What Causes Hip Pain in Adults Under 50?

Hip pain in adults under 50 years old usually results from overuse injuries, muscle strains, or structural problems such as hip impingement and labral tears. In some cases, conditions such as hip dysplasia (a shallow hip socket) and early arthritis can also cause pain and affect normal joint movements.

At Total Orthopedics and Sports Medicine, our fellowship-trained surgeon, Dr. Charles Ruotolo, carefully reviews your medical history, symptoms, and imaging results to identify the source of your pain. Once he confirms the underlying cause, he recommends the most effective hip pain treatment options, including conservative treatment, strengthening exercises, and hip arthroscopy when needed. Call 855-321-6784 to schedule an appointment in Deer Park.

What Triggers Hip Pain in Adults?

Joint inflammation (arthritis), soft-tissue disorders such as hip bursitis or tendinitis, and physical injuries are common causes of hip pain in adults. Other conditions, including avascular necrosis, hip labral tears, and lower back nerve problems, may also trigger pain around the hip joint. Because the location of the pain often points to the underlying cause, early diagnosis helps prevent cartilage damage and long-term joint problems. Here is how these conditions affect the hip joint and trigger pain during daily activities:

Hip Tendinitis

Tendinitis causes inflammation of the tendons surrounding the hip and commonly affects active individuals. This condition often develops when repetitive activities place ongoing stress on the tendons or the iliotibial band. If left untreated, tendinitis can weaken the affected tendons and limit normal hip movement. Over time, ongoing irritation may lead to chronic pain and reduced muscle strength around the hip joint.

Osteoarthritis

According to the American Academy of Orthopedic Surgeons (AAOS), osteoarthritis is a common form of arthritis that occurs due to the gradual degeneration of hip joint cartilage. As the cartilage becomes thinner, the bones begin to rub against each other during movement. This friction causes hip pain, stiffness, and reduced joint flexibility.

Moreover, hip arthritis is characterized by inflammation of the joint, which can lead to severe disabilities and a reduced quality of life. These symptoms are especially common among older adults with predisposing factors such as:

• Family History
• Previous Hip Injury
• Excess Body Weight

Hip Bursitis

Hip bursitis is often caused by muscle imbalance or repetitive motions like running, walking, or climbing stairs, leading to inflammation of the bursa outside the hip joint. As inflammation increases, you may notice discomfort on the outer side of the hip, especially when lying on the affected side or moving the leg. This irritation may also reduce comfort during everyday movements and weight-bearing activities.

Lower Back and Spine Conditions

Lower back and spine issues, such as pinched nerves, can cause referred pain into the buttocks and hip area. For example, a pinched sciatic nerve may send pain signals into the buttocks, hip, thigh, or leg. As a result, you may experience burning pain, numbness, or weakness that extends down the affected leg. Moreover, the following back conditions can also trigger pain that radiates into the hip area:

• Herniated Disc
• Spinal Stenosis
• Degenerative Disc Disease
• Sciatica
• Spondylolisthesis
• Facet Joint Arthritis

Avascular Necrosis

Avascular necrosis develops when blood flow to the femoral head (the ball-shaped top of the thigh bone) is disrupted. Without enough blood supply, the bone tissue gradually weakens and begins to break down. As the condition progresses, the femoral head may collapse and damage the hip joint. This often causes localized pain and catching sensations that worsen with activity, prolonged sitting, or prolonged standing.

Labral Tears

According to NIH research, a torn hip labrum can result from an accident or injury, such as a fall, or from aging and repetitive motions, particularly in young athletes. These conditions repeatedly stress the connective tissue surrounding the hip socket. As a result, the labrum may lose its ability to provide stability and cushion the joint during movement.

Traumatic Hip Injuries

Traumatic hip injuries result from sudden impacts, falls, accidents, or repetitive stress that damage the bones and soft tissues surrounding the hip joint. For example, stress fractures are small cracks in the hip bone that develop from repetitive stress and often affect athletes or people who rapidly increase their activity levels. They are also more common in people with low bone density and cause persistent pain during weight-bearing activities. In contrast, hip fractures typically occur from a fall or serious accident and involve a break in the upper part of the thigh bone near the hip joint. Because these injuries can significantly affect mobility, many patients require surgical treatment to restore stability and function.

How Does Hip Impingement (FAI) Damage the Joint Over Time?

Hip impingement damages the joint through repeated friction between the thigh bone (femoral head) and the hip socket. Over time, this abnormal contact places excessive pressure on the tissues inside the hip joint. As a result, the labrum (the ring of connective tissue around the socket) may tear or get frayed.

Once the labrum is damaged, the hip joint loses its natural cushioning and stability. At the same time, repeated friction gradually wears down the protective cartilage inside the joint. If left untreated, these warning signs may progress to arthritis and long-term joint deterioration.

In addition to structural damage, FAI commonly causes groin pain, stiffness, and restricted range of motion. In fact, research published in the Australian Family Physician found that 88% of patients with FAI report groin pain, while 67% experience lateral hip pain. Another 35% report pain in the front of the thigh, especially during movement and physical activity.

Can Hip Dysplasia Cause Chronic Discomfort in Younger Adults?

Yes, hip dysplasia can cause chronic hip pain and discomfort in younger adults. This condition occurs when the hip socket does not fully cover the ball of the hip joint, which reduces joint stability. Over time, abnormal joint structure places excessive stress on the cartilage and surrounding tissues during everyday movement. This joint instability may lead to muscle fatigue, tightness, and labral tears (damage to the cartilage rim of the hip socket). Moreover, the abnormal joint mechanics can accelerate cartilage wear and increase the risk of early osteoarthritis, particularly in women.

Which Activities Increase the Risk of Hip Problems?

Running and pivoting sports such as soccer and basketball can increase the risk of hip problems over time. These activities place repeated stress on the hip joint, surrounding muscles, and soft tissues. Most hip fractures also occur in sports that involve frequent twisting, such as golf, ballet, and certain yoga poses.

In addition, repetitive activities like running and cycling may increase the risk of trochanteric bursitis, which often causes aching or burning pain along the outer hip. Beyond sports and exercise, certain occupational activities can also place excessive stress on the hip joint, including:

• Heavy Lifting
• Frequent Stair Climbing
• Prolonged Standing or Sitting
• Repetitive Squatting
• Awkward Working Postures

These activities repeatedly stress the hip joint and may contribute to muscle imbalances, cartilage wear, and other structural changes over time. In fact, in a PubMed study, researchers evaluated 198 adults using MRI scans to examine how occupational activities affect hip joint health. Their analysis found that heavy lifting and frequent stair climbing increased the risk of cartilage damage and bone marrow lesions (areas of bone injury) within the hip joint.

How Is Hip Pain Diagnosed in Adults Under 50?

Our orthopedic surgeon, Dr. Charles Ruotolo, reviews your medical history and performs a targeted physical examination. During the evaluation, he may ask about your symptoms, activity level, pain location, and lifestyle to better understand the source of the problem. He also assesses your range of motion, walking pattern, and muscle strength and performs specialized tests, such as the FADIR test, to identify conditions like hip impingement or labral tears.

If the physical examination suggests a bone, joint, or soft tissue injury, our surgeon, Dr. Charles Ruotolo, may recommend the following tests:

X-Ray

An X-ray provides clear images of the hip bone and joint structure. This test helps identify fractures, hip dysplasia (abnormal development of the hip socket), femoroacetabular impingement (FAI), and signs of arthritis. It also helps rule out other bone-related causes of pain, including:

• Stress Fractures
• Avascular Necrosis (AVN)
• Bone Tumors
• Bone Cysts
• Developmental Hip Abnormalities
• Joint Space Narrowing
• Bone Spurs (Osteophytes)

MRI (Magnetic Resonance Imaging)

Research by the National Library of Medicine reports that MRI (Magnetic Resonance Imaging) provides detailed images of the soft tissues inside the hip joint. It helps identify labral tears, tendon injuries, and cartilage damage that may not appear on an X-ray. This information helps guide the most appropriate treatment plan based on the injury’s location and severity.

Ultrasound or Blood Tests

Ultrasound is commonly used to evaluate bursitis (inflamed fluid-filled sacs), tendinitis, and snapping hip syndrome. In some cases, our hip specialist, Dr. Charles Ruotolo, may recommend blood tests to detect infections and other inflammatory conditions. These tests can help identify conditions such as septic arthritis, gout, autoimmune diseases, and other inflammatory joint disorders.

Do Steroid Injections Help Reduce Hip Pain?

Yes, steroid (cortisone) injections can help reduce hip pain by lowering inflammation inside the joint or surrounding tissues. The medication is injected directly into the affected area to reduce swelling and calm irritated pain signals. During the procedure, a hip doctor uses ultrasound or fluoroscopy (live X-ray guidance) to ensure accurate placement of the injection.

However, steroid injections can provide temporary pain relief and improve short-term comfort. They do not address structural problems such as labral tears, hip impingement, or cartilage damage. For this reason, doctors typically limit treatment to 3 to 4 injections per year, as repeated use may increase the risk of cartilage damage over time.

How Can Manual Therapy Help Relieve Hip Strain?

Manual therapy helps relieve hip strain by improving joint mobility and reducing muscle tension around the hip. It uses hands-on techniques to improve movement and break up tissue adhesions (areas of tight scar tissue). As movement improves, the hip can function more efficiently with less stress on nearby muscles and tendons. Manual therapy also prepares the hip for strengthening exercises and supports faster functional recovery.

In fact, NIH research found that manual therapy is often combined with strengthening and mobility exercises to support recovery and improve daily function. In this review, researchers analyzed 19 clinical studies examining exercise therapy for hip osteoarthritis. Their analysis found that land-based exercise reduced pain by approximately 49%, while water-based exercise reduced pain by approximately 53% in the short term. These improvements were noticeable during the first 3 months after treatment.

Can Regenerative Medicine Help Hip Pain in Younger Adults?

Yes, regenerative medicine may help reduce hip pain in younger adults. Doctors often recommend this treatment to stimulate the body’s natural healing response, reduce inflammation, and support tissue repair. They may also help improve symptoms associated with labral tears, tendinitis, and other soft-tissue injuries around the hip joint. As a result, you may experience better joint function, which helps delay the need for hip surgery.

Here are the most commonly used regenerative medicine options to support tissue healing and reduce hip pain:

Prolotherapy

According to a study published in StatPearls, prolotherapy stimulates the body’s natural healing response in the treated tissue. This response increases collagen production and strengthens connective tissues around the joint. Over time, this process may improve tissue strength, ease hip pain, and reduce strain on nearby structures.

Platelet-Rich Plasma (PRP)

PRP uses a small sample of your own blood to create a concentrated solution rich in platelets and growth factors. Then, this solution is injected into the affected hip joint or tendon. The growth factors help stimulate tissue repair and reduce inflammation. As a result, you may experience less pain and improved hip function over time.

Stem Cell Therapy

In this procedure, your doctor collects stem cells from your bone marrow or fatty tissue and injects them into damaged areas of the hip joint. These cells may support the repair of cartilage and other soft tissues inside the joint. However, treatment outcomes may vary depending on your overall health, age, and the extent of cartilage damage within the hip joint. For this reason, doctors often recommend a multidisciplinary care (combining proven therapies) to support recovery and long-term joint function.

Viscosupplementation

Research published in ScienceDirect found that viscosupplementation may help manage hip osteoarthritis when conservative treatments fail to provide relief. This minimally invasive procedure involves injecting hyaluronic acid into the hip joint. During the procedure, the doctor uses ultrasound or X-ray guidance to ensure accurate placement of the injection. After the injection, you may notice gradual improvements in pain and joint movement.

When Is Arthroscopy Needed for Hip Discomfort?

Our hip surgeon, Dr. Charles Ruotolo, may recommend hip arthroscopy when non-arthritic hip pain persists despite medication, injections, or other conservative treatments. He may also recommend this procedure for active younger and middle-aged patients with mechanical symptoms such as locking and inactivity. Other than that, arthroscopy helps treat labral tears, hip impingement (FAI), loose bodies (small fragments within the joint), and synovitis.

During the procedure, the hip doctor uses small instruments to repair damaged tissue and address the underlying cause of the problem. They may also remove loose bodies and reshape impinging bone structures to improve joint movement. However, our hip specialist, Dr. Charles Ruotolo, does not recommend arthroscopic orthopedic surgery for older patients with advanced arthritis. In these cases, a total hip replacement often provides long-term pain relief and joint function.

Which Stretches Can Help Reduce Hip Tightness and Pain?

The Figure-Four Stretch and Kneeling Hip Flexor Stretch can help reduce hip tightness and improve flexibility around the hip joint. The Pigeon Pose and Butterfly Stretch also improve hip mobility by targeting the hip rotators, hip flexors, and inner thigh muscles. These stretches reduce stiffness, improve glute function, and support smoother hip movement during daily activities.

In addition, a study published in the Sports Journal found that the following strengthening exercises can help improve hip stability and overall joint function:

• Squat: Strengthens the glutes, hips, and thigh muscles to support daily movement.
• Monster Walk: Activates the hip muscles and improves the normal range of motion using a resistance band.
• Quadruped Hip Extension: Strengthens the glutes and supports better pelvic control.
• Side-Lying Clam: Targets the hip rotator muscles that help stabilize the hip joint.
• Bridge: Strengthens the glutes and maintains core muscle mass to support hip movement.

Note: You should perform these exercises 3 to 4 days per week and keep 1 to 2 days of rest between sessions to support muscle recovery.

We Can Help You Identify the Underlying Cause of Hip Pain — Visit Us in Deer Park!

Chronic hip pain can interfere with your daily movement and may not fully improve with rest, medication, or home-based exercises. As the discomfort spreads into the groin, thigh, buttocks, leg, or knee, identifying the exact source of the pain can be challenging. This uncertainty often delays proper treatment and may worsen the condition over time.

As a Member of the Alpha Omega Alpha Honor Medical Society, our hip surgeon, Dr. Charles Ruotolo, at Total Orthopedics and Sports Medicine, carefully evaluates the hip joint, surrounding muscles, and movement patterns to identify the source of your pain. Then, he creates a treatment plan that targets the underlying condition. We also monitor your recovery closely to help you return safely to daily activities and exercise. Call 855-321-6784 or visit our clinic for a proper diagnosis and treatment plan.

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