"Hip pain" can mean very different things. Pain deep in the groin, pain on the outside of the hip when you lie on that side, and pain in the buttock that shoots down the leg usually have different causes and need different treatments. Getting the cause right matters more than any single treatment choice, including embolization. This guide explains the most common causes of chronic hip pain in adults, how doctors tell them apart, and which ones embolization has been studied for. For an overview of the procedure, see our hip embolization page.
Where it hurts is the first clue
Doctors often sort hip pain by location, because each area tends to point toward a different group of causes:
| Where you feel it | Common causes |
|---|---|
| Front of the hip or groin | Problems inside the joint: osteoarthritis in older adults; labral tears or hip impingement in younger adults; less often a stress fracture or loss of blood supply to the bone |
| Outside of the hip | Greater trochanteric pain syndrome, which includes gluteal tendinopathy or tears, bursitis and iliotibial band irritation |
| Back of the hip or buttock | Pain referred from the lower back, sacroiliac joint problems, hamstring tendon problems, or irritation of the sciatic nerve deep in the buttock |
This sorting comes from a 2021 review in American Family Physician. It is a starting point, not a diagnosis. Many people have more than one problem at once. In one Brazilian registry of outer hip pain, about two-thirds of the treated hips also showed arthritis on MRI.
Hip osteoarthritis
Osteoarthritis is wear-related damage to the cartilage that lines the ball and socket of the hip, along with changes in the bone and the joint lining. It typically causes:
- Pain in the groin or front of the hip.
- Gradual onset, usually in people over about 45.
- Pain with walking, standing or sitting for long periods.
X-rays often show narrowing of the joint space and bony spurs. Standard first steps include exercise, weight loss if needed, anti-inflammatory medicines and steroid injections, all strongly recommended in the 2026 American College of Rheumatology guideline. Hip replacement is the established treatment for advanced arthritis. Our comparison of hip embolization, hip replacement and injections explains how those options stack up.
Greater trochanteric pain syndrome: bursitis and gluteal tendinopathy
The bony bump on the outside of your upper thigh is called the greater trochanter. Several gluteal tendons attach there, and small fluid-filled sacs called bursae cushion the area. Greater trochanteric pain syndrome (GTPS) is the umbrella term for pain from this region. It used to be called "trochanteric bursitis," but doctors now recognize that irritated or damaged gluteal tendons (gluteal tendinopathy) are a major part of the problem.
GTPS is the most common cause of pain on the outside of the hip. It is seen most often in women between 40 and 60, often without any injury. Typical features include:
- Pain and tenderness over the outside of the hip.
- Pain when lying on the affected side, which can disrupt sleep.
- Pain with walking or other activity, and with sitting for long periods.
Exercise-based physical therapy is the first-line treatment and has the strongest evidence. In the LEAP trial of 204 people, an eight-week education and exercise program outperformed a steroid injection for overall improvement at one year. Injections can help in the short term, and surgery is reserved for people with a clear diagnosis whose pain persists after other treatment.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Embolization Guide.
Other causes worth knowing about
- Labral tears and hip impingement: common causes of groin pain in younger, active adults, sometimes with clicking or catching.
- Lower back problems: arthritis or a pinched nerve in the spine can cause buttock and hip pain, often with pain, numbness or tingling below the knee.
- Sacroiliac joint pain: pain low in the back and buttock, near the dimples above the buttocks.
- Hamstring tendinopathy: pain at the sitting bone, worse with sitting or running.
- Rheumatoid and other inflammatory arthritis: stiffness that is worse after rest, sometimes with other swollen joints.
- Avascular necrosis: loss of blood supply to the ball of the hip, which can cause deep groin pain and needs prompt evaluation.
- Stress fractures and hip fractures: pain with weight bearing, especially after a fall or a sudden increase in activity, or in people with weak bones.
How the cause is diagnosed
A careful history and physical exam come first. Your doctor will ask where the pain is, what makes it worse, and how it affects sleep and activity, then examine your hip, back and walking pattern. For chronic hip pain, standing X-rays of the pelvis and hip are the usual first imaging test. An MRI or ultrasound may follow, especially for outer hip pain or when X-rays do not explain the symptoms. Sometimes a numbing injection is used to confirm that the pain comes from a particular spot.
Which causes has embolization been studied for?
Hip embolization has been studied in small numbers of people with two conditions:
- Hip osteoarthritis, mainly mild to moderate, in studies from Germany, Portugal, Romania, Italy and Brazil.
- Greater trochanteric pain syndrome, mainly in studies from one group in Brazil and in the Portuguese HipE study.
It has not been studied for labral tears, back-related pain, hamstring problems, avascular necrosis, inflammatory arthritis, fractures or pain after hip replacement, and several of these were specifically excluded from the research. Even for arthritis and outer hip pain, the evidence is early and comes without placebo comparisons. Our candidacy guide explains who has been treated so far.
While you sort out the cause
Chronic hip pain rarely needs to be solved in a single visit, and a few steps are reasonable for most people while the diagnosis is confirmed. Staying active within comfortable limits matters, because exercise is strongly recommended for hip arthritis and is the best-supported treatment for outer hip pain. For outer hip pain, the LEAP program paired exercise with education about managing the load on the gluteal tendons during daily activities. Locally applied heat or cold is a conditional option in the 2026 ACR guideline. Keep a short record of where the pain is, what triggers it and what helps, since that history is often the most useful clue your doctor has. If pain keeps you from sleeping or walking, do not wait months to be seen.
When hip pain needs urgent care
Seek emergency care if you have severe hip pain after a fall or injury, cannot walk or put weight on your leg, or have tingling or loss of feeling after an injury. Get same-day medical advice if hip pain starts suddenly and severely without a fall, your hip is hot and swollen, the skin around it changes color, or you feel unwell with a high temperature. These can signal a fracture or a joint infection.
To learn how embolization is used for other joints, explore our embolization guide.
Frequently Asked Questions
How can I tell if my hip pain is arthritis or bursitis?
Arthritis usually causes gradual pain in the groin or front of the hip with stiffness, while greater trochanteric pain syndrome (often called bursitis) causes pain on the outside of the hip, especially when lying on that side. An exam and X-rays help tell them apart, and some people have both.
Is trochanteric bursitis the same as gluteal tendinopathy?
They overlap. Both fall under greater trochanteric pain syndrome, and doctors now recognize that gluteal tendon problems are a major source of what used to be called bursitis.
Can back problems cause hip pain?
Yes. Spine problems can cause pain in the buttock and hip, often with pain, numbness or tingling that travels below the knee. Hip treatments, including embolization, would not be expected to help pain that comes from the spine.
What is the first test for chronic hip pain?
Standing X-rays of the pelvis and hip are the usual first imaging test. An MRI or ultrasound may be added, especially for pain on the outside of the hip.
Keep Reading
- Hip Embolization in Manhattan
- Is Hip Embolization Covered by Insurance?
- Is Hip Embolization Painful? What to Expect Before, During and After
- Hip Arthritis: Symptoms, Diagnosis and Treatment Options
- Hip Embolization: Am I a Candidate?
- Hip Embolization Recovery Timeline
- Embolization Guide: knee, heel, shoulder, elbow and hip
Sources
- Chamberlain, American Family Physician, 2021 — Hip pain in adults: evaluation and differential diagnosis
- NHS — Hip pain: when to get help and common causes
- Gill et al., Cureus, 2025 — Management of greater trochanteric pain syndrome: a narrative review
- Mellor et al., BMJ, 2018 — Education plus exercise vs corticosteroid injection vs wait and see for gluteal tendinopathy (LEAP trial)
- Wang et al., J Orthop Surg Res, 2025 — Conservative treatment for greater trochanteric pain syndrome: network meta-analysis of 19 RCTs
- American College of Rheumatology, 2026 — Update of recommendations for management of osteoarthritis of the knee, hip, and hand (summary)
- Giordani et al., Cardiovasc Intervent Radiol, 2025 — Latino-Hip registry: midterm follow-up of embolization for GTPS (31 patients)
- Cavalheiro, Marinho Lopes et al., Cardiovasc Intervent Radiol, 2026 — HipE study: hip embolization for hip OA and GTPS, 12-month follow-up
- Fleckenstein et al., Cardiovasc Intervent Radiol, 2026 — Transarterial embolization for symptomatic hip osteoarthritis (41 patients)
- Feier, Bloj et al., J Clin Med, 2026 — Periarticular embolization vs conservative care in surgery-ineligible hip OA (prospective comparative study)
- Discalzi et al., Radiol Med, 2026 — FIRE-NEM: microembolization for refractory hip, knee and shoulder pain (42 patients)
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.
