Is My Hip Pain Muscle, Joint or Bone?

Where is the pain, and what does that suggest?

Start with location. MedlinePlus notes that pain from the hip joint itself is often felt most in the groin, and that hip problems can also be felt in the thigh or knee. Pain on the outside of the hip usually involves tendons or a bursa, and pain in the buttock is frequently linked to the lower back or the hamstring.

Try pointing with one finger to the worst spot. If you can press on it and reproduce the pain, the source is often near the surface, such as a tendon or muscle. If the pain feels deep inside and you cannot touch it, the joint or bone is more likely.

• Groin or front of hip: the joint (arthritis, labrum, impingement) or a hip flexor strain
• Outer hip, tender to press: gluteal tendons or bursa
• Buttock: lower back, hamstring tendon or sacroiliac joint
• Deep, hard to pinpoint, worse with weight bearing: joint or bone

What does a muscle strain feel like?

Muscle pain usually has a clear starting point, such as a sprint, a slip or an unfamiliar workout. Cleveland Clinic describes a hip flexor strain as causing pain and a pulling or tight feeling, sometimes with bruising, swelling or muscle spasms. It tends to hurt most when you use or stretch that particular muscle, such as lifting the knee for a hip flexor or bending forward for a hamstring.

The other hallmark is steady progress. Cleveland Clinic notes that most hip flexor strains feel better within a week or two and heal within a few weeks with rest and home care. Muscle pain that is clearly better each week is usually behaving normally.

How can you tell if it is a tendon problem?

Tendon pain on the outer hip is very common. Cleveland Clinic explains that gluteal tendinopathy pain often starts at the bony point on the outside of the hip, which may be tender to touch, and can spread down the outside of the leg toward the knee. It tends to hurt when lying on that side, climbing stairs or hills, sitting cross-legged or standing on one leg to pull on pants.

Unlike a fresh muscle strain, tendon pain often builds gradually and does not settle with rest alone. Cleveland Clinic notes that tendinopathy rarely improves with rest and responds better to targeted physical therapy exercises.

What are the signs that the pain is in the joint?

Joint pain usually lives deep in the groin or front of the thigh. AAOS OrthoInfo describes hip osteoarthritis as causing groin or thigh pain, stiffness that makes walking and bending difficult, and trouble with everyday tasks such as bending over to tie a shoe or rising from a chair. Pain and stiffness are often worse in the morning or after sitting.

A simple clue is rotation. Joint problems often hurt when the leg is turned inward or when you bring your knee up to put on socks. Clicking, catching or a grinding sensation can also point to the joint. AAOS OrthoInfo notes that over time, arthritis can limit range of motion and cause a limp.

In younger, active adults, deep groin pain with sitting, pivoting or deep squats is more often a labral tear or hip impingement than arthritis. The location is similar, which is why imaging is so helpful in sorting out joint pain.

When should you worry that the pain is in the bone?

Bone pain tends to be a deep, dull ache that gets worse with weight bearing and does not ease much when you press or stretch. AAOS OrthoInfo explains that a bone stress injury may first hurt only at the end of activity, then during walking and daily tasks, and eventually can ache at night in bed. It often follows a sudden increase in activity, and people with weaker bones can develop one even with everyday activities.

Bone pain with other warning signs deserves prompt imaging. Pain that is constant, worse at night regardless of position, getting steadily worse, or paired with fever or unexplained weight loss needs an evaluation soon. These are uncommon, and they should not be watched for weeks. If you are a runner or recently ramped up your walking and the groin aches with every step, ask about a stress injury specifically.

Why does an exam settle the question so quickly?

Self-checks give useful clues, but many people have more than one source of pain at once. Arthritis can coexist with outer hip tendon pain, and a stiff hip can strain the lower back. A hands-on exam lets Dr. Stride test each structure separately by pressing on tendons, rotating the joint, checking strength and testing nerves from the back.

Standing X-rays then show the bone and joint space within minutes. MedlinePlus notes that X-rays or an MRI may be needed to diagnose the cause of hip pain. An MRI or ultrasound is added when a tendon tear, labral tear or stress injury is suspected.

What should you do next?

If the pain began with a clear strain and is improving each week, rest and gradual return to activity are reasonable. If it is deep, not improving after a week or two, or comes with any warning signs, get an exam. MedlinePlus suggests contacting a provider if hip pain continues after a week of home treatment.

Before your visit, jot down where the pain is, how it started, what makes it better or worse and whether it wakes you at night. A short list like this, along with any medicines you take, often shortens the path to a diagnosis.

The Saturday Hip Pain Clinic at Dr. Stride Hip & Joint in Memorial City is set up for new hip pain. Bring any imaging you have, and our team will help you find out whether it is muscle, tendon, joint or bone, and what to do about it.

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