Hip pain: five signs not to ignore

The hip is a deep ball-and-socket joint, and it refers pain in confusing ways — into the groin, the outer thigh, the buttock, sometimes down to the knee. That makes it easy to misattribute and easy to postpone.

None of the signs below is a diagnosis on its own. Together they describe a joint that is not coping with its normal load, and that pattern responds far better to early assessment than to late.

Five patterns worth assessing

1. Pain when walking or standingWeight-bearing pain suggests the joint or its surrounding tendons are struggling with load rather than simply being stiff.
2. Stiffness after sitting too longNeeding a minute to 'get going' after sitting is one of the earliest and most commonly dismissed signs of hip joint change.
3. Pain when lying on one sideTenderness lying on the affected side often points to the tendons and bursa on the outside of the hip rather than the joint itself.
4. Sharp pain during movementA catch or sharp pain on twisting, turning or getting into a car suggests something mechanical inside or around the joint.
5. Pain that keeps coming backSymptoms that settle with rest and reliably return with activity indicate a capacity problem — the tissue is not tolerating the demand placed on it.

What an assessment involves

• History: where the pain sits, what provokes it, how it behaves across a day
• Hip range of motion, compared side to side
• Strength testing of the glutes, hip flexors and rotators
• Specific tests to distinguish joint, tendon, bursa and referred spinal pain
• Gait and functional assessment — stairs, sit-to-stand, single-leg stance
• Review of any existing imaging alongside the clinical findings