to 35.0). At 52 weeks that gap held on the same measure, at 20.4 points (95% CI 4.9 to 35.9).
Now read the pain scores, because they say something different. At 52 weeks, average pain was 2.1 in the exercise group and 2.3 in the injection group. On pain alone at one year, the two did not differ.
The exercise advantage at 52 weeks sits in how people rated their overall change, not in the pain number. So read the injection result fairly. It did work, it clearly beat doing nothing at eight weeks, and a year later people in that group hurt about as little as the exercise group did.
Three limits worth knowing before you apply any of this to yourself. First, the trial authors deliberately excluded people with other musculoskeletal complaints, naming low back pain and hip osteoarthritis specifically. That is precisely the overlap this article keeps warning you about.
Second, nobody over 70 was enrolled. If you are 75, this is still the best guide available, and it was not measured on people your age.
Third, every participant had the diagnosis confirmed on MRI before they started. If your outer hip pain has never been imaged, you do not yet know whether you are the person this trial studied.
How long people work at it. The trial program ran 14 individual sessions over eight weeks, with daily home exercises alongside. StatPearls notes that greater trochanteric pain syndrome "can take 3 months or longer to resolve." Plan in months, not weeks.
For more on the outer hip specifically, read our page on physical therapy for hip bursitis.
What it is. Not a hip problem at all. Structures in the lumbar spine refer pain into the buttock and down the leg. The hip gets the blame because that is where you feel it.
Where it hurts. AAFP describes patients with a lumbar source as typically having pain in the lower back or the surrounding muscles as well as in the buttock, often with a history of previous back problems.
The tell is position, not activity. In lumbar spinal stenosis, StatPearls states that symptoms are "aggravated by ambulation and lumbar extension," and that "forward flexion, as if pushing a shopping cart, relieves back pain." People often report that walking downstairs is harder than walking up, because going down puts the spine into extension.
StatPearls also notes that numbness and tingling here "typically involve the entire leg" rather than one narrow strip. That is step 5 of the self test. If leaning on a cart reliably buys you distance, look up the chain, not down.
Why after 50. StatPearls describes lumbar spinal stenosis as a significant cause of disability in older people, and as the most important indication for spinal surgery in patients over 65.
What helps. A completely different plan from the other three. It targets the spine, how you load it, and your walking tolerance. Starting a hip strengthening program for a spine problem is one of the more common ways to waste three months.
We covered this pattern in detail, including the shopping cart sign, in why you cannot stand for long periods anymore after 50.
What it is. Pain high in the front crease, sometimes with a catching or pinching feeling on deep bending or twisting. The usual suspects are the hip flexors, the labrum, or femoroacetabular impingement, where extra bone at the ball or the socket makes contact at the end of the range.
Where it hurts. StatPearls notes that people with impingement often show the location with a "C sign," the index finger and thumb cupped over the front and outer part of the hip. Provoking activities include squatting, driving, and high intensity sport. AAOS adds that "turning, twisting, and squatting may cause a sharp, stabbing pain."
The honest caveat, and it is a large one. StatPearls states that impingement "affects adolescents and the young adult population before radiographic signs of arthritis manifest." If you are over 50, this is the least likely of the four causes here.
Front of hip pain in a 55 year old is far more often early osteoarthritis or an irritated hip flexor than a classic impingement picture. StatPearls also identifies impingement as a risk factor for developing hip osteoarthritis later, so in an older reader the two conditions often blur into the same conversation.
What helps. AAOS lists activity modification, over the counter anti-inflammatory medication, and physical therapy to improve range of motion as the nonsurgical starting point. In practice for a reader over 50, this section usually turns into the osteoarthritis conversation once the joint is examined properly.
You are the reason this section exists. A parent will describe hip pain as "just getting older," then quietly rebuild their life around it. The rebuilding is usually visible long before they mention the pain.
What to watch in how they walk. A shortened step on one side. A dip or a lurch of the shoulders over one leg each time it takes weight. Reaching for furniture on the way across a room. Choosing the long flat route to the car instead of the short one with a curb.
Watch the chairs too. Standing at a family meal rather than sitting, or staying seated when everyone else gets up, both tell you something.
What to ask, in this order. Which part of your hip is it, can you point to it with one finger? Does it wake you at night, and does rolling over help? How far can you walk now compared with a year ago? What have you stopped doing?
That last question gets the real answer. People underreport pain and overreport what they can do, but they will tell you honestly what they no longer bother with.
How to raise it without being patronizing. Do not lead with falling. Lead with the thing they want back. "You used to do the whole loop at the park" is a conversation. "I am worried you are going to fall" is a lecture, and it usually ends the discussion.
Offer to come to the appointment and take notes rather than to speak for them. If a virtual first visit lowers the barrier, start there. Plenty of parents will agree to a video call with a therapist long before they agree to a clinic visit.
If walking itself is the thing that has changed, our guide to walking getting harder with age is a good companion to this section.
Step one, a conversation. The Wellness Video Call is a virtual appointment with Dr. Raj Pusuluri, PT, DPT. You describe where it hurts, what you have stopped doing, and what you want back. He tells you whether this looks like a joint problem, a tendon problem or a spine problem, and whether it needs imaging or a physician first.
Step two, a real examination. Range of motion measured rather than guessed, including hip internal rotation, which AAFP flags as a key finding in hip osteoarthritis. Strength tested side to side. The tests in this article done properly, plus the ones you cannot safely perform on yourself.
Step three, a plan with a date on it. A specific loading program for the specific structure. A home program you will actually do. A scheduled point to measure again. If the numbers have not moved by that date, the plan changes.
Step four, progression. Tendons and worn joints both respond to gradual, progressive load. That is the whole game. It is unglamorous, and it works.
HWY also has the Neubie, an FDA cleared direct current device that is distinct from a TENS unit and used in the clinic only. Its cleared uses include neuromuscular re-education, maintaining or increasing range of motion, and pain management.
It is not the answer to a mechanical hip problem, and nobody here will sell it to you as one. A worn joint or an irritated tendon needs progressive loading. Care is direct pay, no insurance required, and Dr. Raj works almost entirely with adults over 50.
Almost never. Complete rest is a poor medium term strategy for both worn joints and irritated tendons, and lost walking tolerance is hard to win back after 50.
Change the dose instead of stopping. Shorter and more frequent walks. Flatter routes. Then rebuild distance deliberately once you know what you are actually treating.
An X-ray shows the joint. It does not show the tendons, and it does not tell you which finding is causing your particular symptoms.
Plenty of people over 50 have visible joint changes on imaging and no pain at all. Imaging is one input. What reproduces your specific pain during an examination usually matters more.
It can be, and the LEAP trial gives the fairest answer available. A single injection clearly beat doing nothing at eight weeks. Over 52 weeks, education plus exercise beat the injection by about 20 percentage points on overall rated improvement.
On the pain score alone at one year, though, the two groups did not differ. So an injection can buy real relief. What it does not do by itself is move the wider picture of how recovered you feel.
Many people do best using one to make an exercise program tolerable rather than as a replacement for it. That is a conversation to have with whoever would be giving it.
For the outer hip cause, the LEAP program ran 14 sessions across eight weeks, and StatPearls notes the condition often takes three months or longer to settle. For hip osteoarthritis, the GLA:D structure is 12 supervised sessions over six weeks plus three education sessions.
Those are useful anchors rather than promises. Your own plan gets built after the examination, with a review date attached, so you are never left guessing whether it is working.
The first appointment, yes. A Wellness Video Call covers your history, the movements you can safely demonstrate on camera, and a starting plan.
Part of the examination genuinely needs hands, particularly the strength testing and the palpation that separates the outer hip cause from the joint. Most people do a virtual first visit and then come in.
It changes the order of priorities rather than the approach. Pain in both hips makes an inflammatory cause or a spinal source worth ruling in or out earlier, and it makes a proper examination more important rather than less.
It also makes the single leg steps in this article harder to read, because you have no clean comparison side.
If you have read this far, you have probably already picked your row. That is worth something. Most people carry hip pain for a year without ever getting that far.
The next move is to have it measured, have the overlaps sorted out by someone who can test what you cannot, and leave with a plan that has a review date on it.
Book a Wellness Video Call with Dr. Raj: Schedule your call
Or call (971) 202-1979.
North Salem HWY Physical Therapy 2615 Portland Rd NE, Salem, OR 97301 (located at Center 50+) Walk-ins welcome.
South Salem HWY Physical Therapy Clinic South Salem 180 Ramsgate Square S, Salem, OR 97302 By appointment only.
Phone (both locations): (971) 202-1979 Hours: Monday to Friday, 8:00 AM to 5:00 PM Book online: https://meetings.hubspot.com/raj-pusuluri/virtual-pt-visit?uuid=29177845-1ade-43b0-87d2-1cba35e0a730
This article is general information about a common problem. It is not a diagnosis and it is not medical advice for your situation. If your hip pain follows a fall, comes with fever, or stops you bearing weight, seek medical assessment rather than starting an exercise program.