Hip Pain Causes

Most cases of hip pain result from an injury to the hip joint, muscles, tendons, and ligaments. Problems in the lower back or knee can also cause referred or radiating pain to the hip area, mimicking hip pain.

Hip Pain Causes Based on Location

Common causes of hip pain that originate in the hip joint and surrounding structures are:

• Originates inside the hip joint:
  • Hip osteoarthritis
  • Hip impingement
  • Hip labral tears
  • Frozen hip
  • Snapping hip syndrome due to cartilage injury
  • Osteonecrosis
• Originates from structures that support the hip joint, such as muscles, tendons, and bursae (fluid-filled sacs cushioning bones and tendons):
  • Overuse injuries
  • Hip flexor pain
  • Hip tendonitis
  • Hip bursitis
  • Iliotibial band pain
  • Internal and external snapping hip syndrome
• Originates from another nearby source, such as the abdomen, pelvis, buttock, or lower back, and causes radiating or referred pain in the hip:
  • Sciatica
  • Meralgia paresthetica
  • Piriformis syndrome
  • Sacroiliac (SI) joint dysfunction
  • Facet syndrome from the lower lumbar spine
  • Weak core muscles
  • Poor posture
  • Discogenic low back pain

Additionally, traumatic fractures are common in the hip and involve the upper part of the femur (thighbone) near the hip joint.

Hip and Knee Pain

The hip joint connects the upper end of the thighbone (femur) to the pelvis and the knee joint connects the lower end of the thighbone to the leg bone (tibia). A few reasons why hip pain and knee pain occur together are:

• Weak hip joints and muscles: The hip and knee need to work as one single unit for several body functions. For example, while walking, as the heel strikes the ground, the hip joint moves back and forth, propelling the leg forward. However, if the hip joint and muscles are weak or unstable, the joint does not move efficiently. To compensate for the reduced hip movement, the knee joint works harder, increasing stress on the knee. This altered biomechanics is a cause for pain in both the hip and knee.
• Referred pain: Several nerves supplying the hip joint also branch down to the knee. When there's an issue in the hip, these nerves get irritated, causing a sensation of pain that travels down the leg and flares in the knee.

Common conditions that cause hip and knee pain together are hip osteoarthritis, muscle imbalances, hip impingement, hip labral tears, and hip meniscus tears.

Hip and Back Pain

The lower back, or lumbar spine, is made up of five vertebrae stacked upon one another held together with strong ligaments and muscles. Several of these muscles, particularly the hip flexors, originate in the lumbar spine, connecting the lower back to the hip.

A few reasons why hip pain and back pain occur together are:

• Tight hip flexors: The hips and lower back work in tandem when sitting, walking, running or transitioning from one position to another. The core muscles (muscles in the abdomen and lower back) and the hip flexors stabilize the spine as the hip joints move. When the hip flexors are stiff or weak, this delicate balance is disrupted and the lower back muscles work harder, leading to back pain.

Tight hip flexors also pull on the lower back and limit the hip's range of motion, leading to altered biomechanics and pain in the hip joint.

See Understanding Hip Flexor Pain

• Radiating nerve pain: Nerves from the lower back, called the lumbar spinal nerves, travel to the pelvis, hip, and thigh. When these nerves are irritated or pinched in the lower back, the pain travels along the path of the nerve in the pelvis, hip, and leg. This type of radiating nerve pain is commonly called sciatica.

Common conditions that cause hip and back pain together are hip osteoarthritis, muscle imbalances, poor posture, facet joint arthritis, and herniated or degenerated lumbar discs.

Read more about Why Does My Lower Back and Hip Hurt? on Spine-health.com

Hip Pain in Pregnancy

Pregnant women experience hip pain due to several reasons:

• Hormonal changes: A pregnancy hormone called relaxin loosens the ligaments throughout the body, including the pelvic the hip ligaments. This increased laxity can cause instability in the hip joint, leading to hip joint pain in some women.
• Round ligament pain: This pain occurs when the round ligaments, which support the uterus, stretch and adapt to the growing fetus. Round ligament pain is characterized by sharp, stabbing pain felt in the lower abdomen and groin (inner thigh) area – mimicking a hip joint issue.
• Pelvic girdle pain: This pain is felt in the back of the pelvis and can sometimes radiate to the lower back and hips. Pelvic girdle pain is caused by the loosening of ligaments and changes in joint alignment and may sometimes persist after childbirth.
• Weight gain and alerted biomechanics: The growing fetus puts extra weight on the hip joints, further stressing the joint and surrounding muscles, particularly with activities like walking, climbing stairs, or getting up from a seated position. The altered biomechanics can cause a shearing misalignment of the symphysis joint in the front of the pelvis and transfer more stress to the hips. The fetus’ position also shifts the center of gravity forward, altering the body’s biomechanics and putting further strain on the hips.

Pregnancy-related hip pain usually resolves on its own after childbirth. Once hormone levels return to normal, the ligaments around the hips regain their strength, alleviating pain.