Hip Pain: 12 Proven Solutions

Hip pain is a common complaint that can affect people of all ages—from athletes and active adults to older adults with arthritis. Because hip pain can come from the joint itself, surrounding tendons/bursae, the pelvis/sacroiliac joint, or referred pain from the lumbar spine, a stepwise evaluation is essential to match the right treatment to the true pain generator.

Details

1. Prevalence:
   • Hip pain is a widespread issue affecting millions of adults in the United States.
   • Osteoarthritis (OA) is a leading cause of hip pain. The CDC notes OA commonly affects the hips (along with hands, back, and knees). (CDC: Osteoarthritis)
   • Greater trochanteric pain syndrome (GTPS)—a major cause of lateral hip pain—accounts for an estimated 10–20% of patients who present to primary care with hip pain in some studies. (BJGP review on GTPS)
2. Age and Gender Distribution:
   • The prevalence of hip pain increases with age, especially due to osteoarthritis and degenerative tendon disease.
   • Some conditions show gender patterns (for example, GTPS is commonly reported in women in midlife). (BJGP review on GTPS)
3. Obesity and Lifestyle Factors:
   • Obesity is a significant risk factor for arthritis-related hip pain. Excess weight increases joint load and inflammation.
   • Sedentary lifestyles and lack of strength training can contribute to persistent hip pain by reducing stability through the pelvis, glutes, and core.
4. Occupational Factors:
   • Certain occupations involving repetitive movement, heavy lifting, or prolonged standing may increase the risk of hip pain.
   • Workers in construction, healthcare, or manual labor may be more susceptible to hip-related overuse and degenerative conditions.
5. Joint Injuries and Trauma:
   • Prior injuries, fractures, and trauma can increase the likelihood of developing chronic hip pain, including post-traumatic arthritis.
   • Falls, accidents, and sports injuries may contribute to acute or chronic hip pain across age groups.

This guide outlines the causes of hip pain, the steps involved in diagnosing its origin, and a practical spectrum of treatment options—with emphasis on interventional modalities that can reduce pain, restore function, and (in some cases) help patients delay or avoid surgery.

Causes

1. Osteoarthritis: Degeneration of hip joint cartilage, leading to pain, stiffness, and reduced range of motion.
2. Greater Trochanteric Pain Syndrome (GTPS): Lateral hip pain often related to gluteus medius/minimus tendinopathy and/or bursitis (historically labeled “trochanteric bursitis”).
3. Tendinitis / Tendinopathy: Degenerative or inflammatory tendon pain around the hip (gluteal tendons, iliopsoas, hamstrings).
4. Labral Tears: Tears in the labrum cartilage around the hip socket, often causing anterior groin pain, clicking, or catching.
5. Femoroacetabular Impingement (FAI): Abnormal contact between hip bones causing pain and cartilage/labrum damage.
6. Muscle Strains and Tears: Overuse or acute injury to muscles supporting the hip and pelvis.
7. Avascular Necrosis (AVN): Reduced blood supply to the femoral head, potentially leading to collapse and severe hip pain.
8. Stress Fracture or Occult Fracture: Especially in runners, older adults, or those with low bone density—important cause of persistent hip pain.
9. Referred Pain: Lumbar spine or sacroiliac (SI) joint problems can mimic hip pain, especially posterior patterns.

Steps of Diagnosing a Cause

1. Patient History: Pain onset, duration, location (groin vs lateral vs buttock), mechanical symptoms (clicking/locking), and aggravating factors.
2. Physical Examination: Range of motion testing, provocative maneuvers (e.g., FADIR/FABER), gait analysis, strength assessment (gluteals/core), and lumbar/SI screening.
3. Imaging Studies:
   • X-rays: Evaluate arthritis severity, alignment, fractures, and bony impingement.
   • MRI: Labrum, cartilage, tendons, AVN, stress fracture, and soft-tissue causes of hip pain.
   • Ultrasound: Useful for tendon/bursa evaluation and for image-guided injections.
4. Diagnostic Injections: Local anesthetic injection into the hip joint or targeted structures to confirm the primary pain source when symptoms overlap.

Location of Pain and Related Source

1. Anterior/Groin Hip Pain: Often associated with hip joint pathology (osteoarthritis, labral tears, impingement, AVN).
2. Lateral Hip Pain: Common with GTPS (gluteal tendinopathy and/or bursitis) and IT band-related pain.
3. Posterior Hip/Buttock Pain: May be related to gluteal myofascial pain, piriformis syndrome, ischial bursitis, SI joint dysfunction, sacral insufficiency fracture, or referred pain from lumbar spine issues.

Treatment Options

1. Activity Modification + Physical Therapy: Strengthening and mobility work (glutes, core, hip stabilizers) to reduce load and improve mechanics in hip pain.
2. Medications: Pain relievers and anti-inflammatories, depending on the underlying condition and risk profile.
3. Lifestyle Modifications: Weight management, sleep optimization, and graded return-to-activity strategies.
4. Orthotic/Assistive Devices: Canes, shoe modifications, and targeted supports can reduce joint load in some hip pain patterns.

Interventional Modalities

1. Steroid Injections: Image-guided corticosteroid injection into the hip joint or bursa for rapid relief and inflammation reduction.
2. Viscosupplementation: Hyaluronic acid injections (used more commonly in other joints; utilization varies by practice and patient selection).
3. PRP Injections: Platelet-rich plasma to support tissue repair and reduce inflammation in selected tendon/joint indications.
4. Bone Marrow Aspirate Concentrate (BMAC) Injection: Harvesting and injecting concentrated bone marrow cells to promote healing (evidence and indications vary).
5. Lipogems Injections: Micro-fragmented adipose tissue injections used as an orthobiologic option in selected cases.
6. TenJet: A pressurized saline system designed to precisely remove diseased tendon tissue while preserving healthy tissue in chronic tendinopathy.
7. Prolotherapy: Injection-based technique intended to stimulate repair and improve ligament/tendon support in selected patients.
8. Nerve Hydrodissection: Separating nerves from surrounding tissues to reduce irritation or entrapment-related pain.
9. Articular Branch Radiofrequency Ablation (RFA): Uses thermal energy to disrupt pain signals from articular branches (commonly from femoral and obturator nerve contributions) for chronic hip joint pain. (Pain Medicine review)
10. Hip Replacement (Total Hip Arthroplasty): Surgical replacement of the hip joint for end-stage arthritis or severe structural disease when conservative care no longer provides adequate relief or function.
11. Dorsal Root Ganglion (DRG) Stimulation: Electrical stimulation targeting specific nerve pathways to modulate chronic pain, including complex post-surgical pain patterns.

More Detail: Articular Branch RFA for Hip Pain

Articular branch RFA is a minimally invasive option for chronic hip pain when the pain is primarily joint-mediated (for example, osteoarthritis) and conservative therapies have not provided adequate relief. The goal is to reduce pain transmission by treating small nerve branches that supply sensation to the hip joint capsule—often involving femoral and obturator nerve contributions. (Pain Medicine review)

• Diagnostic blocks first: Temporary local anesthetic blocks can help confirm whether the hip joint nerves are the dominant source of hip pain.
• Procedure approach: Performed under imaging guidance to improve accuracy and safety.
• Expected benefit: Many patients experience meaningful improvement for months; durability varies by diagnosis, severity, activity level, and biomechanics.
• Risks: Temporary soreness, bruising, neuritis, bleeding/infection (rare), or incomplete relief.
• Best results: RFA often works best when paired with PT to strengthen hip stabilizers and correct mechanics that perpetuate hip pain.

Hip Replacement – When Surgery Becomes Appropriate

Total hip arthroplasty (hip replacement) is a proven solution for end-stage joint disease when hip pain and stiffness severely limit walking, sleep, and daily function despite optimized non-surgical treatment. (Mayo Clinic: Hip Replacement)

• Common indications: Advanced osteoarthritis, severe structural damage, progressive loss of motion, and major quality-of-life impairment.
• What it solves best: Mechanical, joint-based hip pain from advanced degeneration.
• Important note: Some patients can still have persistent pain after surgery (from muscles/tendons, nerves, back/SI joint issues, or other factors), which is why a complete diagnosis matters even when imaging shows arthritis.

Conclusion

Hip pain is complex and can arise from the joint, tendons/bursae, fractures, reduced blood supply (AVN), or referred sources such as the lumbar spine or SI joint. A personalized diagnostic approach—pairing a detailed exam with targeted imaging and, when needed, diagnostic injections—helps identify the true driver of hip pain so treatment is not guesswork.

From physical therapy and lifestyle optimization to advanced interventional options (including orthobiologics and articular branch RFA), modern care offers multiple pathways to improve mobility and reduce hip pain. For end-stage disease, hip replacement remains a highly effective option. The best plan is the one that matches the right intervention to your diagnosis, severity, and goals—so you can return to activity with confidence.

References:

1. Nho, S. J., & Gomoll, A. H. (2015). The Diagnosis and Management of Labral Tears and Femoroacetabular Impingement of the Hip. JBJS Reviews, 3(6), e3.
2. Piuzzi, N. S., & Chahla, J. (2020). Prolotherapy for musculoskeletal pain: a systematic review. Journal of Clinical Orthopaedics and Trauma, 11, S206–S212.
3. Grimaldi, A., et al. Greater trochanteric pain syndrome: a review of diagnosis and management. Br J Gen Pract. 2017.
4. Pain Medicine. Radiofrequency ablation for chronic hip pain (review).

Further Reading:

1. Mont, M. A., & Hungerford, D. S. (2006). Non-traumatic avascular necrosis of the femoral head. The Journal of Bone and Joint Surgery. American Volume, 88(3), 555–577.
2. Bedi, A., Dolan, M., Leunig, M., & Kelly, B. T. (2011). Static and dynamic mechanical causes of hip pain. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 27(2), 235–251.