Hip Pain

Move Freely Again — Starting With the Right Diagnosis

Hip pain is one of the most frequently misdiagnosed complaints we see. Patients arrive having been treated for hip arthritis when the problem is a tendon on the outside of the hip, or having been told their hip is fine when the real source is the lower back.

At the Chicago Institute for Neuropathic Pain (CINP), our team led by Dr. Rock and our team use examination, imaging and — when needed — targeted diagnostic injections to determine precisely where your hip pain is coming from. Getting that right is what makes treatment work.

What Is Hip Pain?

The hip is a deep ball-and-socket joint surrounded by some of the largest muscles and strongest tendons in the body, and it sits directly beneath the lower back and pelvis. That anatomy means pain felt “in the hip” can arise from the joint itself, from the tendons and bursae around it, from the sacroiliac joint, or from nerves in the lumbar spine.

Patients also use the word “hip” to mean very different places — the groin, the outer thigh, the buttock, the belt line.
Establishing exactly where it hurts is the first step.

Where Do You Feel Hip Pain?

Location is one of the most useful clues we have:

Deep in the groin, with stiffness and trouble putting on socks and shoes

……

This is the classic pattern for the hip joint itself

On the outside of the hip, tender to touch, painful to lie on at night

……

Usually gluteal tendinopathy or trochanteric bursitis, not the joint

In the buttock, worse with prolonged sitting, sometimes radiating down the leg

……

Often the lumbar spine, sacroiliac joint or deep gluteal structures

Just below the belt line at the back of the pelvis, typically one side

……

Commonly the sacroiliac joint

Burning or numbness over the outer thigh

……

Suggests the lateral femoral cutaneous nerve

Front of the thigh down toward the knee

……

May be referred from the lumbar spine

Get expert Hip pain treatment at CINP

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Conditions That Cause Hip Pain

Joint and Soft Tissue Conditions

Hip osteoarthritis

degeneration of the joint surfaces, typically producing groin pain and stiffness that is worse in the morning

Greater trochanteric pain syndrome and gluteal tendinopathy

degeneration of the gluteal tendons where they attach to the outer hip. This is one of the most common causes of "hip pain" and one of the most frequently mislabeled as bursitis or arthritis.

Trochanteric bursitis

inflammation of the bursa over the outer hip, often occurring alongside gluteal tendinopathy

Labral tears and femoroacetabular impingement

injury to the cartilage rim of the socket, common in younger and athletic patients

Hamstring origin tendinopathy

deep buttock pain at the sitting bone, worse with prolonged sitting

Iliopsoas tendinopathy and snapping hip

pain and audible snapping at the front of the hip

Avascular necrosis

oss of blood supply to the femoral head

Persistent pain after hip replacement

pain that continues despite a technically successful procedure

Spine and Nerve-Related Causes

Frequently overlooked, and a particular focus of our practice:
Lumbar radiculopathy an irritated nerve root in the lower back referring pain into the hip, groin or thigh. Upper lumbar levels in particular produce pain in the groin and front of the thigh that is easily mistaken for hip arthritis.
Sacroiliac joint dysfunction pain from the joint between the sacrum and pelvis, felt as hip or low back pain
Deep gluteal syndrome and piriformis syndrome irritation of the sciatic nerve as it passes through the buttock
Meralgia paresthetica compression of the lateral femoral cutaneous nerve producing burning, numbness or hypersensitivity over the outer thigh. Often dismissed for years before it is correctly identified. Learn more about nerve pain.
Lumbar spinal stenosis narrowing of the spinal canal producing hip, buttock and leg pain that worsens with standing and walking and eases when you sit or lean forward

Causes of Hip Pain

Age-related joint degeneration

cartilage wear leading to osteoarthritis

Tendon degeneration

gluteal tendons weaken with age and hormonal change; notably more common in women over 50

Overuse

running, cycling, stair climbing, prolonged standing, repetitive lifting

Injury

falls, sports injuries, motor vehicle collisions, fractures

Obesity

additional load through the hip joint and tendons accelerates wear

Lower back problems

discherniation, stenosis and arthritic change referring pain into the hip

Nerve compression

including compression of the lateral femoral cutaneous nerve by tight clothing, belts, work equipment or weight gain

Prior hip surgery

altered mechanics, scarring or nerve irritation following replacement or arthroscopy

Leg length discrepancy and gait abnormality

uneven loading over time

What Does Hip Pain Feel Like?

Mechanical hip pain — deep, aching groin pain with stiffness, worse with weight bearing and after periods of rest
Tendon pain — sharp, localized pain on the outside of the hip, tender to direct pressure, worse lying on that side
Referred hip pain — originating in the lumbar spine or sacroiliac joint but felt in the hip region
Neuropathic hip pain — burning, electric, tingling or numb; may include areas of skin that feel oversensitive to light touch
Acute pain — days to six weeks, often after a specific event
Chronic pain — beyond three months, typically with progressive limitation of walking distance and daily activity

Symptoms of Hip Pain

Groin pain and stiffness, particularly getting out of a car or a chair
Difficulty putting on socks, shoes or trousers
Pain lying on the affected side at night
Limping, or a noticeable change in walking pattern
Reduced walking distance before pain begins
Clicking, catching or a sensation of the hip giving way
Pain radiating into the buttock, groin, thigh or knee
Burning, numbness or tingling over the outer thigh
Pain that eases when sitting or leaning forward — a pattern that points toward the spine rather than the hip

How Is Hip Pain Diagnosed?

Because so many structures refer pain into the same region, hip pain requires a systematic approach. Dr. Rock begins with a detailed history and a physical examination using specific tests that separate joint, tendon, sacroiliac and spinal sources, then uses targeted studies as needed:

X-rays

to assess joint space narrowing, arthritic change and bone architecture

MRI

for labral tears, tendon degeneration, avascular necrosis and soft tissue detail

Ultrasound

in-office imaging of the gluteal tendons and bursae, and guidance for precise injection

CT scan

for detailed bone anatomy where indicated

Lumbar spine imaging

when the pattern suggests a spinal source

EMG and nerve conduction studies

to identify nerve involvement and localize it

Diagnostic injections

the most decisive test we have. A small amount of local anesthetic placed precisely into the hip joint, the sacroiliac joint, the trochanteric bursa or around a specific nerve tells us definitively whether that structure is the source. If numbing the hip joint doesn't change your pain, your pain is not coming from the hip joint — and that single piece of information can redirect months of treatment.

Treatment Options for Hip Pain

CINP is a non-surgical practice focused on precise, image-guided outpatient treatment:

Image-guided injections and nerve blocks

fluoroscopically guided intra-articular hip injections, ultrasound-guided gluteal tendon and trochanteric bursa injections, sacroiliac joint injections, piriformis injections, and lateral femoral cutaneous nerve blocks for meralgia paresthetica

Radiofrequency ablation

targeting the sensory articular branches supplying the hip joint, or the lateral branches supplying the sacroiliac joint; a durable option for patients who are not surgical candidates or wish to delay replacement

Lumbar spine injections

epidural and selective nerve root injections when the spine is the true source. See our minimally invasive spine therapies.

PRP therapy

platelet-rich plasma for selected gluteal tendinopathy and hip conditions

Neuromodulation

spinal cord or dorsal root ganglion stimulation for refractory hip and groin pain, including persistent pain after hip replacement

Medication management

including agents specific to nerve pain

Coordinated physical therapy

particularly important for gluteal tendinopathy, where targeted trengthening is the foundation of recovery

For an accurate hip pain diagnosis, visit CINP — the best pain clinic near you

Request Appointment

When to See a Hip Pain Specialist

Consider a specialist evaluation if you:

Seek urgent care

for inability to bear weight after a fall, visible deformity, fever with hip pain, or sudden severe pain with no clear cause.

FAQs About Hip Pain

Is my hip pain actually coming from my hip?

Often, no. Pain on the outside of the hip is usually a tendon problem rather than joint arthritis, and pain in the buttock or radiating down the leg frequently originates in the lower back or sacroiliac joint. True hip joint pain is typically felt in the groin. Distinguishing between them is the first thing we do — and a targeted diagnostic injection can settle the question definitively.

What is the difference between hip arthritis and hip bursitis?

Hip arthritis affects the joint itself and produces groin pain with stiffness, particularly when rising from a chair or putting on shoes. What is commonly called bursitis is felt on the outside of the hip, is tender to touch, and hurts when you lie on that side. In most cases it is actually gluteal tendinopathy — a tendon problem — and it responds to different treatment than arthritis does.

Can back problems cause hip pain?

Yes, frequently. Irritated nerve roots in the lumbar spine refer pain into the hip, groin and thigh, and lumbar spinal stenosis produces hip and buttock pain that worsens with walking. A useful clue: pain that improves when you sit or lean forward on a shopping cart points toward the spine rather than the hip.

Can I avoid hip replacement?

For some patients, yes — particularly those with mild-to-moderate arthritis, or those whose pain is coming from tendons or the spine rather than the joint. Image-guided injections, radiofrequency ablation and rehabilitation can meaningfully delay or, in some cases, avoid surgery. For advanced joint destruction, replacement remains the definitive treatment, and we will tell you honestly where you stand.

Why does my hip hurt when I lie on it at night?

Direct pressure on the outer hip compresses the gluteal tendons and bursa against the bone underneath. This is the hallmark symptom of greater trochanteric pain syndrome, and it is one of the more treatable causes of hip pain.

What is meralgia paresthetica?

Compression of the lateral femoral cutaneous nerve, which supplies sensation to the outer thigh. It produces burning, numbness or a patch of skin that feels oddly sensitive — but no weakness, because the nerve is purely sensory. It is commonly caused by tight belts, heavy tool belts, weight gain or pregnancy. It is often missed for years, and it responds well to treatment once identified.

I still have pain after my hip replacement. Is that normal?

A minority of patients continue to have pain after a technically successful replacement. Causes include tendon problems, spine-referred pain, sacroiliac dysfunction, or nerve irritation. These are diagnosable and treatable, and persistent post-surgical pain is an area our practice specifically works in.

Can hip pain be treated without surgery?

In most cases, yes. The majority of hip pain we see responds to accurate diagnosis followed by targeted injections, nerve blocks, radiofrequency ablation and rehabilitation. We refer to a surgeon when surgery is genuinely the right answer.