A guide from Dr Beate Helgers’ private practice in Ahaus.
Hip pain when walking often gradually changes the way you go about your daily life. At first, your walks become shorter. Then climbing stairs becomes more difficult, getting into the car becomes uncomfortable, or after a few hundred metres your hip starts to ache. Some people feel the pain deep in the groin, others on the outside above the hip bone, or more towards the buttocks.
It is precisely these differences that are important for the diagnosis. This is because not every pain we perceive as ‘hip pain’ actually originates in the hip joint. Tendons, muscles, bursa, the lumbar spine or nerves can also cause discomfort. Even a circulatory disorder can make itself felt, particularly when walking.
At Dr Beate Helgers’ private orthopaedic practice in Ahaus, the examination therefore does not begin with the question ‘Is it osteoarthritis?’, but with a more specific one: Where does the pain occur, what kind of activity triggers it, how does it affect your gait – and what happens when you stop walking or sit down?
Key points at a glance
Hip pain when walking is a symptom, not a diagnosis. The location of the pain, the pattern of symptoms under strain and range of motion provide important clues as to the cause.
Pain deep in the groin is more commonly associated with the hip joint; pain on the outer side is more likely to originate from tendon insertions and surrounding structures. This is a guide, not a self-diagnosis.
Hip osteoarthritis often begins gradually. Typical symptoms may include pain on weight-bearing and in the groin, pain when starting to walk, and a decline in range of motion.
If symptoms occur mainly after walking a certain distance, it is not just the hip that needs to be examined. The spine, nerves and blood circulation may also play a role.
Exercise is part of the treatment for many hip complaints. However, it is crucial to determine what level of exertion is appropriate for the underlying cause and the current level of irritation.
Following a fall where you are unable to bear weight, in the event of a fever and severe hip pain, or if you experience sudden, severe symptoms, you should seek immediate medical assessment.
Where is the pain? This is often the first important clue
Patients with ‘hip pain’ point to a wide variety of areas. This alone can steer the examination in a particular direction – without prejudging the diagnosis.
Pain in the groin
A deep pain in the groin, which occurs when walking, climbing stairs or turning the leg, may originate from the hip joint itself. In the case of hip osteoarthritis, pain in the hip and groin whilst walking is one of the typical early symptoms. Other changes in the joint may also manifest themselves there.
For medical assessment, it is also worth noting whether putting on socks and shoes has become more difficult, whether getting into a car is uncomfortable, or whether the leg is less mobile when crossing one leg over the other.
Pain on the outside of the hip
Anyone who points to the side of their hip bone and finds it almost impossible to lie on that side at night may have a different problem to someone with deep groin pain. Important tendons of the gluteal muscles attach to the outside of the hip. The synovial tissue in that area can also become painful.
Such symptoms are often colloquially referred to as ‘bursitis’. However, there may be a more complex tendon or strain-related issue underlying this. It is therefore advisable not to choose a course of treatment based solely on the location of the pain.
Pain in the buttocks or at the back
Pain in the buttocks is often automatically attributed to the hip. However, it can also originate from the lumbar spine, the small vertebral joints, the sacroiliac region or from nerve structures. Particularly if numbness, tingling or pain radiating further down the leg are also present, the spine should be examined as well.
Hip pain when walking: it all depends on the pattern
‘It hurts when I walk’ is, for us, just the start of the medical history. The details are particularly important for further assessment.
Start-up pain: The first few steps are the hardest
Some patients report that the first few steps after getting up or after sitting for a long time are uncomfortable, and that the pain eases slightly after a few minutes. This type of start-up pain can occur with osteoarthritis, but is not conclusive. A physical examination, assessment of range of motion and, if necessary, imaging are crucial.
Pain increases with prolonged strain
If the hip becomes increasingly painful after a long walk, the joint’s or the surrounding tendon structures’ capacity for load-bearing may be reduced. It is then important to establish whether climbing stairs, walking uphill or standing for prolonged periods also trigger symptoms, and how long the pain persists after the activity.
Pain after walking a consistently similar distance
If symptoms reliably begin after a specific distance and subside again at rest, it is worth taking a closer look beyond the hip. For example, narrowing of the spinal canal can cause pain in the buttocks and legs, which worsens when walking or standing and improves when sitting or bending forwards. Circulatory problems in the legs can also cause exertion-related pain.
This is a good example of why ‘hip pain when walking’ does not automatically mean ‘hip osteoarthritis’.
Limping or compensatory movements
Pain alters movement. Some people unconsciously shorten their stride, shift their weight to the other side or turn their leg differently. These compensatory movements can contribute to further discomfort in the back, knee or the opposite side. For this reason, when diagnosing load-dependent hip pain at our private orthopaedic practice in Ahaus, we specifically include an assessment of gait as part of the examination.
Is it hip osteoarthritis?
Osteoarthritis is a common cause of hip pain, particularly from middle age onwards. However, it is not the only one.
Typical signs may include:
Pain in the hip or groin area when walking or climbing stairs
Pain on starting to move after sitting for a long time or in the morning
Increasingly limited mobility
Difficulty putting on shoes and socks
Difficulty getting into a car or crossing one’s legs
Shorter distances that can be walked pain-free
However, it is important to note that the severity of symptoms and the extent of changes visible on an X-ray do not necessarily correlate. An X-ray shows the structure. It does not fully reveal how resilient a person actually is, how they move, or the source of their current pain.
Therefore, treatment should not be based solely on the statement ‘There is wear and tear’.
What can I do myself?
In the case of mild, non-acute hip discomfort without any warning signs, there are a number of measures that can help you to better assess the situation initially and put appropriate strain on the joint.
1. Observe the pain pattern
For a few days, make a note of when the pain starts: immediately with the first few steps, only after 20 minutes, only on inclines, or particularly when climbing stairs? Where exactly is it located? How quickly does it improve again at rest? This information is often more helpful for the examination than simply rating the intensity of the pain on a scale.
2. Pace your activity rather than avoiding it completely
For many degenerative hip conditions, regular exercise is one of the most important measures. This does not mean ‘training away’ sharp pain. It makes more sense to apply a level of strain that remains manageable and allows the pain to subside afterwards.
Cycling, adapted walking or exercises to improve strength and mobility may – depending on the findings – be more beneficial than complete rest.
3. Use shoes and walking aids pragmatically
Well-fitting, sturdy shoes can make walking more comfortable. If the distance you can walk is already significantly limited or if you feel unsteady, a walking stick can provide temporary relief. It is usually held on the less affected side. Whether an aid is appropriate can be assessed on a case-by-case basis.
4. Do not focus solely on the hip
If symptoms recur time and again after walking longer distances, it is worth also considering the trunk, pelvis, knees, feet and your overall gait. A functional analysis can provide additional insights, particularly in the case of recurring problems.
What you should avoid doing
Treat every case of hip pain as osteoarthritis
Pain on the outside of the hip, in the groin and in the buttocks can have various causes. A treatment that is appropriate for osteoarthritis may therefore not be suitable for a tendon problem or for symptoms originating from the spine.
Consistently ‘walking off’ sharp pain
Exercise is important. However, it must be done in moderation. If pain escalates significantly with every walk and persists for hours afterwards, the level of exertion should be adjusted and the cause investigated.
Treating only the X-ray findings
Signs of osteoarthritis can be important. However, they do not automatically explain every current symptom. To make a sound decision on treatment, imaging, physical examination, the location of the pain, range of motion and limitations in daily life must all be taken into account.
Accepting a compensatory posture for weeks on end
Anyone who limps persistently or places significantly less weight on one side alters their entire pattern of movement. This can lead to further problems. If the gait pattern remains altered over a prolonged period, the cause should be investigated.
How do we investigate hip pain when walking at our orthopaedic practice in Ahaus?
At our private practice in Ahaus, the examination begins by asking what exactly happens whilst walking. Not all hip pain can be reproduced whilst lying on an examination couch. That is why the weight-bearing pattern is particularly important.
Depending on the symptoms, we look at factors including:
Gait pattern and any compensatory or avoidance movements
Mobility of the hip joint, particularly rotation and flexion
Pain during specific movements and stress tests
Strength of the hip-stabilising muscles
Tendon insertions and painful structures on the outer side
Lumbar spine and neurological findings, if symptoms radiate
Knee, leg alignment and foot, if the movement pattern is abnormal
Depending on the clinical question, ultrasound, X-rays or an external MRI scan may be appropriate. Existing images and findings are taken into account in the assessment. The decisive factor is always whether the imaging answers a specific medical question.
What conservative treatments are available?
At Dr Beate Helgers’ private practice, treatment is not organised according to the ‘one diagnosis – one therapy’ principle. The key factors are which structure is likely to be involved, the extent to which mobility is restricted, and what the patient hopes to achieve again in their daily life.
The treatment approach in Ahaus combines three areas.
1. Reducing pain and restoring mobility
If pain significantly restricts walking, targeted pain and inflammation management may initially be necessary. Depending on the findings, options may include, for example, medication, injections, manual therapy or other pain management measures.
In cases of active irritation, the initial aim is not maximum training, but rather to restore a resilient baseline condition.
2. Treating functional interrelationships
A painful hip joint does not function in isolation. The pelvis, gluteal muscles, fascia, trunk, knees and feet all influence gait. Depending on the findings, manual therapy, acupuncture, electrotherapy, neuromuscular techniques or targeted treatment of muscle and fascial structures may form part of the treatment plan.
The key is not to use as many methods as possible, but to select the one that is appropriate for the current cause and stage of the condition.
3. Building resilience and stability
In the long term, walking is not just about whether the hip is pain-free, but whether the muscles and movement patterns can once again cope well with the strain. Strength, coordination and controlled movement therefore play a particularly important role, especially in cases of recurring symptoms.
In Ahaus – where medically appropriate – movement and gait analyses, medical exercise therapy in a one-to-one setting and individually tailored training programmes can be incorporated into the treatment plan.
What works – and what doesn’t?
What may be beneficial
What cannot be reliably promised
Pinpointing the exact location of pain and the strain on walking
Deriving a definitive diagnosis based solely on the location of the pain
Examining the hip, spine and gait in conjunction
Treating every instance of hip pain as osteoarthritis
Adapt exercise to the level of irritation and the patient’s tolerance
Consistently ‘train away’ acute pain
Use imaging selectively when it answers a specific question
Equate X-ray or MRI findings with the cause of the pain
Make full and structured use of conservative treatment
Ensure that surgery is never necessary
When does surgery become an option?
Hip surgery is not automatically the next step simply because osteoarthritis is visible on an X-ray. In cases of advanced hip osteoarthritis, a hip replacement may be advisable if pain and limitations in everyday life are severe and conservative treatments do not provide sufficient relief.
The decision should therefore not be based solely on the X-ray image. Key factors include the severity of pain, range of motion, ability to walk, sleep quality, independence, previous treatment and personal goals.
The aim of conservative treatment is not to delay a medically necessary operation at any cost. Rather, it is intended to determine what can realistically be achieved without surgery – and when a surgical consultation becomes the better option.
When should hip pain be investigated promptly?
Many hip problems develop gradually and can be investigated at a leisurely pace. However, there are situations in which you should not wait too long:
Following a fall or accident, you are barely able to put any weight on your leg, or cannot do so at all.
The hip is suddenly very painful and movement is barely possible.
You experience a fever, chills or a pronounced feeling of being unwell alongside hip pain.
Your leg suddenly appears significantly shorter or misaligned.
You also experience new-onset numbness, a marked loss of strength or signs of paralysis.
The leg feels noticeably cold or pale, or the pain, which worsens with weight-bearing, increases rapidly.
If you experience any of these symptoms, urgent medical assessment may be required.
Get your hip pain checked in Ahaus
If hip pain is reducing the distance you can walk, keeps coming back or is increasingly limiting your mobility, it is worth having it examined thoroughly. Our aim is not simply to identify the cause of the pain as quickly as possible, but to narrow down the cause as far as possible and use this to draw up a sensible treatment plan.
Dr Beate Helgers’ Private Orthopaedic Practice Fuistingstraße 4 · 48683 Ahaus 02561 – 963 963 2
Mon–Fri: 8.00 am–6.00 pm
Appointments can be booked by telephone or, for first-time and new patients, via the online booking system.
Frequently asked questions about hip pain when walking
Why does the hip sometimes hurt all the way down to the knee?
Pain originating in the hip joint can radiate down the thigh and as far as the knee. For this reason, the hip is sometimes examined when the cause of knee pain is unclear. Conversely, discomfort in the hip area may originate from the back or neighbouring structures.
Can hip osteoarthritis exist without severe pain?
Yes. Changes visible on X-rays do not always correspond to the severity of pain. Some people have clear radiological signs of osteoarthritis but relatively few symptoms, whilst others feel more restricted despite having fewer visible changes.
Can a leg really become shorter as a result of hip osteoarthritis?
In cases of advanced changes, leg length may be altered either functionally or structurally. However, the impression of a shorter leg is often caused by pelvic alignment, restricted movement or compensatory posture. This should be measured and examined, rather than simply being corrected based on a subjective feeling.
When is an MRI scan of the hip recommended?
An MRI scan may be advisable if the physical examination and, where appropriate, X-rays or an ultrasound scan leave a specific question unanswered, if certain soft-tissue or bone changes are suspected, or if symptoms persist without a clear cause. It is not the first test carried out for every case of hip pain.
Is cycling better than walking if your hip is playing up?
Cycling puts a different strain on the hips to walking and is better tolerated by some people. Whether it is suitable for you depends on your mobility, your sitting position and the cause of your symptoms. It should not be seen as a universally ‘better’ form of exercise.
Why is it often difficult to put on socks when you have hip problems?
To do this, the hip joint requires a combination of flexion and rotation. If these movements are restricted or painful, difficulty putting on shoes and socks is often one of the first signs.
Is a cortisone injection always advisable for hip pain?
No. An injection should be based on a clear medical indication and correspond to the suspected cause of the pain. Furthermore, a decision must be made as to which specific structure is to be treated. A blanket injection for ‘hip pain’ is not a treatment plan.
Can people with statutory health insurance also book an appointment in Ahaus?
Yes. The practice is a private practice. Patients with statutory health insurance can receive treatment as self-paying patients. Private patients and those entitled to a health allowance will also be invoiced in accordance with the GOÄ.
About the author
Dr Beate Helgers, MD – Specialist in Orthopaedics
Dr Beate Helgers studied medicine at Ruhr University Bochum. Her medical training took her, amongst other places, to the University Orthopaedic Clinic at St Josef’s Hospital in Bochum, the Department of General and Trauma Surgery at Marienkrankenhaus Schwerte, the University Orthopaedic Clinic at RWTH Aachen University, and the Paracelsus Clinic in Marl.
In 1996, she obtained her PhD in orthopaedics, and in 1998 she was recognised as a specialist in orthopaedics. In 2011, she established her own private practice in Dorsten-Lembeck; since 2020, she has also had a branch in Ahaus. Today, Steinfurt and Gescher are also part of the practice network.
Her treatment approach combines orthopaedic diagnostics and pain management with an analysis of functional relationships and – where medically appropriate – active stabilisation and exercise therapy.
