Do you experience sudden sharp hip pain that comes and goes? It might be related to particular movements or even occur when you are just sitting still! Sharp hip pain can be concerning, particularly if it’s severe pain. Because it’s not there all the time, it can be frustrating trying to get an answer for what is causing this sudden hip pain.
This blog is dedicated to helping outline the most common causes of hip pain that comes and goes. Sudden hip pain can come from a number of hip structures and even from outside the hip – like the lower back.
The most common hip structures that can cause sharp hip pain are:
- the hip joint, including hip labral tear,
- the soft tissues, including muscle and tendons tear and bursitis,
- bones, including fracture or stress fracture, and
- nerves, including the sciatic nerve and many other smaller nerves around the hip.
For each of these potential causes, we’ll help you decide if this is a likely cause of your pain. We’ll be giving you clues about how where pain from each structure is felt and when you are most likely to feel the pain.
You might notice as you read on, that some of the activities that bring on the sharp pain will be similar for different causes. This is where the location of pain can assist in heading down a particular diagnostic path.
You’ll also find a list of common diagnoses for pain from each of these sources below.
In this blog you will find information on the following topics:
Symptoms of sharp pain from the hip joint
Sharp hip pain related to the hip joint is most commonly felt during:
- deep hip flexion
- deep squat
- knee pushed close to the chest
- weightbearing rotation
- twisting or changing direction when walking or running
- getting out of a chair and twisting
- stretching out the hip
- moving from sitting to standing after prolonger sitting
- walking or running with large strides
- split lunges in the gym
- moving the hip sideways when bent
- moving the leg in and out of the car or bed
- moving the leg to the side when sitting
Common diagnoses related to sharp pain from the hip joint
Different hip joint conditions can result in pain associated with the structures of the hip joint. The most common causes of sharp pain from the hip joint include:
- hip osteoarthritis
- hip labral tear
- femoroacetabular impingement (FAI or hip impingement)
- acetabular dysplasia
- hip ligament injury (iliofemoral ligament injury or ligamentum teres injury)
You can read more about understanding hip joint anatomy and joint related hip pain by clicking here.
2. Sharp pelvic pain related to the pelvic joints – sacroiliac joints or pubic symphysis
Sharp pain from the pelvic joints is most common in pregnant women, following pregnancy, in those with hypermobility or following some sort of trauma to the pelvis.
Location of sharp pain from pelvic joints: sacroiliac joints or pubic symphysis
Pelvic pain from the sacroiliac joints or pubic symphysis may spread from the area of joints into the buttocks or groin region.2 See the image below for typical pain locations of sharp pelvic pain.
Sharp pain related to the pelvic joints is most commonly felt directly in the location of these joints in the upper buttocks, or directly over the central pubic region.
Symptoms of sharp pain from pelvic joints
Sharp pain related to the sacroiliac joints or pubic symphysis is most commonly felt when:
- rolling in bed
- standing on one leg
- dressing – putting pants on in standing
- walking – especially upstairs or with long strides
- activities where the legs are wider apart
- sumo squat
- forward, backward or sideways lunges
- leg lifting
- to dress
- to walk upstairs
- to get the leg in-out of the car or bed
Common diagnoses related to sharp pain from the pelvic joints (sacroiliac joints and pubic symphysis)
The most common causes of sharp pain from the sacroiliac joint or pubic symphysis include:
- pregnancy related pelvic pain or pregnancy related pelvic girdle pain
- sacroiliac joint dysfunction
- pelvic instability or sacroiliac joint instability (SIJ instability)
- symphysis pubis diastasis (a separation of the joint, without fracture – usually associated with pregnancy or trauma)
- symphysis pubis dysfunction (SPD)
- sacroiliitis (an inflammatory condition of the sacroiliac joint)
Hip flexor related sharp hip pain
There are several different muscles that make up the hip flexors, the name given to the muscle group at the front of the hip that helps lift the knee up towards the chest. They are iliacus and psoas (often considered as one and named “iliopsoas”), the rectus femoris (also one of your quadricep muscles), sartorius and the tensor fascia lata muscle (TFL).
Location of sharp hip flexor related pain
Sharp hip flexor pain related to the iliopsoas muscle, tendon or bursa is usually located over the front of the hip, about halfway along the groin crease. Sudden hip pain related to the rectus femoris (which is also part of the quadriceps at the front of the thigh) is usually felt a little further to the outside of the hip – deep at the front corner of the hip if the rectus femoris tendon is involved, or a little further down into the muscle if there is a tear at the muscle-tendon junction.3
You can read more about hip flexor strains by clicking here.
Symptoms associated with sharp hip flexor related pain
Sharp pain related to the iliopsoas is most commonly felt when:
- Lifting the leg (flexing the hip) – to dress, walk upstairs, or sometimes even walking on the flat
- Stretching the hip flexors – hip flexor stretch, long strides or lunging (back hip)
Sharp pain related to the rectus femoris is most commonly felt when:
- Contracting the muscle hard – sprinting, kicking
- Stretching the muscle – stretching the heel to the buttock, hip flexor stretch, long strides
Common diagnoses related to sharp pain from the hip flexors
The most common causes of sharp pain from the hip flexors:
- Hip flexor muscle strain, tear or injury
- iliopsoas, psoas or iliacus strain
- rectus femoris strain (rec fem injury)
- internal snapping hip, anterior snapping hip, internal coxa saltans
- iliopsoas tendinopathy
- iliopsoas impingement – tendon impingement usually again a prosthetic hip
- iliopsoas bursitis
Sharp soft tissue-related pain at the side of the hip
There are a number of soft tissue structures that might be the source of sharp pains around the side of the hip. The most common sources include:
- the hip abductor muscles – especially the gluteus medius and minimus and tensor fascia lata (TFL) muscles
- bursae at the greater trochanter (bone at the side of the hip) – trochanteric bursa or subgluteus maximus bursa, sub gluteus medius bursa, sub gluteus minimus bursa
- Iliotibial band (ITB).
Location of sharp soft tissue-related pain at the side of the hip
The location of pain will depend on the condition. For example, an acute muscle tear in the abductor muscles will be felt in the muscle belly or the junction between the muscle and the tendon.
Perhaps even more commonly, we see sharp pain from the hip abductor tendons, bursae and the ITB at a common point of pressure at the greater trochanter. The pain from these soft tissues may also spread down the other thigh.
Symptoms associated with sharp soft-tissue related pain at the side of the hip
Sharp pain related to the hip abductor muscles, tendons and bursae is most commonly felt when4:
- standing and moving on one leg e.g., to dress, single leg squat
- walking upstairs or uphill
- walking or running on uneven surfaces
- landing heavily on one leg
- lying on your side, especially on a hard surface like the floor
- performing an ITB stretch or buttock stretch – pulling the knee across the body.
Sometimes there may also be symptoms such as a snapping or clicking sound or sensation at the side of the hip.
Occasionally sharp pain at the side of the hip when climbing stairs may make you feel like your leg will collapse. This is usually just your nervous system’s response to the sudden sharp hip pain.
Common diagnoses related to sharp pain from the soft tissues of the side of the hip
The most common soft tissue causes of sharp pain at the side of the hip include:
- gluteal muscle tear or strain, hip abductor muscle injury, gluteus medius tear
- gluteal tendinopathy (gluteal tendonitis or tendinitis) or greater trochanteric pain syndrome (GTPS)
- gluteal tendon tear (gluteus medius tendon tear, gluteus minimus tendon tear)
- hip bursitis or trochanteric bursitis
- external snapping hip, external coxa saltans, snapping iliotibial band / ITB
- TFL tendinopathy
- ITB fasciopathy
You can read more about gluteal tendinopathy (and trochanteric bursitis) and if you might have it. by clicking here.
Soft tissue-related sharp buttock pain
The most frequent muscle strain that results in sharp sudden hip pain in the buttock region is a gluteus maximus muscle injury. Strains of this glute max muscle can occur with explosive lunging or stepping up motions or lifting a heavy weight.
Sharp pain in the buttock is sometimes diagnosed as piriformis syndrome, but in this case the actual source of the pain is not the muscle itself but the sciatic nerve. We’ll talk more about nerves next.
A tear of the top of the hamstring muscle can also occur, but this is more likely to be felt in the back of the thigh.
The hamstring muscles join onto the pelvis via their tendons that connects to the sitting bone. The hamstring tendons are a common source of sharp pain over the sitting bones.
Location of sharp soft tissue-related buttock pain
If the buttock pain is related to a muscle tear, the pain will be localised to the area of the tear – e.g., in the gluteus maximus muscle or the top of the thigh. Hamstring tendon pain (proximal hamstring tendinopathy +/- tear) is felt at the sitting bone.
Symptoms associated with sharp soft-tissue related buttock pain
Sharp buttock pain related to a gluteus maximus strain is usually felt:
- when running or sprinting
- during a deep squat or lunge
- stepping up a step, especially a high step or box
- lifting a heavy weight
- bending forward with knees bent.
Sharp buttock pain related to proximal hamstring tendinopathy or tear is usually felt:
- when sitting down, especially on a hard seat
- during a hamstring stretch
- when running, particularly fast or uphill
- kicking (follow through)
- bending over /lifting with knees straight.
Common diagnoses related to sharp buttock pain from the soft tissues
The most common soft tissue causes of sharp buttock pain include:
- gluteal strain, gluteus maximus strain, glute max tear
- proximal hamstring tendinopathy, hamstring tendinitis, high hamstring tendinopathy
- proximal hamstring tendon tear or avulsion.
You can read more about proximal hamstring tendinopathy here.
Soft tissue-related sharp pain in the groin
Sudden sharp pain felt in the groin region can be related to injury of the adductor muscles of the inner thigh and/or their tendons and fibrous connections (aponeurosis) at the front of the pubic symphysis (pubic joint at the front of the pelvis).5
The abdominal muscles also join onto the pelvis and into the inguinal ligament that runs across the groin crease. Injuries to the abdominals may occur in the groin region and may cause sharp groin pain when strained.
Be aware that sudden sharp pain felt in the groin or lower abdomen on bracing of your abdominal muscles, for example coughing, may also be from an inguinal hernia. If you experience pain like this, you should discuss it further with your doctor.
Location of soft tissue-related sharp groin pain
Sharp pain related to an adductor muscle tear will generally be felt in the location of the tear. Muscle spasm may also cause pain over a wider area, but the sharp pain is usually in the location of the tear.
Sharp pain related to the adductor tendons or connections into the fibrous aponeurosis is usually felt locally at or near the pubic region at the very top of the inner upper thigh.
Sharp pain from an abdominal injury (or a hernia) may be felt in the inguinal region.
See the graphic to see pain locations.
Symptoms associated with soft-tissue related sharp groin pain
Sudden sharp pain in the groin relating to the tendons can occur with a kicking or leg swinging type motion, or with stepping quickly either out to the side or across the body.
Sharp groin pain related to the adductor muscles, tendons, or their connections is usually felt:
- with sideways movements e.g., cutting or changing direction when running,
- running fast, particularly accelerating,
- squeezing the knees together.
Sharp groin pain related to the abdominal muscles and their connections may be felt:
- during a sit up, abdominal twist or other forceful abdominal exercises or activities
- lifting or straining
- sometimes with coughing (but get this checked for a hernia).
Common diagnoses related to sharp groin pain from the soft tissues
There are many different diagnoses used for soft tissue related pain in the groin area. The most common diagnoses used for sharp groin pain include:
- adductor related groin pain
- adductor tear, strain, injury or avulsion
- groin strain
- adductor tendinopathy
- inguinal related groin pain
- sportsman’s /sports hernia
- conjoint tendon tear
- posterior abdominal wall injury or deficiency
- pubic related groin pain
- pubic aponeurosis tear
- rectus abdominis tendinopathy
An acute fracture is not usually hard to diagnose as it is related to a traumatic event and pain levels are generally high. But bone pain related to injuries that occur more gradually, may come and go in the earlier stages.
Sharp pain related to bone is most commonly felt when:
- weightbearing on the bone, with pain increasing with impact
- standing (if acute fracture),
- standing on 1 leg,
- walking or running – particularly as the heel strikes the ground and load is accepted onto that leg
- jumping, hopping, landing on the leg.
- twisting the bone e.g., twisting in bed or twisting when standing or walking
Whereas soft tissue related pain often warms up and improves with activity, bone pain doesn’t tend to warm up but instead gets worse with further impact, and eases with rest.
If you are an endurance athlete with sharp hip pain every time your foot hits the ground when running, and it does not seem to warm up, time to get some scans just to make sure you don’t have a stress fracture!
What are some of the more common diagnoses related to sharp pain from bones in adults?
Bone related pain may be due to:
- fracture of the femur, pelvis or sacrum, related to an acute trauma or a surgical procedure
- bone stress injury, bone stress response or stress fracture – related to an accumulation of repetitive bone stress – most commonly in long distance runners
- insufficiency fracture – a fracture in osteoporotic bone
You can read more about bone related pain on our Hip Pain Explained page, under the “BONE” tab – click here.
Sharp bone related hip pain in adolescents
Traumatic and stress fractures also need to be considered in adolescents, particularly after an accident or in young endurance athletes.6
By far the most common type of sharp bone-related hip pain we see in adolescents is apophysitis. This is related to traction on the bony growth centres (apophyses) by muscles that attach at these points.
Apophysitis is most common in children or adolescents who have been through a recent growth spurt and/or are very active in sports involving running, changing direction and kicking.
Location of pain
The location of pain will depend on which growth centre (apophysis) is involved. See the infographic for locations of pain related to apophysitis. The usual pain areas are the front corner of the pelvis (attachments of the rectus femoris, sartorius and TFL muscles), and the sitting bone (attachment of the hamstring muscles).
Sharp pain related to apophysitis is most commonly felt when the muscles are tugging on the growth centres:
- Running, especially sprinting
- Rapidly moving into a stretch position e.g., doing the splits.
This pain will tend to get worse during a training session or competition and will ease with rest.
Sharp pain related to a slip in the femoral growth plate (slipped capital femoral epiphysis) is usually felt when:
- walking or standing on one leg
(Other things to look out for – shortening of the leg and toes turned outwards)
What are some of the more common diagnoses related to sharp pain from bones in adolescents?
Bone related pain in children or adolescents may be due to:
- ASIS apophysitis, sartorius apophysitis
- AIIS apophysitis, Rectus femoris apophysitis
- iliac crest apophysitis, TFL apophysitis
- ischial apophysitis, hamstring apophysitis
- pubic apophysitis, adductor apophysitis
- avulsion fracture – if the muscle tugs the growth plate away from the main bone
- traumatic or stress fractures
- Perthes disease or Legg-Calvé-Perthes Disease
- Slipped Capital Femoral Epiphysis or Slipped Upper Femoral Epiphysis
Read more about growing pains, and apophysitis by clicking here.
Symptoms of nerve pain around the hip
Sudden sharp hip pain can certainly be related to nerves – this is usually referred to as neuralgia. Sharp hip pain related to nerve is most commonly felt when the nerve is stretched. The type of position that causes pain will depend on the particular nerve.
- Pain related to nerves at the front of the hip and pelvis (including femoral, ilioinguinal, iliohypogastric and genitofemoral nerves) will usually be felt when the front of the hip is put on stretch, for example:
- hip flexor stretch
- walking with large strides
- long lunge (back hip)
- wind up for kicking
- backward bending
- Pain related to nerves at the back of the hip and pelvis (including sciatic, posterior femoral cutaneous and cluneal nerves) will usually be felt when the back of the hip is put on stretch, for example:
- hamstring (back of thigh) and/or buttock stretching
- sitting, particularly in a slumped position with legs outstretched
- kicking – follow through phase
- forward bending
- Pain related to nerves at the side of the hip (including ilioinguinal, iliohypogastric, lateral femoral cutaneous, and gluteal nerves) will usually be felt when the side of the hip is put on stretch, for example:
- ITB or trunk side stretch
- sitting with legged crossed
- side bending of the body (stretched side)
There are other symptoms that are often experienced with neuralgia:
- a burning sensation
- odd zings or zaps of pain
- strange sensations such as itching, ‘skin crawling’ or ‘water trickling’ sensations
- tingling (pins and needles) or numbness
- weakness – only for those nerves that supply muscles, like the femoral, sciatic or gluteal nerves.
Weakness generally only occurs where there is quite significant impingement of a peripheral nerve. The smaller sensory fibres are always affected first, so pain and sensory disturbance (weird feelings or lack of sensation) are the main symptoms. Weakness can also occur where there has been direct trauma to the nerve, through injury or a surgical procedure.
What are some of the more common diagnoses related to sharp hip pain from peripheral nerves?
The most commonly diagnosed peripheral nerve related hip pain conditions include:
- deep gluteal syndrome
- piriformis syndrome
- ischial tunnel syndrome
- sciatic nerve entrapment or impingement
- femoral neuralgia
- meralgia paraesthetica (or meralgia paresthetica) – entrapment or injury of the lateral femoral cutaneous nerve
- cluneal neuralgia.
If you are experiencing pain, check out our course and see if it is suitable for you.
Sharp hip pain from nerve roots in the lower back (pinched nerve or referred pain)
Nerve related pain felt at the hip can also be due to impingement or irritation of the spinal nerve roots as they leave the lower spine (before forming the peripheral nerves).
This means that a problem like a disc bulge in the lower back can cause pain at the hip and/or anywhere along the pathway of the nerves that arise from that nerve root. This is called radicular pain.
Location of lumbar nerve root pain at the hip
One nerve root in the lower back can contribute to a number of smaller peripheral nerves once it exits the spine. This is why the area of pain will be different to nerve pain from irritation of specific peripheral nerves along their own pathways.
The graphic below highlights a general map of where pain is expected to be felt for the different lumbar nerve roots at each level of the lower back. The longer you’ve had pain for though, the less specific the area of pain becomes.
Symptoms of radicular pain around the hip
Radicular pain at the hip:
- is often, but not always, associated with some lower back pain.
- is not usually localised to a small region of the hip.
- might be experienced as shooting pain through the hip region and down into the thigh, leg and even the foot.
- is commonly aggravated by back movements e.g., bending, twisting, lifting.
- may be accompanied by burning, tingling, numbness and muscle weakness.
You can read more about nerve pain, neuralgia versus radicular pain from the spine, by clicking here.
You can also read more about lower back related hip and pelvic pain by clicking here.
Other causes of sudden, sharp hip pain
Other, less frequent medical conditions may also need to be ruled out when investigating sudden, sharp hip pains:
- hip joint infection (septic arthritis),
- rheumatoid arthritis,
- other types of arthritis such as psoriatic arthritis,
- avascular necrosis,
- gynaecological conditions such as ovarian cysts and endometriosis,
- vascular conditions (blood vessels),
- referral from other structures within the pelvis.
Therefore, it is always worthwhile seeking a medical assessment from a qualified health professional / health provider. Should other investigations be indicated, for example, medical imaging, or blood tests, your medical team will ensure these are performed.
When should I seek emergency care for sudden, sharp hip pain?
If your pain is severe or if your pain continues over several days, you should contact your doctor or physical therapist/physiotherapist. They will do a thorough assessment and develop a plan on to treat your condition.
If you have had a fall, been in some form of accident or sustained a sporting injury, you should seek medical attention immediately if your hip is bleeding significantly, if you can see exposed bone or muscle or if you are unable to put weight through the leg due to the pain.
You should also seek immediate help:
- if the shape of the hip joint appears deformed
- if it is obviously swollen
- if your pain is severe
- if you are unable to move your hip or leg.
Septic arthritis related to an infection within the hip joint is an important condition to diagnose as quickly as possible. Left untreated this condition can result in long term joint damage such as joint deformity and osteoarthritis.
Signs of a hip joint infection include:
- sudden onset of severe hip pain
- joint swelling
- warmth and redness around the hip joint.
How is sharp hip pain diagnosed?
Hip pain is diagnosed through:
- a detailed patient interview, including your medical history
- a thorough physical exam of the hip and back region
- imaging studies as required – xrays (radiographs), MRI scan, CT Scan, ultrasound.
Treatment options for sudden hip pain
There are a variety of medical treatment and therapy options for sudden sharp hip pain, depending on the underlying cause and the severity of the condition.
Your general practitioner or an orthopedic surgeon will offer medications, injections or surgical solutions for your hip problems.
A physical therapist / physiotherapist, exercise physiologist, or occupational therapist can offer rehabilitation and help with work or home modifications.
Physical therapists, massage therapists and acupuncturists can also provide hands-on treatments to help with pain in the hip area and lower back pain.
A treatment plan for sharp hip pain might include:
- Physical therapy / physiotherapy
- Advice and education
- Pain management
- Exercise therapy
- Hands on treatments
- Workplace assessment
- Exercise Physiology
- Gym program
- Occupational therapy
- Assisting with installing aids around the home – e.g., rails & ramps
- Ergonomic/workplace assessment
- Massage and acupuncture for short term pain relief
- Medication – pain medication, anti-inflammatory medication, nerve calming drugs
- Corticosteroid injection / steroid injections
- Local anaesthetic injection
- Epidural injections
- Nerve roots blocks in the lower back
- Radiofrequency neurotomy
- Platelet rich plasma – PRP Injections
- Botox injections to reduce severe muscle spasm
- Hip arthroscopy
- Hip resurfacing surgery
- Total hip replacement surgery
- Spinal surgery
This blog has aimed to summarise many of the possible causes for sudden sharp hip pain, and what treatment options are available.
We strongly advise you seek out the help and advice of a Hip Pain Professional to help you with a diagnosis and treatment program. You can find a healthcare provider with a specific interest in hip and pelvic pain in our directory by clicking here.
Remember that if you struggle to find a health professional that knows hips near to you, you are now able to consult over video conferencing with most professionals globally.
At Hip Pain Help we are here to help you on your journey to recovery.
Meet our Hip Pain Professionals – Health professionals that know hips
Check Out More You Can Read on Hip Pain Relief at HipPainHelp:
Causes, Effects & Exercises for Lordosis to Reduce Hip and Back Pain: learn about pelvic posture and how adjustments may help provide hip or pelvic pain relief
Hip Hanging is Easy – But May Not Be A Good Way to Stand For Hip Pain Relief: Hip hanging is easy, but for prolonged periods may be contributing to your hip or pelvis pain. Learn more and learn strategies on how to correct this.
Top Tips for Hip Pain Relief Sitting, when Socialising or Travelling: here we discuss strategies that may help reduce your hip and pelvis pain when sitting, for example with work, travel and play.
What is the Best Good Posture for Hip Pain Relief: Is there any one good posture that could best help with hip pain relief is not such an easy question to answer!
3. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings? Serner A, Weir A, Tol JL, Thorborg K, Roemer F, Guermazi A, Hölmich P. Br J Sports Med. 2016 Dec;50(24):1541-1547.
4. Grimaldi A, Mellor R, Nicolson P, Hodges P, Bennell K, Vicenzino B. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. British Journal of Sports Medicine. 2017 Mar;51(6):519-524. doi: 10.1136/bjsports-2016-096175. Epub 2016 Sep 15.
6. Rossi, F. and Dragoni, S. (2001). Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiology, 30(3), pp.127-131.
This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.
Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.
Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.
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