When a 30-something or 40-something shows up with hip pain, arthritis is usually not the answer. But that's where most internet searches lead, and the anxiety spiral begins. Here's what's actually causing hip pain in younger adults.
The Most Common Culprits
Hip Flexor Tendinitis / Iliopsoas Syndrome
Feels like: Pain in the front of the hip, worse with sitting for long periods, going from sitting to standing, or climbing stairs. Deep ache in the groin.
Who gets it: Runners, cyclists, desk workers, anyone who sits a lot and then exercises without adequate hip flexor mobility work.
What to do: Stretch the hip flexors (half-kneeling lunge stretch, couch stretch). Strengthen the glutes (the hip flexors overwork when the glutes are weak). Reduce running volume temporarily. It usually resolves in 4-6 weeks with consistent management.
Hip Labral Tear
Feels like: Catching, clicking, or locking sensation in the hip. Pain with pivoting or twisting. A deep ache in the groin that's hard to localize. Sitting in low chairs or car seats is uncomfortable.
Who gets it: Athletes (soccer, hockey, martial arts), people with femoroacetabular impingement (FAI), and sometimes with no identifiable cause.
What to do: Diagnosis requires an MRI with arthrogram (dye injected into the joint). Not all labral tears need surgery. Many respond to physical therapy focusing on hip stability and avoiding positions that provoke symptoms (deep squats, sitting cross-legged). Surgery (arthroscopic labral repair) is considered when 3-6 months of PT hasn't helped.
Greater Trochanteric Pain Syndrome (Hip Bursitis)
Feels like: Pain on the outside of the hip, over the bony prominence. Worse when lying on that side at night. Aching after walking or climbing stairs.
Who gets it: Women more than men (3:1 ratio). Runners. People who suddenly increase walking or stair climbing.
What to do: The name "bursitis" is somewhat misleading - the bursa may not actually be inflamed. The real problem is usually gluteal tendinopathy (breakdown of the gluteus medius tendon). Treatment: lateral hip strengthening (sidelying leg raises, banded walks), avoid crossing legs and lying on the affected side, and consider a cortisone injection if pain is preventing sleep. Stretching the IT band does not help (despite what the internet says).
Stress Fracture
Feels like: A deep, aching pain in the groin or front of the thigh that gets worse with weight-bearing activity and improves with rest. Typically comes on gradually over weeks.
Who gets it: Distance runners, military recruits, people with low bone density, female athletes with menstrual irregularities.
What to do: This is the one you don't want to miss. A hip stress fracture (femoral neck) can become a complete fracture if you keep running on it, which is a surgical emergency. If you have groin pain that worsens with running and doesn't fit the other patterns, get an MRI. X-rays are often negative early.
Femoroacetabular Impingement (FAI)
Feels like: Groin pain with deep flexion (squatting, sitting in low chairs, bringing knee to chest). Pain during or after sports. Stiffness in the hip.
Who gets it: Active people in their 20s-40s. The hip anatomy is abnormal from birth (cam or pincer morphology), but symptoms typically start with increased activity or sports.
What to do: Physical therapy first. Modify activities that provoke pain (avoid deep squats, limit sitting with knees above hips). If conservative treatment fails after 3-6 months, arthroscopic hip surgery can reshape the bone and repair the labrum. Results are good in appropriately selected patients.
When to See a Doctor
- Pain that lasts more than 2-3 weeks despite rest and basic stretching
- Groin pain that gets worse with weight-bearing activity (rule out stress fracture)
- Clicking or catching in the hip with specific movements
- Night pain that disrupts sleep
- Limping or inability to bear full weight
The Imaging Question
X-rays are the starting point and can show arthritis, FAI bone morphology, and obvious fractures. But for soft tissue problems (labral tears, tendinopathy, stress fractures), MRI is needed. An MRI with arthrogram is the gold standard for labral tears.
Don't assume a normal X-ray means nothing is wrong. Most hip problems in younger adults are soft tissue issues that don't appear on X-rays.