Hip pain · St. Louis
Hip pain in the groin and hip pain in the buttock are not the same diagnosis.
Where your hip pain sits tells us more than how much it hurts. Groin pain usually points inside the joint. Pain over the outer hip or buttock usually points outside it, or to the spine above it. Getting that right at the first visit saves months of treating the wrong part.
What does the location of your hip pain tell you?
Deep groin pain, sometimes felt as far as the inner thigh, is the mark of a problem inside the joint itself. That means a labral tear, femoroacetabular impingement, or osteoarthritis. Pain over the point of the hip or across the buttock is usually extra-articular, meaning outside the joint. Most often it is the tendons and bursa (a fluid-filled cushion) on the outside of the joint. It is often mistaken for hip disease when it is not coming from the joint at all. Pain that runs down the back of the leg past the knee is rarely the hip. That pattern belongs to the lumbar spine. Treating it as a hip problem delays finding the real source.
What causes pain inside the hip joint?
Two mechanical drivers do most of the damage inside the joint. In younger, active patients, it is femoroacetabular impingement: extra bone on the ball, the socket, or both. That bone pinches the labrum again and again until it tears. The labrum is the cartilage rim that seals the joint. In older patients, that same cartilage simply wears thin over decades of load, and osteoarthritis is the endpoint. The third driver is behavior, and it builds on itself. A hip that hurts to move gets moved less. The muscles around it get weak. The joint loses the muscle support that was partly making up for the mechanical problem. That speeds up the very process that started the pain.
Confirming the joint with an injection, not a guess
The hip sits too deep to reach reliably by feel. Imaging alone overcalls the diagnosis. Plenty of hips with labral fraying or mild arthritis on a scan are not the real source of a patient’s pain. An image-guided intra-articular injection is placed under fluoroscopic (live X-ray) or ultrasound guidance. It tells us for sure whether the joint itself is making your symptoms. Meaningful relief confirms it. A joint that does not respond sends us looking elsewhere before any bigger step is taken.
Why does the outside of my hip hurt when I lie on it at night?
GREATER TROCHANTERIC PAIN SYNDROME
Some pain sits over the outer point of the hip and is worse lying on that side at night and worse climbing stairs. That pain is more often gluteal tendinopathy than arthritis. That is injury to the gluteus medius or minimus tendons where they attach at the greater trochanter (the bony knob on the outer hip). This is the single most common reason a patient is told they need a hip replacement. What they really need is targeted loading exercise and, sometimes, a guided injection into the tendon or bursa. It is diagnosed on exam and confirmed with ultrasound, not by the same workup used for joint disease.
The load and metabolic terrain
Whatever part is making the pain, the body it sits inside matters. Systemic inflammation from insulin resistance flows through hip cartilage the same way it does through the knee. It speeds up breakdown no matter what you weigh. Long hours of sitting, like a desk job or a long commute, shorten the hip flexors. That changes how load moves across the joint, in ways patients rarely connect to their pain. Rebuilding hip strength and motion, paired with the same metabolic work we build into every plan here, is what keeps an injection’s relief from being temporary. See metabolic health and pain.
When is a hip replacement the right choice?
Advanced osteoarthritis with bone-on-bone contact and a fixed loss of motion is a hip that has moved past what injections and therapy can offer. For that patient, total hip replacement is one of the most reliably successful operations in orthopedics. We do not delay that referral to sell one more injection. What we will not do is send a patient with gluteal tendinopathy or an unconfirmed diagnosis toward that same operation because the imaging showed some wear that isn’t actually the source of their pain.
What happens at a hip pain visit, and after an injection?
The first visit is an exam, not a procedure. We watch you walk, test hip rotation lying down, press on the outer hip and check the low back and the nerves to the leg, because all three can be the source. A standing X-ray shows the joint space; ultrasound in the office shows the outer hip tendons. If an injection makes sense, it is placed under image guidance with local anesthetic. You stay awake, there is no sedation, and most people drive themselves home. The numbing medicine can leave the leg heavy for a few hours, and if it does, someone else drives until it wears off.
Normal activity, including work, resumes within two to four hours. For the rest of that day you keep a simple log of how the usual painful moves feel, such as stairs, getting out of a car or putting on a sock. That log is the diagnosis. At follow-up we read it together and start the glute and hip-stabilizer program that keeps the relief from fading.
What are the red flags for hip pain?
- Sudden inability to bear weight, especially after a fall — rule out a fracture before anything else, especially in older patients with osteoporosis.
- Hip pain with fever — needs same-day evaluation for a septic joint.
- New weakness, numbness, or bowel or bladder change alongside hip and leg pain — suggests a spinal source needing urgent workup. See when it is an emergency.
Orthobiologic treatment options
When the joint itself is the source, cortisone only quiets the lining for a while. Orthobiologics aim at the joint: PRP placed inside the capsule under image guidance, and bone marrow concentrate when the bone under the cartilage is part of the pain. The result rides on the platelet dose delivered and on rebuilding the glutes and hip stabilizers afterward. The full picture, including the honest evidence, is on hip arthritis.
The tendons on the outside of the hip can be treated with PRP too, placed into the damaged tendon under ultrasound. If your knee hurts as well, bone-on-bone knee explains what we can still offer a badly worn knee.
Common questions
Do I need a referral to have my hip looked at?
No. Hip pain visits are booked directly, without a referral from another doctor. Some insurance plans want one on file anyway, and if yours is one of them we will tell you before the visit. Do you need a referral for pain management? covers which plans ask.
Why does my back exam matter if my hip is what hurts?
Because a pinched lumbar nerve root and a diseased hip can cause overlapping pain patterns, and treating the wrong one delays relief for months. We examine the spine on every hip visit for this reason. See sciatica for the pattern that most often gets confused with hip disease.
Can an MRI tell me for certain what is wrong?
Not on its own. Labral fraying and mild arthritis show up on scans of hips that do not hurt at all. So scan findings must be matched against your exam, and often an injection’s response, before we call them the cause. What to expect covers how we sequence imaging against exam findings.
I was told I need a hip replacement. Should I get a second opinion?
If a confirming intra-articular injection has not been done, yes. Gluteal tendinopathy and pain spreading from the lumbar spine are both routinely mistaken for end-stage hip arthritis. A diagnostic block is a low-risk way to confirm the joint before you agree to surgery. Image-guided joint injections explains how that confirmation works.
Does losing weight fix hip pain?
It reduces one input, which is mechanical load. But the metabolic and behavioral drivers matter just as much. And a hip too painful to move makes weight loss harder, not easier. We address the pain and the terrain together rather than asking you to fix one before we treat the other. It is the same approach described in knee pain for the joint that shares this same terrain problem.
How can you tell if groin pain is coming from the hip?
Deep groin pain, sometimes reaching the inner thigh, is the classic sign of a problem inside the hip joint. Because the joint sits too deep to check by touch and scans often overcall it, we confirm it with an image-guided injection into the joint. Meaningful relief means the joint is the source. No relief sends us looking elsewhere before any bigger step.
What are the most common causes of hip pain?
Inside the joint, the usual causes are a labral tear, femoroacetabular impingement (extra bone that pinches the joint rim), and osteoarthritis. Outside the joint, the most common cause is gluteal tendinopathy, an injury to the tendons on the outer point of the hip. Pain that runs down the back of the leg past the knee usually comes from the lower spine, not the hip.
How do you relieve hip and groin pain?
First we confirm which structure hurts, because the joint, the tendons and the spine are treated differently. A confirmed joint problem may get an image-guided injection. Tendon pain usually needs targeted loading exercise and sometimes a guided injection. Either way, rebuilding hip strength and motion, along with metabolic work on inflammation, is what keeps the relief from being temporary.
Related reading
- Orthobiologics and PRP injections in St. Louis
- Image-guided joint injections
- Knee pain
- Sciatica
- Metabolic health and pain
- Trigger point injections
- Hip arthritis
Sources
- Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis. American Family Physician, 2021. PubMed 33448767
- Klauser AS et al. Greater trochanteric pain syndrome. Seminars in Musculoskeletal Radiology, 2013. PubMed 23487333
- Brinkman JC et al. The Management of Acetabular Labral Tears: A Contemporary Review. Current Reviews in Musculoskeletal Medicine, 2026. PubMed 42334787
We will find the actual structure before we treat one
Groin, outer hip, buttock, and referred back pain get treated differently because they come from different places. We will tell you which one is yours, confirm it, and only then build a plan.
4479 Woodson Rd, Suite 401
St. Louis, MO 63134
Next to St. Louis Lambert International Airport, off I-70 at Woodson Road.