Hip pain when walking or climbing stairs

Where is the pain?

The hip is a deep ball-and-socket joint surrounded by large muscles and tendons, so "hip pain" can mean several different things. Where you feel it when you walk or climb stairs is one of the most useful clues:

• Outer hip, over the bony point at the side, worse lying on that side and climbing stairs — most often a tendon or bursa problem.
• Groin or front of the hip, worse with deep bending, sitting for long periods or twisting — more often the joint itself.
• Buttock, sometimes spreading down the back of the thigh — may be the hip, the lower back or the muscles and nerves between them.

Pain in all three areas can be felt when walking, so your clinician will also look at how the pain started, what makes it worse and how the hip moves.

Common causes

Greater trochanteric pain syndrome (GTPS). This is the most common cause of outer hip pain, especially in women over 40. The gluteal tendons that attach to the bony point at the side of the hip, and the bursa over them, become irritated by compression and overload. Lying on that side, standing on one leg, crossing your legs and climbing stairs typically hurt. It was once called "trochanteric bursitis", but the tendons are usually the main issue. See greater trochanteric pain syndrome.

Hip osteoarthritis. Age-related change in the joint surfaces can cause groin or front-of-hip pain, morning stiffness and difficulty with socks and shoes. It often develops gradually and is common from middle age. Exercise, weight management and load advice are the mainstay of care, and many people stay active for years. See hip osteoarthritis.

Femoroacetabular impingement (FAI). In some people the shape of the ball or socket means the bones meet earlier than usual at the end of a movement. Deep squatting, sitting for long periods and twisting sports may cause a pinching pain in the groin. It is more common in younger, active adults. See femoroacetabular impingement.

Hip labral tear. The labrum is a ring of cartilage that deepens the socket. It can be injured with a twist, or gradually with impingement. Groin pain with clicking, catching or a sense of instability is typical. See hip labral tear.

Other possibilities include piriformis syndrome and other buttock muscle problems, hip flexor strain after a sudden sprint or kick, and pain referred from the lower back or sacroiliac joint.

What may help at home

• Adjust the load without stopping altogether. Cut back on long walks, hills and stairs for a week or two if they flare the hip, but keep moving. Walking on the flat, cycling and swimming suit many people.
• For outer hip pain, reduce compression. Avoid crossing your legs, standing with your weight on one hip, and lying on the painful side. A pillow between the knees in bed can help.
• For groin pain, avoid prolonged deep bending. Choose a higher chair, avoid low sofas and deep squats while it is irritable.
• Strengthen the hip and thigh gradually. Exercises such as bridges, sit-to-stand and side-lying leg raises may help the hip cope with load. Build up slowly.
• Check footwear and foot posture. Where foot posture seems to be contributing, a 3D foot scan can show whether custom orthotics may help spread the load.

Many people notice improvement within a few weeks. If the hip is not settling, or you are unsure what is causing it, an assessment can clarify why.

What assessment and treatment involve

At your first appointment, one of our physiotherapists or our chiropractor will take a history, examine how your hip, back and pelvis move, test strength and balance and explain what they find. Most hip problems are diagnosed by examination. Where imaging would change the plan — for example a suspected labral tear or significant arthritis — we can arrange X-ray or MRI through our imaging partner, often with same- or next-day appointments subject to availability.

Treatment is usually a progressive exercise programme alongside hands-on techniques and advice on activity and load. For long-standing gluteal tendon pain, focused shockwave may be discussed. Where a joint is very painful, a prescribed anti-inflammatory injection or hyaluronic acid injection may be considered as part of a wider plan. Outcomes vary from person to person, and fees are on our fees page.

When to seek urgent help

• Call us for a same-day assessment if the pain followed a fall or injury, if you cannot put weight on the leg, or if the pain is severe, worsening or waking you every night. We can examine you and arrange fast-track imaging where needed.
• Go straight to A&E for more severe symptoms, such as a suspected broken bone after a fall (particularly in older adults), an obvious deformity or a leg that looks shortened and turned out.
• Call 999 for life-threatening signs, such as hip or leg pain with a high fever and feeling very unwell, or a sudden hot, swollen calf with chest pain or breathlessness.

When to book

If hip pain when walking or on stairs has lasted more than two to three weeks, keeps coming back, or is affecting your sleep, work or exercise, an initial assessment at our Bloomsbury clinic is a sensible next step. We will examine the hip, explain what we find and agree a plan with you.