Hip Pain When Walking: Causes, Symptoms, and Management

Why do my hips hurt when I walk?

Hip pain experienced during walking is a common and often complex issue, frequently stemming from a range of musculoskeletal, structural, or referred conditions affecting the intricate network of bones, joints, muscles, tendons, and bursae around the hip.

Understanding Hip Anatomy and Biomechanics

The hip is a marvel of engineering: a ball-and-socket joint designed for both mobility and stability, crucial for bipedal locomotion. It comprises the head of the femur (thigh bone) fitting into the acetabulum (socket in the pelvis). Surrounding this joint are powerful muscle groups (gluteals, hip flexors, adductors, abductors), numerous tendons, shock-absorbing bursae, and a crucial cartilaginous ring called the labrum. Walking involves a complex interplay of these structures, requiring coordinated strength, flexibility, and balance. Any disruption to this system can manifest as pain.

Common Causes of Hip Pain During Walking

The precise location and nature of your hip pain can often provide clues to its underlying cause.

Musculoskeletal Issues

These are some of the most frequent culprits, often related to overuse, muscle imbalances, or inflammation.

• Osteoarthritis (OA): This degenerative joint disease involves the breakdown of cartilage within the hip joint. As cartilage wears away, bone-on-bone friction occurs, leading to pain, stiffness, and reduced range of motion, particularly during weight-bearing activities like walking. Pain is often felt in the groin, buttock, or outer thigh.
• Bursitis: Bursae are small, fluid-filled sacs that reduce friction between bones, tendons, and muscles.
  • Greater Trochanteric Bursitis: Inflammation of the bursa on the outside of the hip (greater trochanter). Pain is typically felt on the outer hip and often worsens with walking, lying on the affected side, or standing after sitting.
  • Iliopectineal Bursitis: Less common, this affects a bursa at the front of the hip. Pain is usually in the groin or front of the hip, exacerbated by hip flexion (e.g., lifting the leg).
• Tendinopathy: Inflammation or degeneration of tendons.
  • Gluteal Tendinopathy: Affects the tendons of the gluteus medius and minimus muscles where they attach to the greater trochanter. Similar to trochanteric bursitis, it causes lateral hip pain that worsens with walking, stairs, or single-leg stance.
  • Hip Flexor Tendinopathy (Psoas Tendinopathy): Affects the iliopsoas tendon at the front of the hip. Pain is felt in the groin or front of the hip, particularly with hip flexion (e.g., lifting the knee during the swing phase of walking).
  • Adductor Tendinopathy: Affects the inner thigh muscles. Pain is in the inner thigh or groin, especially with activities involving leg crossing or pushing off.
• Muscle Strains and Imbalances:
  • Gluteal Weakness: Weakness in the gluteus medius and minimus can lead to abnormal gait mechanics (e.g., Trendelenburg gait), placing increased stress on the hip joint and surrounding structures, causing pain on the side of the hip.
  • Tight Hip Flexors: Can pull the pelvis into an anterior tilt, increasing lumbar lordosis and placing abnormal stress on the hip joint and lower back during walking.
  • Piriformis Syndrome: The piriformis muscle, located deep in the buttock, can compress the sciatic nerve, causing buttock pain that may radiate down the leg, often worsened by walking or prolonged sitting.
• Iliotibial (IT) Band Syndrome: While more commonly associated with knee pain, tightness or friction of the IT band (a thick band of fascia running along the outside of the thigh) can cause pain on the outer hip due to friction over the greater trochanter during repetitive hip flexion and extension (walking).

Structural Issues

These involve damage or abnormalities to the bones or cartilage of the hip joint itself.

• Femoroacetabular Impingement (FAI): An abnormal bone growth on either the femoral head (CAM impingement) or the acetabulum (pincer impingement), or both. This leads to abnormal contact and pinching of the hip joint during movement, causing groin pain, especially with deep hip flexion or internal rotation, which can be exacerbated by walking.
• Labral Tear: A tear in the labrum, the cartilaginous rim that deepens the hip socket and provides stability. Tears can result from trauma, FAI, or degeneration. Symptoms include sharp groin pain, clicking, catching, or a sensation of instability, often worsened by walking.
• Stress Fractures: Tiny cracks in the bone, most commonly the femoral neck or pelvis, caused by repetitive stress (e.g., long-distance running, sudden increase in activity). Pain is typically deep, aching, and worsens significantly with weight-bearing activities like walking.
• Avascular Necrosis (AVN): Occurs when blood supply to the femoral head is interrupted, leading to bone death and collapse. Causes deep, persistent hip pain that worsens with weight-bearing.

Referred Pain

Pain felt in the hip may not always originate from the hip itself.

• Lumbar Spine Issues: Conditions like sciatica, herniated discs, or spinal stenosis in the lower back can cause nerve compression, leading to pain that radiates to the buttock, hip, or down the leg, mimicking hip pain. Walking can sometimes exacerbate these symptoms.
• Sacroiliac (SI) Joint Dysfunction: The SI joints connect the sacrum to the pelvis. Dysfunction here can cause pain in the lower back, buttock, and sometimes radiate to the hip or groin, often asymmetrical and worsened by walking or prolonged standing.
• Knee Problems: Significant pain or dysfunction in the knee can alter gait mechanics, placing abnormal stress on the hip and leading to compensatory pain.

Identifying the Location of Your Pain

Pinpointing the exact location of your hip pain can help narrow down the potential causes:

• Groin/Anterior Hip Pain: Often indicates issues within the hip joint itself (e.g., osteoarthritis, FAI, labral tear, hip flexor tendinopathy, iliopectineal bursitis).
• Lateral/Outer Hip Pain: Commonly associated with soft tissue problems outside the joint (e.g., greater trochanteric bursitis, gluteal tendinopathy, IT band syndrome).
• Posterior Hip/Buttock Pain: Can suggest issues with the gluteal muscles, piriformis syndrome, or referred pain from the lumbar spine or SI joint.

When to Seek Professional Medical Advice

While some mild hip pain may resolve with rest, it's crucial to consult a healthcare professional (e.g., physician, physical therapist, sports medicine specialist) if you experience:

• Severe or sudden pain
• Pain that worsens or persists despite rest and self-care
• Pain accompanied by fever, redness, or swelling
• Inability to bear weight on the affected leg
• Deformity around the hip joint
• Numbness, tingling, or weakness in the leg

A thorough evaluation, including a physical exam and potentially imaging (X-rays, MRI), is essential for an accurate diagnosis and appropriate treatment plan.

Initial Self-Care Strategies

While awaiting professional assessment, these steps can help manage discomfort:

• Rest and Activity Modification: Reduce or temporarily stop activities that aggravate your pain. Substitute with low-impact options like swimming or cycling if tolerated.
• Ice or Heat: Apply ice packs to the painful area for 15-20 minutes several times a day to reduce inflammation. Heat may be beneficial for muscle stiffness once acute inflammation subsides.
• Over-the-Counter Pain Relievers: NSAIDs (e.g., ibuprofen, naproxen) can help manage pain and inflammation, but use them as directed and be aware of potential side effects.
• Gentle Movement: Maintain some range of motion with gentle, pain-free movements within your comfort zone, but avoid movements that reproduce or worsen pain.

The Role of Exercise and Movement

Once a diagnosis is established, targeted exercise is often a cornerstone of treatment. A physical therapist can design a personalized program that may include:

• Strengthening Exercises: Focusing on the gluteal muscles (gluteus medius/maximus), core stabilizers, and hip abductors/adductors to improve stability and support.
• Flexibility and Mobility Exercises: Addressing any muscle tightness (e.g., hip flexors, hamstrings, IT band) that may contribute to pain or altered mechanics.
• Gait Retraining: Correcting abnormal walking patterns that may be contributing to hip stress.
• Proprioceptive Training: Exercises to improve balance and coordination, enhancing joint awareness and stability.

Consistency and proper form are paramount to prevent further injury and promote healing.

Prevention and Long-Term Management

Proactive measures can help reduce the risk of hip pain:

• Maintain a Healthy Weight: Excess body weight significantly increases stress on the hip joints.
• Regular, Balanced Exercise: Incorporate strength training, flexibility, and cardiovascular activities. Focus on balanced muscle development around the hips and core.
• Proper Footwear: Wear supportive shoes that fit well, especially for walking or exercise.
• Warm-Up and Cool-Down: Always include dynamic warm-ups before activity and static stretches afterward.
• Gradual Progression: Increase the intensity, duration, or frequency of exercise slowly to allow your body to adapt.
• Listen to Your Body: Don't push through pain. Rest and modify activities when discomfort arises.

Conclusion

Hip pain during walking is a multifaceted issue with a broad spectrum of potential causes, ranging from common musculoskeletal imbalances to more serious structural conditions. While initial self-care can offer temporary relief, an accurate diagnosis by a healthcare professional is paramount for effective, long-term management. Understanding the biomechanics of your hip and engaging in a tailored rehabilitation program are key steps toward alleviating pain and restoring optimal function, allowing you to walk freely and without discomfort.