Muscle, joint & pain

Groin Pain or Side Pain: Two Different Hips

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Two of the most common causes of hip pain live in completely different places: osteoarthritis deep in the joint itself, felt in the groin, and bursitis or gluteal tendinopathy on the bony point of the outer hip, felt on the side. Knowing which one you have starts with pointing to exactly where it hurts.

Last updated: July 2026

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Groin Pain or Side Pain: The Fastest Clue

Hip osteoarthritis and hip bursitis are two of the most common reasons for hip pain, and they announce themselves in almost opposite places 1. Osteoarthritis wears down the cartilage inside the ball-and-socket joint, so its pain concentrates in the groin and can spread to the front of the thigh or knee. Bursitis, and the tendon irritation that usually goes with it, sits over the bony point on the outer hip instead.

That single distinction — groin versus outer hip — resolves a large share of the broader question of why does my hip hurt before any test is ordered.

What Hip Osteoarthritis Feels Like

Hip osteoarthritis pain is typically felt deep in the groin, sometimes radiating down the front of the thigh toward the knee, and it is often accompanied by stiffness that is worst first thing in the morning or after sitting for a while, then eases somewhat with movement 1. It tends to build gradually over months to years rather than appearing overnight.

Osteoarthritis is the most common form of arthritis, caused by the gradual breakdown of the cartilage that cushions the joint, and it becomes more frequent with age and, after age 50, more frequent in women 2. In the United States, an estimated 58.5 million adults have doctor-diagnosed arthritis of some kind 3. This pairing, hip arthritis and the groin ache, is common enough that clinicians usually ask about groin pain first when an older adult reports hip trouble — though X-ray severity does not always track with how much pain someone feels, and this radiographic hip OA vs symptoms discordance is one reason exam findings and daily function matter as much as the film itself.

What Hip Bursitis Feels Like

Pain from bursitis, or from the gluteal tendons that more often turn out to be the real source of this kind of ache, is felt over the bony point on the side of the hip — sharp or aching, worse when lying directly on that side, climbing stairs, or standing up after sitting. It rarely reaches into the groin the way arthritis does.

This pattern is sometimes called greater trochanteric pain syndrome, since research over the past two decades has shown that the tendons attaching to that bone, not the bursa itself, are usually the main problem — a distinction that mostly changes what the condition is called, not how it is treated. This nocturnal hip pain, worse when lying on the affected side, is one of the more reliable ways to distinguish it from arthritis pain, which is less consistently tied to sleeping position.

Why the Two Conditions Get Mixed Up

Both conditions can cause a limp, both can flare with walking or stairs, and both are common enough in the same age group that a person can plausibly have either, or both together. The clearest way through the confusion is still location: groin pain points toward the joint itself, outer hip pain points toward the tendons and bursa beside it.

A clinician's exam adds to this: rotating the hip inward and outward tends to reproduce joint-based pain, while direct pressure over the bony point on the side of the hip, or resisted movement of the leg out to the side, tends to reproduce tendon-and-bursa pain instead. A third possibility worth ruling out is pain referred from the low back — sciatica vs hip pain is its own common source of confusion, since a pinched nerve in the low back can send referred hip pain into the buttock and outer thigh that mimics bursitis without any problem in the hip joint or tendons at all.

How Treatment Differs

First-line treatment for hip osteoarthritis strongly favors exercise, along with weight loss for people who are overweight, as the interventions with the most consistent benefit, with topical or oral anti-inflammatory medication and corticosteroid injections used more selectively 4. Guideline-based physical therapy for hip osteoarthritis also emphasizes patient education and manual therapy alongside exercise 5.

One common treatment turns out not to help much either way: acetaminophen provides only a small, not clinically meaningful benefit for hip and knee osteoarthritis pain, despite how often it is reached for first 6.

Managing the Outer-Hip Pain

Care for bursitis and gluteal tendinopathy typically starts with activity modification — avoiding lying directly on the painful side, reducing time spent standing on one hip, and a graded loading exercise program for the gluteal muscles — before moving toward an injection for pain that does not settle.

The ACR/Arthritis Foundation guideline for osteoarthritis, in the same spirit, recommends against several once-common but low-value treatments while strongly endorsing exercise and self-management as the foundation of care regardless of which structure in the hip is actually causing the pain 4.

Common questions

Yes, this is common, especially in older adults. The two conditions share risk factors like age and activity level, and having pain in the joint itself does not protect against also developing tendon or bursa irritation on the outer hip.

Not usually. X-rays show bone and joint space, so they can reveal the joint narrowing typical of arthritis, but bursitis and gluteal tendon problems are soft-tissue conditions better seen on ultrasound or MRI, when imaging is needed at all.

Pain that is worse lying on the affected side at night is a classic feature of bursitis and gluteal tendinopathy, since direct pressure on the outer hip compresses the irritated tendons. Arthritis pain is less consistently tied to sleeping position and more often tied to how much walking or standing happened that day.

Groin pain is the most typical location, but hip arthritis pain can also spread to the buttock, the outer hip, or down the front of the thigh toward the knee, which is part of why location alone does not always settle the question without an exam.

Exercise has the most consistent evidence behind it for hip osteoarthritis, and a graded loading program for the gluteal muscles plays a similar role for bursitis and tendinopathy. Both usually start with movement and activity modification before medication or injections enter the conversation.

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When Hip Pain Needs Prompt Attention

  • —Inability to bear weight on the leg, especially after a fall, in an older adult
  • —Hip pain with fever, redness, or warmth over the joint
  • —Sudden, severe hip pain with a visible leg deformity or shortening
  • —Hip pain accompanied by unexplained weight loss

Inability to bear weight after a fall, especially in an older adult, warrants same-day evaluation or an emergency room visit to check for a hip fracture.

This article is for general education and does not replace an in-person exam and evaluation by a clinician.

References

  1. 1.American Academy of Orthopaedic Surgeons (OrthoInfo) (2024). Osteoarthritis of the Hip. OrthoInfo — AAOS. link ✓That hip osteoarthritis causes progressive groin/hip pain and stiffness, and that initial management is nonsurgical.
  2. 2.National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2023). Osteoarthritis. NIAMS, National Institutes of Health. link ✓That osteoarthritis is the most common form of arthritis, caused by cartilage breakdown, and becomes more common with age and in women after 50.
  3. 3.Theis KA, Murphy LB, Guglielmo D, et al. (CDC/MMWR) (2021). Prevalence of Arthritis and Arthritis-Attributable Activity Limitation — United States, 2016-2018. MMWR (CDC Morbidity and Mortality Weekly Report). linkUS prevalence estimate that about 58.5 million adults had doctor-diagnosed arthritis in 2016-2018.
  4. 4.Kolasinski SL, Neogi T, Hochberg MC, et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology / Arthritis Care & Research. doi:10.1002/art.41142 ✓Strong recommendation for exercise and weight loss, conditional recommendation for topical/oral NSAIDs and intra-articular corticosteroids, and recommendation against several low-value therapies for hip osteoarthritis.
  5. 5.Cibulka MT, Bloom NJ, Enseki KR, et al. (2017). Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.2017.0301 ✓Clinical practice guideline recommending physical therapy interventions, including patient education, manual therapy, and exercise, for hip osteoarthritis.
  6. 6.Machado GC, Maher CG, Ferreira PH, et al. (2015). Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. doi:10.1136/bmj.h1225 ✓That paracetamol provides only a small, not clinically important effect on pain and disability in hip and knee osteoarthritis.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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