Hip Pain: Causes, Treatment, and When to See a Physiotherapist

Published July 2026 · 10 min read · By the Circle Physiotherapy Clinical Team

Medically reviewed July 2026 by registered physiotherapists at Circle Physiotherapy Brampton.

Quick answer: Where your hip hurts is the biggest clue to what is wrong. Pain on the outside of the hip is usually gluteal tendinopathy, not true bursitis; pain in the groin or front of the hip usually comes from the hip joint itself — osteoarthritis, impingement, or a hip flexor strain; pain that flares with sitting often involves the deep gluteal muscles, the hamstring origin, or a nerve referred from the low back. Most hip pain responds well to physiotherapy built around load management and progressive strengthening. Circle Physiotherapy assesses and treats hip pain seven days a week at 10725 McLaughlin Rd Unit #5 in Brampton's Mount Pleasant area, with direct billing to most insurers.

"Hip pain" is really several different problems wearing the same name. The joint sits deep in the groin, but pain can show up on the outer thigh, in the buttock, down the leg, or only at night — and each pattern points to a different structure and a different fix. That is why the treatment your neighbour swears by can make your hip worse. This guide walks through hip pain the way a physiotherapist actually assesses it: by where it hurts and when it hurts, then what the evidence says to do about it.

Why Does the Outside of My Hip Hurt When I Lie on That Side?

Outer hip pain that flares when you lie on that side is most often gluteal tendinopathy — irritation of the gluteus medius and minimus tendons where they anchor to the bony point of the hip — a condition doctors group under the umbrella term greater trochanteric pain syndrome. For years this was routinely labelled hip bursitis, but imaging studies have shown the tendons, not the bursa, are the primary problem in most cases; the small fluid sac is usually only irritated secondhand, if at all. The distinction matters, because a tendon problem needs progressive strengthening, while treating it as pure inflammation — rest and repeated injections — often disappoints.

The classic picture is a woman over 40 (though it affects men and younger athletes too) with pain directly over the bony outer hip that is worse lying on that side at night, climbing stairs, standing on one leg, or after long walks. A key driver is compression: positions that squash the tendons against the bone — crossing your legs, standing with your hip hitched out to one side, sleeping on the sore hip — keep the irritation going even on days you do everything else right.

What Causes Pain in the Groin or Front of the Hip?

Groin and front-of-hip pain usually comes from the hip joint itself, because that is where the joint actually lives — deep in the fold of the groin, not out on the side where most people point. The common culprits sort roughly by age and activity:

• Hip osteoarthritis — gradual cartilage wear producing deep groin ache, morning stiffness that eases with movement, and difficulty with socks, shoes, and getting out of low chairs. Most common from middle age onward.
• Femoroacetabular impingement (FAI) and labral irritation — extra bone contact or irritation of the cartilage rim of the socket, felt as a pinching groin pain with deep squats, low seats, or twisting sports. More typical in younger, active adults.
• Hip flexor strain — an overload of the muscles at the front of the hip after a spike in running, kicking, or hill work, tender with resisted knee lift and long strides.

These conditions overlap in symptoms but diverge in treatment — an arthritic hip wants graded strength and mobility work, an impinging hip wants technique and range modifications first — so an accurate assessment up front saves months of guessing.

Why Does My Hip Hurt When Sitting?

Hip pain that builds with sitting usually points away from the hip joint and toward the structures you are actually sitting on: the deep gluteal muscles, the hamstring attachment, or a nerve referring from the low back. In deep gluteal syndrome — the family that includes piriformis-related pain — the sciatic nerve gets irritated as it passes through the buttock muscles, producing a deep ache or burning that worsens on firm chairs and long drives. Pain sharply localized to the sit bone, especially in runners, suggests proximal hamstring tendinopathy at its origin. And buttock pain with tingling or pain running down the leg raises the question of sciatica from the lumbar spine rather than anything in the hip at all. Sitting-related hip pain is the pattern people most often get wrong on their own — stretching harder and sitting on tennis balls tends to aggravate an irritated nerve — which is why it deserves a proper assessment rather than a guess.

Is My Hip Pain Actually Coming From My Back?

Quite possibly — the lumbar spine is one of the most common sources of pain felt around the hip and buttock, and referred back pain regularly masquerades as a hip problem. The joints, discs, and nerves of the lower back share nerve pathways with the buttock, groin, and thigh, so an irritated spinal segment can project pain into the hip region without the hip itself being injured. Some clues favour the back: pain that changes with bending, lifting, coughing, or prolonged sitting; pain that travels below the knee; tingling or numbness. Clues favouring the hip: deep groin pain, pain with putting on socks, a limp, and pain reproduced by rotating the hip.

A physiotherapist differentiates the two systematically — screening the spine with repeated movements to see if hip symptoms change, then testing the hip directly with rotation and impingement tests, resisted muscle testing, and single-leg tasks. When treating the back changes the "hip" pain and hip tests are clean, the answer is clear. Getting this call right early is the single biggest time-saver in hip rehab, because months spent strengthening a hip that was never the problem help nobody.

Hip Pain at Night — What Helps?

The fastest wins for night-time hip pain are positional: stop compressing the sore tendon and support the hip in neutral. If the outer hip is the problem, avoid lying on the painful side, and when lying on the good side place a firm pillow between your knees and ankles so the top leg cannot drop across your body — that dropped-leg position squeezes the gluteal tendons exactly where they hurt. A mattress topper can pad a very firm bed, and back sleepers with arthritic hips often do better with a slim pillow under the knees. Just as important is what you do in the daytime: night pain usually tracks daytime overload, so a day of long walks, stairs, and leg-crossing tends to be followed by a bad night. Settling the daily load and building tendon capacity — the physiotherapy piece — is what makes the nights improve for good rather than one at a time.

How Does Physiotherapy Treat Hip Pain?

Physiotherapy for hip pain is built on two pillars with the strongest evidence behind them: load management and progressive gluteal strengthening. Load management means finding the level of activity your hip currently tolerates — trimming the specific aggravators like stair volume, leg-crossing, or a sudden jump in walking — without resting so much that the tissue weakens further. Progressive strengthening then rebuilds the capacity of the gluteal muscles and tendons step by step, from isometric holds through bridges and band work to single-leg loading. For gluteal tendinopathy and hip osteoarthritis alike, structured strengthening is the intervention clinical guidelines put at the centre of care.

Around that core, your physiotherapist layers what your assessment shows you need: manual therapy to ease stiff joints and guarded muscles, gait and movement retraining to correct the hip-hitch or trunk lean that keeps overloading one side, and education so you know which symptoms to push through and which to respect. At our Brampton physiotherapy clinic this is delivered one-on-one, seven days a week, with direct billing to most major insurers so treatment is not delayed by paperwork.

Do I Need an X-Ray or a Hip Replacement?

Usually neither — most hip pain is assessed and treated well without imaging, and a hip replacement is an end-stage option, not a next step. X-rays are genuinely useful when the story suggests them: significant trauma, suspected arthritis that has stopped responding to conservative care, unexplained night pain, or planning for surgery. But imaging findings correlate poorly with pain — plenty of people have arthritic-looking X-rays and comfortable hips, and vice versa — so a scan alone should never decide your treatment. If an X-ray is warranted, your physiotherapist will say so and coordinate with your doctor.

Even confirmed hip arthritis is typically managed conservatively for years with strengthening, activity modification, and weight and pain management — and many people never need surgery at all. Replacement enters the conversation when pain is severe despite a genuine run of conservative care, function keeps shrinking, and the joint is end-stage on imaging. Doing the rehab first is not a delay tactic: stronger hips before surgery mean better recoveries after it, and your first visit establishes the baseline everything is measured against.

Exercises That Usually Help (and Two That Often Make It Worse Early On)

The exercises that help most hip problems are the unglamorous strength builders, dosed to your irritability level:

• Bridges — lying on your back, feet hip-width, lifting the hips by squeezing the glutes; progress to single-leg as pain allows.
• Side-lying work — clamshells and side-lying leg raises done with the body in a straight line, building the gluteus medius without compressing it.
• Sit-to-stand and step-ups — functional loading that translates directly into stairs, chairs, and confidence.
• Isometric holds — gentle sustained glute contractions, often the best-tolerated starting point when the hip is very irritable.

And the two that commonly backfire early on, especially with lateral hip pain: aggressive stretching of the outer hip and ITB — pulling the knee across the body feels productive but compresses the gluteal tendons against the bone, the very mechanism driving the pain — and sitting with crossed legs (or standing hitched onto one hip), which does the same thing slowly all day. Both often become fine later; in the irritable early phase they are the most common reason a hip that should be settling is not.

When Should You Seek Medical Review for Hip Pain?

See a doctor promptly — before starting or continuing rehab — if your hip pain comes with any of the following:

• Significant trauma such as a fall or collision, especially in older adults
• Inability to put weight through the leg
• Fever, chills, or feeling generally unwell alongside hip pain
• Constant night pain with systemic symptoms such as unexplained weight loss
• A new lump or swelling in the groin

These signs are uncommon, but they can indicate fracture, infection, or other conditions that need medical work-up first. Physiotherapists screen for exactly these red flags at every initial assessment and refer on without delay when something does not fit.

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