Hip and leg pain: causes and treatment

Hip pain (in Spanish, coxalgia) can start in the joint itself, in the muscles and tendons around it, or in the lower back, which sometimes causes pain felt in the hip and down the leg. Working out where it comes from is the first step, because each source is treated differently.

Is it your hip or your back?

If the pain…	It usually comes from…
Is in the groin or front of the hip and gets worse putting on socks or turning your leg	The hip joint
Is on the side of the hip and hurts lying on that side or climbing stairs	The tendons and bursa on the outside of the hip (gluteal tendinopathy, bursitis)
Starts in the lower back or buttock and runs down the back of the thigh, sometimes with tingling	The lower back and an irritated nerve, as in sciatica

It isn't always that clear-cut, and sometimes there's more than one source. At your first visit we test how your hip and back move to tell them apart.

Causes by age

Young people and athletes: muscle overload, tendinopathy and hip impingement (femoroacetabular impingement). We explain it in why does my hip hurt if I'm young?.
From around 50: hip osteoarthritis (coxarthrosis) and gluteal tendinopathy are the most common.
At any age: pain coming from the lower back, especially if you sit for long hours.

Common symptoms

Pain walking, climbing stairs or standing up after sitting.
Stiffness in the morning or when you start moving.
Difficulty crossing your legs, putting on socks or getting into a car.
Pain running down the leg, with or without tingling, when the source is the back.

How we treat it

Depending on the source, the plan combines:

Mobilisation and adjustments for the hip, pelvis and lower back to restore movement.
Soft-tissue work on the glutes, hip flexors and lower-back muscles.
Strength training for the glutes and thighs. For hip osteoarthritis, exercise is the first-line treatment in clinical guidelines, with manual therapy as an add-on.
Everyday advice: how to sit, sleep and pace your walking or running.

Many people improve within a few weeks when the cause is muscular or mechanical. With a compressed nerve or advanced osteoarthritis it takes longer, and we coordinate with your doctor.

When to see a doctor straight away

Severe pain after a fall, especially in older people (there may be a fracture).
Fever, or a hot or red hip.
Weakness in the leg, numbness around the groin, or changes in passing urine.
Hip pain in a child who is limping.

Frequently asked questions

Is hip pain always osteoarthritis? No. In young people it almost never is, and at any age it can come from the tendons or the back.

Does walking make it worse? It depends on the cause. Walking at a comfortable pace usually helps; if the pain builds during the walk or the next day, cut the distance for a while.

Can I keep exercising? Usually yes, adjusting the intensity. Complete rest tends to make stiffness worse.

How long does it take to improve? From a few days for a mild overload to several weeks if a nerve is irritated or there's osteoarthritis.