Hip Pain That Will Not Quit: Common Causes and How PT Helps

By Dr. Matt Johnson, PT, DPT, OCS, CMPT, TPI-CERT, FAAOMPT – Updated 30 September 2026

Hip pain can be sneaky. It might show up as a deep ache in the groin, a sharp pinch when you sit too long, or a soreness on the outside of the hip that flares when you lie on that side at night. And because the hip sits so close to the lower back and shares nerves with the leg, it can be genuinely hard to know where the pain is coming from. If your hip pain has hung around and you are tired of guessing, this guide will help. We will walk through the common causes, how to tell hip pain from back pain, what actually helps, and when it is time to get it checked, so you can get back to moving freely without drugs or surgery.

Common causes of hip pain

The hip is a large, deep ball-and-socket joint built to carry load and move in every direction. When it hurts, the cause usually falls into a few categories, and most respond well to the right care.

Bursitis and tendon irritation on the outside of the hip. Pain on the bony point on the outside of the hip is one of the most common patterns we see. It often involves irritation of a bursa, a small cushioning sac, or the tendons that attach nearby. As the AAOS OrthoInfo guide to hip bursitis describes, this pain typically sits at the point of the hip, spreads down the outer thigh, and is often worse at night when lying on that side and when getting up after sitting.

Joint-related pain and early arthritis. Pain felt deep in the groin or the front of the hip, along with morning stiffness that eases as you move, can point to the joint itself. This is common as we age and usually responds well to targeted exercise and activity adjustments.

Muscle and tendon overload. The muscles around the hip and pelvis do a lot of work. Overload from a sudden increase in activity, or from weakness that makes some muscles pick up more than their share, can create a nagging ache.

Referred pain from the back. Sometimes what feels like hip pain is actually coming from the lower back, where an irritated nerve refers pain into the hip and buttock. This is the source of a lot of confusion, so it deserves its own section.

Is it your hip, or your back?

This is one of the most common questions we hear, and it genuinely matters, because the treatment differs. Here is a practical way to think about it.

More likely the hip joint itself when the pain is felt in the groin or deep in the front of the hip, when it worsens with deep squatting, pivoting, or crossing your legs, and when you feel stiffness or catching in the joint.

More likely the lower back when the pain sits more in the buttock or the outer hip and travels down the back of the leg, when it changes with the position of your spine (such as bending or arching), and when it comes with tingling or numbness.

The two can also happen together, and the outside of the hip is a spot where hip and back problems can feel almost identical. That overlap is exactly why a hands-on assessment beats guessing. If a back nerve is the real driver and testing is warranted, your therapist may suggest nerve testing at Neuromuscular Diagnostics, which offers EMG and NCV nerve testing.

Pain is where you feel it, not always where it starts

The outside-hip example is a perfect illustration of a principle we come back to often: the sore spot is not always the source. Weak hip and pelvic muscles, a stiff lower back, or even the way you stand and walk can all funnel stress toward the outside of the hip. Treating only the tender spot with rest or a rub often brings short-lived relief, while addressing the movement pattern that overloaded it is what makes relief last. That is why a good hip assessment looks at your back, your pelvis, and how you move, not just the point that hurts.

The everyday patterns behind Chicago hip pain

Hip pain often builds from ordinary habits rather than a single injury. Long hours sitting, whether commuting, at a desk, or on the couch through a long Chicago winter, keep the hip flexors short and the glutes underused, a combination that loads the hip poorly when you finally get up and move. Sleeping on one side night after night compresses the outer hip. A sudden spring return to running or long walks along the lakefront after a sedentary winter can overload muscles that are not ready. None of these are dramatic, which is exactly why hip pain so often sneaks up gradually.

What actually helps

Keep moving in comfortable ranges. Gentle, regular movement usually beats prolonged rest, which can stiffen the joint and weaken the muscles that support it.

Strengthen the hip and pelvic muscles. The glutes and deep hip muscles are the engine and the stabilizers of the hip. Building them is one of the most reliable ways to unload an irritated hip and keep pain from returning.

Adjust the daily loads. Small changes, such as how you sit, sleep, and get up from a chair, can take meaningful pressure off the hip while it settles.

How physical therapy helps at Muscle & Joint

At Muscle & Joint Physical Therapy, we assess how your hip, pelvis, and lower back move together, where you are stiff or weak, and what brings on your pain, then build a plan to ease the pain and restore free, strong movement. As an independent, employee-owned clinic, we take the time to sort out the hip-versus-back question and explain what we find in plain language. Learn more on our hip and pelvic pain physical therapy in Chicago page.

Depending on what we uncover, your care may include hands-on manual therapy to restore motion, targeted strengthening for the hip and core, and coaching on the daily habits that are loading the joint. Where the lower back is part of the picture, we address that too, and you can read more on our lower back pain physical therapy in Chicago page. The general medical guidance agrees with our clinical experience here: the Mayo Clinic notes that bursitis is usually managed conservatively, with activity changes and therapy, rather than jumping to invasive options.

We cannot promise a specific outcome, since every hip is different. What we can offer is skilled hands, real recovery, and clear answers. Many people find that with the right plan, they can walk, sit, and sleep more comfortably again.

A simple self-check

You cannot diagnose a hip from an article, but these questions help you describe it and decide what to do.

Where is the pain? Groin and deep front-of-hip pain leans toward the joint. Outer-hip pain that is worse lying on that side leans toward bursitis or tendon irritation. Buttock pain traveling down the leg leans toward the back.
What makes it worse? Deep squatting and pivoting stress the joint. Lying on the side stresses the outer hip. Bending and arching the spine stress the back.
How long has it lasted? A few days of soreness after a big activity is often self-limiting. Weeks of ongoing pain is a signal to get it addressed.

Where is the pain? Groin and deep front-of-hip pain leans toward the joint. Outer-hip pain that is worse lying on that side leans toward bursitis or tendon irritation. Buttock pain traveling down the leg leans toward the back.

What makes it worse? Deep squatting and pivoting stress the joint. Lying on the side stresses the outer hip. Bending and arching the spine stress the back.

How long has it lasted? A few days of soreness after a big activity is often self-limiting. Weeks of ongoing pain is a signal to get it addressed.

See a physical therapist if your hip pain has lasted more than a week or two, limits your walking, or disrupts your sleep. In Illinois you may be able to start without a referral, though your insurance may have its own rules.

Seek prompt medical care if hip pain follows a fall, you cannot bear weight, or the leg looks turned or shortened, since those can signal a fracture or other urgent problem.

How long does hip pain take to settle?

We avoid firm promises, since hips vary, but here is what is typical. Irritation and overload patterns often improve within a few weeks of consistent care that pairs hands-on treatment with the right strengthening. Longstanding or joint-related pain can take longer, and the goal there is often to build strength and adjust loads so you can stay active and comfortable. The people who do best are the ones who keep up the hip and core strengthening after the pain eases, since that is what protects the joint going forward. After your first visit, we will give you an honest, individualized picture.

Simple daily habits that protect your hips

Because so much hip pain builds from ordinary routines, a few small habits can go a long way toward keeping it away. These are easy to fold into a normal Chicago day.

Break up long sitting. Stand, stretch, and walk for a minute or two every half hour or so, especially on long workdays or commutes, to keep the hips from stiffening.
Wake up the glutes. A short daily set of simple glute exercises keeps the hip’s main stabilizers doing their job, so the joint and outer hip are not left to absorb the load.
Mind your sleep setup. If you sleep on your side, a pillow between the knees keeps the hip in a more neutral, comfortable position and takes pressure off the outer hip.
Ramp activity gradually. When you return to running or long walks after a quieter stretch, build up over a couple of weeks rather than all at once.

Break up long sitting. Stand, stretch, and walk for a minute or two every half hour or so, especially on long workdays or commutes, to keep the hips from stiffening.

Wake up the glutes. A short daily set of simple glute exercises keeps the hip’s main stabilizers doing their job, so the joint and outer hip are not left to absorb the load.

Mind your sleep setup. If you sleep on your side, a pillow between the knees keeps the hip in a more neutral, comfortable position and takes pressure off the outer hip.

Ramp activity gradually. When you return to running or long walks after a quieter stretch, build up over a couple of weeks rather than all at once.

Small, consistent habits like these often do more for long-term hip comfort than any single treatment.

Frequently asked questions

How do I know if it is my hip or my back? As a rough guide, groin and deep front-of-hip pain points toward the hip joint, while buttock pain that travels down the leg, or pain that changes with the position of your spine, points toward the back. They can overlap, so a hands-on exam is the clearest way to tell, and it directs treatment to the real source.

Does hip pain mean I will eventually need a hip replacement? Not usually. Many causes of hip pain, including bursitis, tendon irritation, and even a lot of joint-related pain, improve with physical therapy and activity changes. We will give you an honest picture of what we see and whether a specialist opinion is worth getting.

Why is my hip worse at night? Outer-hip pain, in particular, often flares at night because lying on that side compresses the irritated tissues. Adjusting your sleep position, sometimes with a pillow between the knees, can reduce the pressure while the area settles.

Is it safe to keep exercising? Often, with the right adjustments. We can usually help you keep moving by modifying which activities, ranges, and loads you use, rather than shutting everything down, since staying active generally helps the hip.

Can sitting all day cause hip pain? It can contribute. Long sitting keeps the hip flexors short and the glutes underused, which changes how the hip is loaded when you stand and move. Regular movement breaks and glute strengthening help offset it.

Move freely again

Hip pain can quietly limit the simple things, from your walk to the office to your sleep, but it does not have to be permanent. With the right plan, most people move and rest more comfortably again. Muscle & Joint Physical Therapy has two Chicago locations, Lakeview and Ravenswood, with therapists who will answer your questions and remember your name.

Ready to start? Request an appointment online, or give us a call:

Lakeview: 773-857-0689
Ravenswood: 773-337-7747

Where Comebacks Happen.®

About the Author

Dr. Matt Johnson, PT, DPT, OCS, FAAOMPT, is the founder of Muscle & Joint Physical Therapy. A board-certified orthopedic specialist and Fellow of the American Academy of Orthopedic Manual Physical Therapy, he has advanced training in manual therapy and dry needling and treats everyone from weekend warriors to marathon runners, golfers, and CrossFit athletes.

This article is general health information, not medical advice, and reading it does not create a provider-patient relationship. Every person is different. Please talk with a licensed physical therapist or physician about your specific situation. If your symptoms are severe or worsening, please see a provider promptly.