The debilitating condition known to afflict roughly 10% of British adults casts a shadow over their lives, quietly compromising their long-term health.

For those experiencing hip pain, the discomfort is inescapable. The hip joint plays a vital role in nearly all our movements—whether it’s walking, standing, twisting, or sitting. When pain strikes, routine activities quickly become arduous.

If neglected, hip pain can lead to a cascade of complications.

Limited mobility can elevate the risk of obesity, while instability and poor balance significantly heighten the likelihood of dangerous falls. Hip osteoarthritis, a degenerative joint disease affecting over three million people in the UK, is often cited as the main culprit. However, specialists caution that it is just one of many possible causes.

In reality, numerous sources of hip pain are often overlooked, not just by those suffering but also by healthcare providers.

‘The hip is one of the most injury-prone parts of the body,’ says Professor Adam Taylor, an anatomy expert at Lancaster University.

‘It’s constantly moving in all directions while bearing weight and it’s surrounded by multiple layers of connective tissue. That makes it difficult to pinpoint exactly what is causing the pain.’

In some cases, the discomfort doesn’t originate in the hip at all but is referred from elsewhere in the body.

It’s an issue I know only too well. I lived with undiagnosed hip pain for nearly three years.

Today, I’m physically fit and largely pain-free, but I only discovered the real cause after years of being failed by the medical system and deciding to investigate it myself. Now, I want to help others do the same.

With that in mind, I’ve spoken to some of Britain’s leading hip-pain specialists to uncover every major cause of the condition and, encouragingly, I learned that all of them can be treated, often with relatively simple lifestyle changes.

That even includes osteoarthritis, which currently leads to almost 100,000 NHS hip replacements every year. Experts say that, with the right steps, many of those operations could be avoided.

So here’s what could really be behind your hip pain – and how to fix it.

Arthritis warning signs you should not ignore

Anyone over 50 who develops hip pain that steadily worsens has a high chance of osteoarthritis, experts say.

More than ten million people in the UK are thought to have the painful joint condition, which most commonly affects the knees and hips.

‘These are large, weight-bearing joints that support us for our entire lives,’ says Dr Ben Faber, an arthritis specialist at Bristol University and adviser to the charity Arthritis UK. ‘Over time, that constant pressure can cause osteoarthritis to develop.’

The condition occurs when cartilage – the tough tissue that cushions joints and allows bones to move smoothly – gradually wears away.

The hip is a ball-and-socket joint, with the rounded head of the thigh bone fitting into a socket in the pelvis. As cartilage thins, the bones rub against each other, causing stiffness, inflammation and pain.

Hip osteoarthritis is most common in older adults and people who are overweight, due to years of extra strain on the joint. However, it can also affect younger people, particularly after a serious hip injury such as a fracture.

Doctors also see hip pain caused by inflammatory arthritis, including rheumatoid arthritis, which is driven by an over-active immune system. This tends to affect younger patients and only rarely leads to hip replacement.

Osteoarthritis is usually investigated with an X-ray, but experts warn it may not show up in the early stages, so diagnosis is often based on symptoms.

‘Doctors look for pain during movement that doesn’t ease after a few minutes,’ says Professor Taylor. ‘There is often reduced flexibility and many patients describe a cracking or grinding sensation.’

While there are no drugs that can reverse osteoarthritis, experts say there are effective ways to manage it – and even avoid surgery.

Weight loss is one of the most powerful tools. A 2022 New Zealand study found that for every 1 per cent of body weight lost, people with hip osteoarthritis cut their risk of joint replacement by 3 per cent.

Exercise is also crucial. A major 2013 study revealed that patients who regularly walked or ran were significantly less likely to need surgery than those who were inactive.

‘With osteoarthritis, it’s very much “use it or lose it”,’ says Dr Faber. ‘If you stop moving, the muscles around the joint weaken and the tendons stiffen.’

For those already in pain, experts often recommend water-based exercise. Swimming, or walking in the shallow end of a pool, reduces strain on the joints while building strength and flexibility.

‘Water-based exercise is a no-brainer,’ says Dr Faber. ‘The water supports your body weight and takes pressure off the hips.’ 

Common condition with pain in bed 

Experts say the location of hip pain can often reveal what is causing it. And one of the most common – and frequently missed – causes is gluteal tendinopathy, which typically triggers pain on the outside of the hip or upper thigh.

‘Patients often notice discomfort when lying on their side at night, or when walking,’ says Giuseppe Salustri, a physiotherapist at The Physio Box clinic in London.

Gluteal tendinopathy occurs when one of the gluteal tendons – tough bands of tissue that anchor muscle to bone – becomes irritated or damaged. These tendons sit just beneath the buttock on the outer side of the hip. The condition is particularly common in runners, but also affects many post-menopausal women, as falling oestrogen levels can make tendons stiffer and less resilient.

Research also suggests it is more likely to affect those who regularly cross their legs, putting repeated strain on the outer hip tendons.

Crucially, experts say tendinopathy often doesn’t show up clearly on scans, meaning it can be misdiagnosed or missed altogether. It can also be stubborn to treat. Simply resting the joint is rarely enough. ‘Tendons heal slowly because they have a poor blood supply,’ says Professor Taylor. ‘Blood flow is essential for repair, so prolonged rest won’t solve the problem.’

Instead, specialists recommend regular, controlled movement and targeted stretching to stimulate blood flow and strengthen the tendon. ‘Exercises that load the tendon through its full range of movement are particularly helpful,’ says Dr Faber. ‘This might include gentle kicking or resistance exercises in a pool.’

Hands-on physiotherapy may also help. While massage treatment for joint pain is often debated, evidence suggests it can be effective for tendon injuries.

‘Massage is one of the few interventions shown to reliably increase blood flow to tendons,’ says Professor Taylor.

One exercise which Mr Salustri often recommends is clamshells.

Lie on your side with your knees and ankles together and an exercise band around your thighs.

Bend your hips and knees to about 45 degrees. Keeping your feet touching, lift the top knee and then slowly lower it. Repeat ten times for three sets daily.

Look out for a swollen red patch

However, tendinopathy isn’t the only cause of pain on the outside of the hip. Experts say that, in older adults, up to one in ten cases of hip pain may be caused by bursitis. The condition develops when a bursa – a small, fluid-filled sac that cushions joints – becomes inflamed. In the hip, this usually occurs over the bony point on the outside of the joint.

Bursitis is more common in those who place repeated pressure on the hip, by lying on one side for long periods, walking on hard surfaces or performing repetitive physical work. It also becomes more likely when getting older, as the bursa becomes less resilient.

In severe cases, bursitis may show up on a scan, but often it doesn’t. Even so, experts say it is usually easier to spot than other hip problems.

‘The pain typically flares up when you lie on the affected side,’ says Professor Taylor. ‘It can also be tender or painful to touch.’

Research shows the skin over the inflamed bursa may appear red, swollen or feel warm – a key clue that helps distinguish bursitis from tendon or joint pain.

Unlike tendinopathy, rest is important in the early stages.

Patients should avoid aggravating positions, including sleeping on the painful side. Anti-inflam­matory painkillers, such as ibuprofen, can help and steroid medication may be used in more severe cases.

Once symptoms ease, gentle strengthening exercises are essential to prevent recurrence.

One commonly recommended move is the side-lying leg raise. Lie on your pain-free side and lift the top leg about 20 to 30 degrees, keeping the toes pointing forwards. Lower with control. Repeat ten times for three sets.

The aim is to strengthen the glutes that support the hip and protect the bursa from further irritation.

How to tackle runners’ hip

Hip pain that strikes when you lift your knee towards your chest may be caused by a structural problem in the joint, experts say.

One common culprit is femoroacetabular impingement (FAI), a condition in which small bony growths develop around the hip joint. These growths can catch or pinch surrounding tendons and soft tissue during movement, triggering sharp pain.

‘Patients often feel it when bringing the knee up towards the chest,’ says Mr Salustri.

‘The tendon effectively catches on the bone, making activities like running or climbing stairs painful.’

Research suggests these bony changes develop over time due to repeated stress on the joint. As a result, athletes, particularly runners, are among those most at risk.

FAI is therefore more common in younger, physically active adults, unlike osteoarthritis, which tends to develop later in life.

Unlike many other causes of hip pain, FAI is usually visible on scans, such as X-rays or MRI, and surgery is rarely the first line of treatment.

‘The goal is to improve tendon flexibility and hip movement so the joint can function comfortably despite the extra bone,’ says Professor Taylor. ‘With the right physiotherapy programme, most people can manage the condition without surgery.’

Mr Salustri often recommends hip flexor stretches.

Lie on a bed with your hips at the edge and your legs hanging down. Keeping your hips flat, pull one knee towards your chest until you feel a stretch in the front of the opposite hip. Hold for 30 seconds. Repeat three times on each side, daily.

Hip giving way? It could be a tear

A hip that feels unstable, catches during movement or seems to ‘give way’ may be caused by a tear in the joint’s cartilage, experts say.

The condition, known as a labral tear, occurs when the ring of cartilage that helps hold the thigh bone securely in the hip socket becomes damaged.

Along with instability, patients often report stiffness, sharp pain during movement and a clicking or catching sensation.

Labral tears become more common with age as cartilage thins but they can also be triggered by osteoarthritis or femoroacetabular impingement.

‘It’s very common for bone growths or arthritis to lead to labral tears,’ says Professor Taylor. ‘The first step is usually to treat the underlying problem. Surgery is only considered if other treatments fail.’

Labral tears are usually identified on an MRI scan. However, not all tears cause symptoms and many sufferers don’t require treatment. For those who do, targeted exercises can help strengthen the muscles that stabilise the hip.

One commonly recommended move is the hip bridge.

Lie on your back with your knees bent and feet flat on the floor. Tighten your core and squeeze your glutes as you lift your hips into a straight line from shoulders to knees. Lower slowly. Repeat ten times for three sets. The aim is to improve stability and reduce stress on the damaged joint.

It took me three years to find cause, says Ethan

Hip pain isn’t always caused by a problem in the joint itself – something I learned the hard way.

In 2021, aged 25, I developed severe pain in my left hip, which I initially assumed was caused by running.

Over the next few years, I was given several possible diagnoses, including gluteal tendinopathy. But despite repeated physiotherapy, the pain got worse.

Scans failed to show anything abnormal, leaving doctors unsure what was causing my symptoms. But nearly three years later, after a physiotherapist suggested it might be arthritis, I saw a rheumatologist. I was eventually diagnosed with axial spondyloarthritis – an inflammatory spinal condition which often doesn’t show up on scans in its early stages. 

Inflammation in the spine can trigger pain in the hips and buttocks, even when those joints are structurally normal – a phenomenon known as referred pain.

Treatment with immune-suppressing injections and pain-relief medication made a major difference.

But regular exercise has been just as important. I now stretch several times a week, swim twice weekly and lift weights three times a week, focusing on strengthening my hips, lower back and legs.

The condition is incurable – but staying active has kept me mobile and largely pain-free.

Simple tweaks saved me from an operation 

Sally Potter was only nine years old when she was diagnosed with congenital dysplasia of the hip – a birth defect that meant her left hip joint didn’t quite fit in its socket. 

The condition left her with one leg slightly shorter than the other and severe arthritis and pain in her hip.

Despite this, Sally, now 59, says she refuses to get a hip replacement despite it being recommended to her by medics for the past 20 years.

‘Doctors are continually surprised that I’m still walking at all, let alone without crutches,’ she says. ‘But my mantra is to just keep moving, even when it’s really painful.’

The Devon-based hypnotherapist, pictured, says she keeps hip pain at bay through a combination of lifestyle changes. ‘The most important thing that I do is to keep my muscles strong to support the joint,’ Sally explains.

‘I do regular pilates, swim and walk for miles around the moors. I also use a raise inside my shoe, which has been really helpful.

‘Occasionally, I have a massage or see a physiotherapist and I eat a very healthy diet and don’t drink, which I noticed made the pain worse.

‘I’ve been on the list for a hip operation a couple of times as surgeons have told me it could fix my pain. But I cancelled the surgery. It’s now been 20 years since I was first offered the procedure and I hope never to need it.

‘I feel as long as I keep moving and looking after my hip, I can continue to manage for the rest of my life.’