Hip Pain When Walking: Common Causes and What Actually Helps

Hip pain when walking is one of the most life-limiting movement problems — and one of the most commonly misunderstood. Whether it's a sharp twinge in the outer hip, a deep ache in the groin, or a pain that builds the longer you walk, the experience is the same: something that should be effortless and automatic has become something you have to think about.

For clients across Barnoldswick, Earby, Skipton, and the wider Pendle and Craven area, hip pain when walking is one of the most common presenting complaints — and one that responds very well to the right approach. Here's what's typically causing it, and what actually works.

Where the Pain Is Matters

Before looking at causes, it's worth noting that the location of hip pain often points to a different underlying problem:

• Outer hip pain (the side of the hip, sometimes referring down the outer thigh) — most commonly greater trochanteric pain syndrome or gluteal tendinopathy
• Deep groin pain (felt inside the hip joint itself) — more likely to indicate hip joint pathology, labral involvement, or hip osteoarthritis
• Buttock pain (posterior hip, sometimes down the leg) — often related to the sciatic nerve, the piriformis, or the sacroiliac joint
• Pain that starts in the lower back and radiates to the hip — may originate from the lumbar spine rather than the hip itself

Getting the location right matters because the treatment differs significantly between these patterns. What helps outer hip pain (loading the gluteal tendons) can actually aggravate deep groin pain, and vice versa.

The Most Common Causes of Hip Pain When Walking

1. Gluteal Tendinopathy (Greater Trochanteric Pain)

This is the most common cause of outer hip pain in adults — particularly women over 40 and anyone who has been less active for a period. The gluteal tendons (connecting the glute muscles to the greater trochanter at the top of the femur) become irritated and overloaded, producing pain that is typically:

• On the outer hip, sometimes extending into the outer thigh
• Worse after prolonged sitting, particularly with crossed legs
• Worse walking up slopes or stairs
• Aggravated by lying on the affected side
• Better with movement initially, worse with prolonged activity

The counterintuitive truth about gluteal tendinopathy is that stretching — which most people instinctively try — often makes it worse. The irritated tendon responds to compression, and many stretches compress it. The treatment that consistently works is progressive tendon loading, not stretching and rest.

2. Hip Osteoarthritis

Hip OA is very common in the over-50 population across Barnoldswick, Skipton, and the wider area — and while it's often treated as a purely structural problem ("the joint is worn"), it has a very significant muscular component that can be directly addressed.

Classic features of hip OA walking pain:

• Deep ache in the groin or inner thigh
• Stiffness after rest — worst first thing in the morning or after sitting
• Reduced range of motion, especially rotation
• Pain that builds with longer walks and settles with rest
• Occasional groin pain that refers to the knee

Exercise is one of the most evidence-supported treatments for hip osteoarthritis — consistently outperforming passive treatments in long-term outcomes. Strengthening the muscles around the hip reduces the load on the joint surface, reduces pain, and improves function.

3. Hip Flexor Strain or Tightness

The hip flexors — particularly the iliopsoas — can become strained, tight, or irritated, producing pain at the front of the hip that's often worse when you first start walking or when you lift the leg. This is particularly common in people who sit for long periods, those returning to walking or exercise after a break, and those who carry one-sided loads repeatedly.

Hip flexor pain when walking is often misinterpreted as a groin strain. The key distinguishing feature is that it tends to ease once you've been walking for a few minutes, then returns if you stop and start again.

4. Sciatic Nerve Irritation

Sometimes hip pain when walking isn't coming from the hip at all — it's nerve pain originating in the lumbar spine or piriformis region that refers into the hip and buttock area. Sciatic-pattern pain is typically:

• A burning, shooting, or electric sensation rather than a dull ache
• Running down from the hip into the thigh or calf
• Worse with sustained walking, particularly downhill
• Sometimes accompanied by numbness or tingling

If your hip pain has any of these neural qualities, it needs to be assessed with that in mind — the treatment differs significantly from muscular or tendon-based hip pain.

5. Weak Hip Abductors and Altered Gait

When the hip abductor muscles (glute medius and minimus) are weak, the pelvis drops on the non-stance side during walking — a pattern called Trendelenburg gait. This places abnormal load on the hip, lower back, and knee of the stance leg, and produces a slow-building ache that worsens with distance.

Many people aren't aware they walk this way. It only becomes apparent when you observe someone from behind — or when you find that their hip pain consistently correlates with walking duration rather than any specific movement.

What's Usually Not Causing It

Before getting into what to do, it's worth clearing up some common misconceptions:

"It must be cartilage wear"

Cartilage degeneration is extremely common on imaging — but correlation isn't causation. Many people with significant cartilage changes on MRI have no knee pain, and many people with significant knee pain have minimal cartilage changes. The pain pattern described here (specifically worse descending stairs) is a mechanical and muscular problem in the vast majority of cases, not a structural one.

"It's just arthritis — nothing can be done"

Osteoarthritis of the knee is common, particularly in people over 50, but it responds well to targeted exercise — often better than any other treatment. Muscle strengthening around the knee joint reduces the load on the joint surfaces and consistently reduces pain, regardless of the degree of arthritis visible on X-ray.

"I just need to rest it"

Rest reduces irritation in the short term but does nothing to address the weakness and control deficits that are causing the problem. The knee will hurt again when you return to stairs. Progressive loading — done correctly — is what produces lasting change.

What a Proper Programme Looks Like

For most people with hip pain when walking, an effective programme combines:

• Hip strengthening — targeted work for the glute medius, glute maximus, and hip abductors, progressed gradually
• Tendon loading — if gluteal tendinopathy is involved, specific progressive exercises that load the tendon appropriately without compression
• Gait retraining — correcting Trendelenburg drop and other movement pattern problems that are driving the load
• Walking tolerance progression — gradually increasing walking duration and gradient in a structured way, rather than pushing through pain or avoiding walking entirely
• Load management — understanding what activities aggravate the hip and temporarily modifying them while capacity is being rebuilt

The in-home setting is particularly effective for hip pain rehabilitation because Paul can observe you walking in your actual environment — on your specific floors, your garden path, your local terrain — and correct patterns in the context where they matter.

Hip Pain When Walking in Your 40s, 50s and 60s

Hip pain in this age group is common — but it's not inevitable, and it's not something you simply have to live with. The conditions that cause hip pain when walking are all directly addressable with the right programme.

After 40, the muscle mass and tendon resilience that previously protected the hip from the demands of walking starts to decline without targeted maintenance. What was manageable at 38 becomes limiting at 52. But the trajectory can be changed — and it changes through progressive loading, not rest.

Read more about strength training for people over 40 and why it becomes particularly important when hip pain starts to emerge.

After a Knee Replacement or Surgery

Stair descent is one of the last functional movements to fully recover after knee surgery — and one of the most common complaints at physiotherapy discharge. The basic exercises given post-operatively are rarely sufficient to fully restore the eccentric strength and hip control needed for confident, pain-free stair descent.

If you've had a knee replacement or surgery and stairs are still uncomfortable, this is exactly the kind of gap that in-home functional training is designed to fill. Read more about why pain sometimes returns after physiotherapy and what comes next.

Getting Assessed

A thorough movement assessment for hip pain when walking includes:

• Single-leg squat and step-down testing to identify the movement pattern causing pain
• Hip strength and stability assessment
• Ankle dorsiflexion measurement
• Observation of your actual staircase in your home
• A specific programme built around what's actually causing your pain — not a generic knee protocol

Paul Sudds provides in-home assessments and training across Barnoldswick, Earby, Skipton, Gargrave, Colne, and the wider Pendle and Craven area.

To book your assessment, get in touch here or call Paul directly on 07511 236885.

You can also read about what happens during an in-home movement assessment, explore the Skipton in-home training page, or see how the programme is structured.