Hip pain is a broad term that can describe discomfort in the side of the hip, groin, buttock or upper thigh. While many conditions overlap in symptoms, there are key features that help physiotherapists differentiate the underlying cause.

Here are the five most common causes of hip pain, and the clinical clues we use to tell them apart.

1. Gluteal Tendinopathy (Lateral Hip Pain)

This is one of the most common causes of hip pain, especially pain felt on the outside of the hip.

Key features:

• Pain over the bony side of the hip
• Worse when lying on the affected side
• Pain with walking, stairs or standing on one leg
• Often aggravated by prolonged sitting or crossing legs

Differentiating clue: Pain is usually load-related rather than movement-limited, and strength testing of the hip abductors is often provocative.

2. Hip Osteoarthritis

Hip osteoarthritis typically causes deep joint pain that progresses gradually over time.

Key features:

• Groin or deep hip pain
• Stiffness, especially in the morning or after rest
• Reduced hip range of motion
• Pain that worsens with prolonged activity

Differentiating clue: Loss of movement (particularly internal rotation) and stiffness are more prominent than sharp pain.

3. Hip Flexor or Adductor Tendon Pain

These structures are commonly irritated by sudden increases in activity, kicking sports or repetitive sprinting.

Key features:

• Pain at the front of the hip or groin
• Worse with lifting the leg, running or kicking
• Tenderness over the hip flexor or inner thigh
• Pain during acceleration or uphill walking

Differentiating clue: Pain is often reproduced with resisted muscle testing rather than joint movement.

4. Referred Pain from the Lower Back

Not all hip pain comes from the hip itself.

Key features:

• Pain that shifts location
• Associated back stiffness or discomfort
• Symptoms that change with posture or spinal movement
• Possible referral into the buttock or thigh

Differentiating clue: Hip imaging may be normal, while spinal movement or positions reproduce symptoms.

5. Femoroacetabular Impingement (FAI) or Labral Pathology

These conditions usually affect younger or active individuals, but can occur across age groups.

Key features:

• Deep groin pain
• Pain with squatting, twisting or prolonged sitting
• Catching, clicking or sharp pain
• Symptoms during sport or loaded hip flexion

Differentiating clue: Pain is often position-specific, particularly in deep hip flexion or rotation.

Why Differentiation Matters

Many hip conditions share similar symptoms, but respond very differently to treatment. Strengthening, load management, mobility work or activity modification may be helpful — but only when matched to the correct diagnosis.

Treating “hip pain” without understanding the underlying cause often leads to slow progress or flare-ups.

When to Seek a Physio Assessment

If your hip pain is persistent, worsening, affecting sleep or limiting your activity, a structured assessment can clarify the source and guide the right treatment plan.

Our physiotherapists regularly assess and treat hip pain across the Northern Beaches, helping people return to comfortable movement, sport and daily activity.