Chronic knee pain
Hip and knee pain refer to each other; assessing both is standard practice.
Chronic hip pain explained.
'Hip pain' covers at least three distinct problems with different treatments. Getting the location right is most of getting the plan right.
What is chronic hip pain?
Chronic hip pain is pain in or around the hip lasting three months or longer. Where it is felt matters: groin pain usually points to the hip joint itself, outer-hip pain to gluteal tendinopathy or bursitis, and buttock pain often to the lumbar spine or sacroiliac joint referring down. Each has a different evidence-based treatment path.
At a glance
- Definition
- Hip-region pain lasting 12 weeks or more
- ICD-10
- M25.55- (pain in hip); M16.- for hip osteoarthritis
- Groin pain
- Usually the hip joint — osteoarthritis or femoroacetabular impingement
- Outer hip pain
- Usually gluteal tendinopathy (greater trochanteric pain syndrome), not true bursitis
- Buttock pain
- Often referred from the lumbar spine or sacroiliac joint
- First-line care
- Exercise and load management for all three; injections and surgery are selective
Key takeaways
- Location is the first diagnostic step — groin, outer hip, and buttock mean different things.
- Outer-hip pain is usually tendon-related, and the old label 'trochanteric bursitis' is mostly a misnomer.
- Stretching a painful gluteal tendon by crossing the leg over often makes it worse, not better.
- Hip replacement is one of the most effective operations in medicine — for end-stage joint disease, not for tendon pain.
- Long-standing hip pain usually has a sensitisation component worth treating in its own right.
Where does it hurt? Mapping hip pain to its cause
| Where you feel it | Most likely source | Typical pattern |
|---|---|---|
| Groin, deep, sometimes into the front of the thigh | Hip joint — osteoarthritis or impingement | Stiff after rest, worse on deep flexion and rotation, hard to put socks on |
| Outer hip, over the bony point | Gluteal tendinopathy (greater trochanteric pain syndrome) | Very painful lying on that side, worse on single-leg loading and stairs |
| Buttock, sometimes down the back of the leg | Lumbar spine or sacroiliac joint referral | Changes with spinal position, may come with back pain or leg symptoms |
| Front of hip with catching or clicking | Femoroacetabular impingement or labral irritation | Younger, more active people; pain on deep squatting and pivoting |
The C-sign. People with true hip joint pain often cup the hand above the greater trochanter with the thumb toward the groin when describing where it hurts. It is a surprisingly reliable pointer to the joint itself.
Why does my outer hip hurt when I lie on it?
That pattern is close to diagnostic for gluteal tendinopathy, the most common cause of lateral hip pain. It was long called trochanteric bursitis, but imaging and surgical series show the tendon — not the bursa — is usually the problem.
Tendons dislike two things in particular: compression, and sudden increases in load. The classic aggravators for this tendon all involve compressing it against the bone:
- Lying on the affected side — direct compression, which is why night pain is so characteristic.
- Crossing your legs, or standing with the hip pushed out to one side.
- Stretches that pull the leg across the body — often prescribed with good intentions, and often the thing making it worse.
Treatment is the opposite of intuition: reduce compression, then load the tendon progressively. Isometric holds early, then graded strengthening of the hip abductors. Most cases improve substantially with a well-run program over three to six months.
How is chronic hip pain treated?
Hip osteoarthritis
- Exercise therapy — strengthening and aerobic activity, first-line in every guideline.
- Education and load management, including pacing and activity modification.
- Weight management where relevant.
- Analgesia for symptom control, used to enable activity rather than replace it.
- Total hip replacement for end-stage disease with substantial functional loss. Outcomes are excellent and satisfaction is among the highest of any elective operation.
Gluteal tendinopathy
- Remove compression — side-lying positioning, avoid leg-crossing and hip-hanging stances.
- Progressive loading starting with isometrics and building to full abductor strengthening.
- Patience. Tendons remodel slowly; three to six months is a normal timeframe.
- Corticosteroid injection gives short-term relief but underperforms exercise at one year, so use it to enable loading rather than instead of it.
How Karuna can help
Hip pain narrows life quickly — walking distance, stairs, sleeping position, sitting tolerance. When it has lasted months, the fear attached to those activities becomes part of what maintains the pain.
Karuna's 12-week program addresses that layer directly: VR embodiment training and graded exposure to rebuild confidence in loading, weight-shifting, and walking, with weekly one-on-one coaching and physician oversight, entirely from home. See how it works.
Frequently asked questions
What is the ICD-10 code for chronic hip pain?
M25.551 is pain in the right hip, M25.552 the left, M25.559 unspecified. Hip osteoarthritis uses M16.- with laterality.
Should I stretch a painful outer hip?
Usually not with the classic cross-body stretches. Those positions compress the gluteal tendon against the greater trochanter, which is the mechanism that irritates it in the first place.
Progressive strengthening — starting with isometric holds — is the better-supported approach, alongside removing the compressive positions from your day.
Can hip pain come from the back?
Yes, frequently. Lumbar spine and sacroiliac joint problems refer into the buttock and sometimes down the leg, and are a common reason 'hip' treatment fails.
A useful clue: pain that changes with spinal position rather than with hip movement points upstream.
When should I consider hip replacement?
When you have end-stage osteoarthritis on imaging, substantial pain and functional limitation, and a genuine course of exercise-based conservative treatment has not given you enough.
It is a highly effective operation with high satisfaction rates. The reason to try conservative care first is that a meaningful proportion of people do well enough without it — not that the surgery is a poor option.
Why is my hip pain worse at night?
For gluteal tendinopathy, side-lying compresses the tendon directly. For hip osteoarthritis, the joint stiffens with prolonged stillness.
Positioning helps: a pillow between the knees when side-lying reduces the adduction that compresses the tendon.
Related guides.
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