Hip Pain After 50: What Is Actually Going On?

Hip pain after 50 is common, but the cause is often not what people expect. Understanding what is driving it is the first step toward getting the right help.

Many people who develop hip pain after 50 worry right away about arthritis, deterioration, or eventually needing a hip replacement. But for many, especially women in the perimenopausal and postmenopausal years, the real cause is more specific, and more treatable, than that. In practice, what I hear most often is not just pain, but worry about what it means and where it might lead.

What you feel may not be coming only from the joint.

Is This Arthritis? Do I Need a Hip Replacement?

Hip osteoarthritis is real, and it does become more common with age. But hip pain does not always mean hip arthritis. Many people with significant arthritis findings on imaging have minimal symptoms. Many people with significant pain have minimal findings.

One very common cause of lateral hip pain doesn't actually come from the joint itself. The ache on the outside of the hip, the soreness when you lie on your side, the discomfort walking up stairs or standing on one leg, is a condition called greater trochanteric pain syndrome, or GTPS. It involves the gluteus medius and gluteus minimus tendons, and sometimes the bursa, at the outer edge of the hip. It is not primarily an arthritis problem. And it responds well to the right approach.

If you have been told you have trochanteric bursitis, that is an older term for the same general area. The current understanding is that tendon involvement, specifically gluteal tendinopathy, is usually the primary issue.

It can also help to know which symptoms point where:

GTPS tends to look like:

• Pain on the outside of the hip

• Soreness when lying on the affected side

• Pain climbing stairs or walking uphill

• Discomfort standing on one leg

Hip joint osteoarthritis tends to look like:

• Pain in the groin or deep in the hip

• Significant stiffness, especially in the morning

• Reduced range of motion

• Pain getting in and out of a car or low chair

These patterns overlap, and imaging can help clarify, but the symptom picture often tells a meaningful story on its own.

Why Did This Start Without an Obvious Injury?

This is the question most people cannot answer, and it matters. You did not fall. You did not twist it. It just started hurting and seems to have come out of nowhere.

Greater trochanteric pain syndrome most commonly affects postmenopausal women between 45 and 63 years old. That pattern is not a coincidence. Hormonal changes during the menopause transition may influence tendon and muscle health, which helps explain why symptoms can appear in midlife without a clear trigger. When estrogen declines, tendons can become more sensitive to load and less resilient to the everyday demands placed on them, such as walking, climbing stairs, and standing.

This does not mean the pain is inevitable or permanent. It means there is a real physical reason why the hip becomes irritated even without a specific injury. The demands you have always placed on it may now exceed what the tendon can comfortably handle.

Muscle loss also plays a role. The gluteus medius is a key hip stabilizer. When it weakens, the tendon absorbs more stress with every step. Over time, that adds up, leading to tissue strain and inflammation.

If you want to understand more about how hormonal changes affect your joints more broadly, the post Menopause and Joint Pain: What's Actually Happening in Your Body goes deeper into that connection.

Should I Rest It or Keep Moving?

Rest is a reasonable instinct when something hurts. But for gluteal tendinopathy, prolonged rest is rarely the answer, and can make things worse over time.

A randomized clinical trial comparing education plus exercise, corticosteroid injection, and a wait-and-see approach found that education plus exercise resulted in higher rates of patient-reported global improvement and lower pain intensity than no treatment at eight weeks, and continued to outperform corticosteroid injection at the one-year mark.

What the education component covers matters. Tendons are sensitive to compression, and certain positions load the gluteal tendons in ways that slow recovery:

• Sitting with your legs crossed

• Deep hip stretches like the figure-four or pigeon pose

• Lying directly on the painful side

Learning to modify those habits, while gradually increasing the right kind of load through targeted exercise, is what tends to produce lasting improvement. The tendon needs progressive, appropriate loading to rebuild its capacity. Rest reduces pain temporarily but does not address the underlying tolerance problem.

If you are experiencing any of the following, get assessed sooner rather than later:

• Severe pain that makes it difficult to bear weight

• Pain accompanied by fever

• Night pain that is getting progressively worse

• Hip pain following a significant fall or trauma

A Note for Men

While GTPS is significantly more common in women, particularly after menopause, men can and do develop the same condition. Things like walking differently, doing a lot of activity without enough strength support, and age-related tendon changes can all contribute. The good news is that the rehab approach is usually similar.

What Actually Helps

The evidence points to a structured approach: understanding which positions and movements compress the tendon, modifying those in the short term, and building the load tolerance of the gluteus medius and surrounding muscles progressively over time.

This is not a passive process. It requires the right exercises, done in the right sequence, with attention to how your body responds. If you have been dealing with lateral hip pain and are not sure where to start, that is exactly what a structured rehab plan addresses.

One thing worth knowing: tendon recovery is slower than most people expect. Tendons have a poorer blood supply than muscle, which means progress is measured in weeks and months, not days. Patience and consistency with the right loading program matter more than intensity.

For related reading, the post Is Strength Training Safe With Joint Pain? covers how to approach exercise when something already hurts.

Download the free guide: Active Again Over 50: A 5-Day Guide to Simple Joint-Loving Habits That Ease Back and Hip Pain and Rebuild Strength.

Frequently Asked Questions

Is hip pain after 50 always arthritis?

No. Hip pain after 50 has several common causes, and arthritis is just one of them. Gluteal tendinopathy and greater trochanteric pain syndrome are frequently misidentified as arthritis but respond differently to treatment.

What does greater trochanteric pain syndrome feel like?

It typically presents as pain on the outside of the hip, soreness when lying on the affected side, and discomfort with stairs, walking uphill, or standing on one leg. Groin pain is less typical and may suggest a joint rather than tendon issue.

Can I exercise with lateral hip pain?

In most cases, yes, with modification. The goal is to reduce compressive loading on the tendon in the short term while gradually building the strength and load tolerance of the surrounding muscles. Avoiding all movement tends to slow recovery rather than support it.

Why does hip pain get worse when lying down at night?

Lying directly on the affected hip compresses the gluteal tendons against the greater trochanter, which can increase pain. A pillow between the knees when side-lying reduces that compression and often helps significantly.

About the Author:

Dr. Melanie Wintle is a chiropractor and corrective exercise specialist with over 30 years of experience helping adults stay strong, mobile, and independent as they age. She focuses on strength training, mobility, and rehab strategies that support long-term joint and overall health.

References

Cowan, R. M., Ganderton, C. L., Cook, J., Semciw, A. I., Long, D. M., & Pizzari, T. (2022). Does menopausal hormone therapy, exercise, or both improve pain and function in postmenopausal women with greater trochanteric pain syndrome? A 2 × 2 factorial randomized clinical trial. The American Journal of Sports Medicine, 50(1), 70–79. https://doi.org/10.1177/03635465211061142

Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H., & Vicenzino, B. (2018). Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: Prospective, single blinded, randomised clinical trial. BMJ, 361, k1662. https://doi.org/10.1136/bmj.k1662

Segal, N. A., Felson, D. T., Torner, J. C., Zhu, Y., Curtis, J. R., Niu, J., & Nevitt, M. C. (2007). Greater trochanteric pain syndrome: Epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation, 88(8), 988–992. https://doi.org/10.1016/j.apmr.2007.04.014

Disclaimer

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