Some hip symptoms should not wait for a routine appointment
Seek Urgent Medical Help for These Warning Signs
- Severe hip or groin pain after a fall, collision or other injury—especially when you cannot stand or take a few steps.
- A leg that appears shortened, turned outward or deformed, or an open wound near the hip.
- New numbness, weakness, tingling or a foot that becomes cold, pale or blue after an injury.
- A hot, very painful hip with fever, chills, confusion or feeling seriously unwell. A deep hip infection may not cause obvious skin redness.
- Sudden severe hip pain without injury, or rapidly worsening rest or night pain, particularly with steroid exposure, reduced bone strength or cancer history.
- A child with fever, sudden hip, thigh or knee pain, a new limp, or refusal or inability to bear weight.
- Hip or back pain with new loss of bladder or bowel control, numbness around the genitals or anus, or rapidly worsening weakness in both legs.
- One-sided leg swelling with chest pain, breathlessness, coughing blood, fainting or collapse.
Do not attempt to straighten or “put back” a deformed hip. Keep the person still and comfortable, avoid walking on the injured leg and arrange emergency transport. Follow the emergency team’s instructions about food and drink if an operation may be required.
A Simple Map of the Hip
Where is the Pain Felt?
“Hip Bursitis” is Often an Incomplete Label
Persistent pain over the outer hip frequently involves the gluteus medius or minimus tendons and the way the area is loaded, rather than an isolated inflamed bursa. Treatment therefore usually emphasises gradual gluteal strengthening, reducing compression and improving load tolerance—not repeated injections alone.
How the Pain Began Changes the Differential
Common Causes of Hip-Region Pain
Hip Pain and Limping in Children
Children are not simply small adults. Hip disease may be reported as thigh or knee pain, and an unwell child who cannot bear weight needs urgent assessment. Common or important possibilities include:
- Transient synovitis, sometimes called irritable hip: often follows a viral illness, but infection must first be considered in a febrile or very unwell child.
- Septic arthritis or bone infection: fever, marked pain, restricted movement and refusal to walk are urgent warning signs.
- Slipped upper femoral epiphysis: usually affects adolescents and may present with hip, thigh or knee pain and an altered foot position.
- Perthes disease: loss of blood supply to the developing femoral head can cause a persistent limp and reduced hip movement.
- Injury, stress injury or inflammation: the history, examination and age determine the appropriate imaging pathway.
Do not repeatedly force a painful child’s hip through movement or assume a limp is “growing pain.” Until assessed, keep the child from sport and activities that provoke pain.
What Happens During an Orthopaedic Assessment?
- History: exact location, onset, injury, stiffness, clicking, walking distance, night pain, fever, medicines and relevant medical risks.
- Function: gait, stairs, getting into a vehicle, putting on footwear, sitting, side-lying, work and sport.
- Observation: standing posture, limp, leg position, bruising, swelling and muscle bulk.
- Movement: flexion, extension and rotation, comparing sides and noting which movements reproduce familiar pain.
- Strength and tenderness: gluteal, flexor, adductor and hamstring function, with palpation of relevant structures.
- Beyond the hip: lower back, nerves, circulation, abdomen, groin, knee and leg length when the presentation requires it.
Provocative tests do not diagnose a labral tear, impingement or tendon disorder by themselves. Their value comes from reproducing the person’s familiar symptoms in a pattern that fits the complete assessment.
Which Tests or Scans Might Be Needed?
A Normal X-ray Does Not End Every Fracture Assessment
After trauma, continuing inability to bear weight or strong clinical suspicion may require MRI or CT even when initial radiographs are negative or uncertain. MRI is also particularly useful for bone stress injury and early avascular necrosis. Do not repeatedly test the leg by walking on it while awaiting reassessment.
What Can I Do Safely at First?
- Keep moving within tolerance: avoid prolonged bed rest for ordinary non-traumatic pain, but reduce movements that cause a sharp or lasting flare.
- Protect after injury: do not bear weight when a fracture is possible. Use support and seek assessment rather than “walking it off.”
- Cold for a fresh flare: apply a wrapped cold pack for up to 15–20 minutes. Protect skin and avoid cold where sensation or circulation is poor.
- Reduce outer-hip compression: avoid standing with the hip pushed sideways, crossing legs tightly or sleeping directly on the painful side. A pillow between the knees may help.
- Use comfortable seating: a firm chair that is not very low may make standing easier during an irritable phase.
- Consider walking support: a correctly sized stick in the hand opposite the painful hip can reduce load and improve confidence.
- Check medicine safety: kidney, stomach, heart or liver disease, pregnancy, allergies and blood thinners change which pain medicines are suitable.
Seek review when pain affects normal activity or sleep, worsens or recurs, produces a persistent limp, or fails to show steady improvement with sensible early care. Sudden severe pain, fever or inability to walk belongs in the urgent pathway.
Treatment Depends on the Pain Source and Your Goals
An injection is not a substitute for diagnosis or rehabilitation. Repeated steroid exposure can have local and systemic risks, including temporary blood-glucose elevation, and injection into or close to a tendon requires particular caution.
Useful Terms on a Hip Report
Myth vs Fact
Frequently Asked Questions
When should I arrange an orthopaedic consultation?
Arrange review when pain follows an injury, causes a persistent limp, limits ordinary activity or sleep, worsens or returns, or does not show steady improvement with sensible early care. Use the urgent pathway for red flags.
Is it safe to walk with hip pain?
Gentle walking is often useful for non-traumatic pain when it does not cause a marked limp or lasting flare. Do not bear weight after significant trauma or when fracture is suspected; seek assessment and use support.
Why is my hip pain felt in the groin?
The hip joint lies deep beneath the groin, so joint pain is commonly felt there. Hip flexors, adductors, hernias and abdominal or pelvic conditions can also cause groin pain, making examination important.
Why does my outer hip hurt when I lie on it?
Direct compression can irritate sensitive gluteal tendons and a nearby bursa. Avoiding the painful side temporarily, using a pillow between the knees and progressive strengthening may help once the diagnosis is clear.
Can back problems cause hip pain?
Yes. Lower-back joints and nerves can refer pain to the buttock, side of the hip, groin or leg. Numbness, tingling, weakness and pain below the knee make nerve involvement more likely but are not required.
Can hip problems cause knee pain?
Yes. The hip can refer pain down the thigh to the knee. Hip examination is especially important when knee findings do not explain symptoms or when a child presents with knee pain and a limp.
Will I need an X-ray?
Not every person needs imaging. When chronic hip pain or trauma requires a scan, hip and pelvis radiographs are commonly first. Typical osteoarthritis can often be diagnosed clinically unless features are atypical.
When is MRI useful?
MRI is useful for suspected occult fracture, bone stress injury, avascular necrosis, infection, tumour, tendon injury, cartilage or labral disease when the result is likely to change management.
Can ultrasound diagnose hip arthritis?
Ultrasound may show fluid and superficial tendons or bursae, but X-ray and clinical assessment are generally more useful for ordinary osteoarthritis. Ultrasound cannot completely assess deep bone, cartilage or the labrum.
Should I stretch a painful hip?
Gentle movement may help stiffness, but aggressive stretching can compress an irritable outer-hip tendon or aggravate an acute injury. Match the exercise to the diagnosis rather than forcing a painful range.
Do I need a walking stick?
A temporary stick can improve confidence and reduce load when walking is painful. It is commonly held in the opposite hand and adjusted so you can walk upright rather than leaning heavily.
Is a steroid injection a permanent cure?
No. It may provide temporary relief for a carefully selected joint, bursa or surrounding structure. Accuracy, infection risk, blood-glucose effects and tendon health are considered, and rehabilitation usually remains important.
Why can a fracture be missed on the first X-ray?
Some non-displaced or stress fractures are too subtle to see initially. Continuing severe pain or inability to bear weight may require MRI or CT even when the first radiograph was reported as normal or uncertain.
When can I return to running or sport?
Return depends on the diagnosis, not a fixed date. Walking and daily activity should be comfortable, movement and strength restored, and running, jumping or cutting load rebuilt gradually without a worsening response the following day.
What if hip osteoarthritis becomes severe?
Exercise, education, suitable pain relief and weight support where relevant remain important. If pain, stiffness or loss of function substantially affects quality of life despite appropriate non-surgical care, referral to a higher centre for joint-replacement assessment may be discussed.