Hip

What Actually Prevents Hip Pain and Injury: The Evidence Across the Whole Hip

Ten conditions, and a set of levers that look different from the knee. This is the evidence-led overview of how to protect your hips, with detailed guides for the problem that fits you.

Written by Dr Isa Waheed, MBBS MFSEM

Published 2 October 2026Last reviewed 2 October 202612 min read27 studies reviewed

Key takeaways

The hip is driven by a different mix from the knee. Here the shape of the joint, the strength of the bone, and your genes matter more, while body weight is a smaller and more complicated lever.
The two shapes that matter most are cam morphology, extra bone on the femoral neck, and hip dysplasia, a shallow socket. Each roughly doubles the risk of hip osteoarthritis, and cam morphology largely forms during the teenage years in those playing high-level impact sport.
Weight at the hip cuts more than one way. It is only a modest driver of hip arthritis, but in teenagers excess weight is the dominant cause of a slipped growth plate, and in older age being underweight more than doubles the risk of a hip fracture.
Bone health runs through the serious hip conditions. In older adults, balance exercise, treating osteoporosis, and fracture-risk screening genuinely prevent hip fractures. In young athletes, enough fuel and sensible training load protect against stress fractures.
Some hip problems are easily missed or urgent. Knee pain in an overweight teenager can be a slipped hip, groin pain in an endurance athlete can be a stress fracture that may displace, and new hip pain after steroid treatment can be early bone death. All need prompt assessment.

Start here: the hip is many problems, not one

The hip is not a single condition with a single fix. It is the site of at least ten distinct problems, from the worn joint of osteoarthritis to the torn tendon behind outer hip pain, the stress fracture of the overtrained runner, and the slipped growth plate of the overweight teenager. They affect very different people, and advice built for one can be useless for another.

As with the knee, though, a manageable set of factors genuinely moves the needle, and this overview covers that shared set before pointing you to a detailed guide for your specific problem. What is striking about the hip is how different that set looks. At the knee, body weight is the dominant lever. At the hip, the shape of the joint, the health of the bone, and your inherited risk matter more, and weight plays a smaller and more surprising role.

One principle runs through everything here. The strength of the evidence varies a great deal across the hip. For hip fracture, the structural causes of arthritis, and the management of gluteal tendinopathy, there are high-quality trials and large reviews. For conditions like deep gluteal syndrome and pelvic avulsions there are only small case series. Throughout these guides the confidence of the advice is matched to the strength of the evidence behind it, and where the evidence is thin that is said plainly.

What makes the hip different from the knee

Three things set the hip apart, and they reshape what prevention looks like.

The first is shape. The way a hip is built predicts whether it wears out. Hips with cam morphology, meaning extra bone at the femoral head-neck junction, were about two and a half times more likely to develop osteoarthritis in pooled prospective studies, and dysplastic hips, meaning a shallow socket, about two and a third times more likely [3] [5]. A large individual-participant analysis of nearly 24,000 hips confirmed the cam finding, with the highest risk in men and at ages 51 to 60 [4]. These shapes are not something most people can change in adulthood, but recognising them changes how a hip should be managed, and cam morphology in particular has a window in which it forms, which the next section covers.

The second is bone. More than at the knee, hip problems are bone problems. The femoral neck is where older adults fracture, where endurance athletes develop stress fractures, and where the blood supply can fail and bone can die. That makes bone strength, falls risk, and training load central to hip prevention in a way they are not for the knee.

The third is inheritance. Genes explain a large share of hip osteoarthritis risk, with twin studies putting the heritability of needing a hip replacement at around two-thirds [10]. A family history of hip replacement is a real reason to act earlier on the factors you can change. Heavy physical work adds to this picture: across pooled cohort and case-control studies, regularly lifting heavy loads roughly doubled the risk of hip osteoarthritis in men, and the risk rose with years of exposure [11].

The things that genuinely change your risk

Mind the shape of the hip, and protect it while it forms

Because cam morphology is one of the main structural drivers of hip arthritis, the question of where it comes from matters. The evidence points to adolescence. High-level male athletes were between about two and eight times more likely than non-athletes to develop cam morphology, and it appears to form while the growth plate is still open, with a frequently reported link between how much sport a young athlete does and how pronounced the shape becomes [6] [7]. This does not mean children should avoid sport, whose benefits are large, but it does make the teenage years the window in which the adult shape of the hip is partly set.

The flip side is knowing what not to do about shape in adults. Cam and pincer shapes, and labral tears, are extremely common in people with no pain at all, and no good evidence supports operating on these shapes in someone without symptoms (covered further under the myths below). Shape is a risk marker to understand, not in itself a problem to fix surgically.

Protect your bone, across the whole lifespan

This is where the strongest hip prevention evidence sits, and it applies at both ends of life. In older adults, exercise that challenges balance prevents falls, with high-certainty evidence from more than a hundred trials: balance and functional exercise cut the rate of falls by about a quarter, and programmes combining balance with resistance training by about a third [16]. Treating diagnosed osteoporosis prevents fractures, with bisphosphonates and denosumab reducing hip fractures in postmenopausal women who have it [17], and screening women aged 70 to 85 for fracture risk reduced hip fractures by over a quarter in a large UK trial [18]. Vitamin D with enough calcium adds a modest further reduction [19].

In young athletes, the bone threat is the stress fracture, and the levers are different. Low energy availability, meaning not eating enough to match training, is common in athletes and is linked to impaired bone health and more bone stress injuries [21], while in military recruits calcium and vitamin D during heavy training cut stress fractures by about a fifth [22]. Building training load gradually, rather than spiking it, is the recurring message. Across the lifespan the theme is the same: strong bone, and loads it is ready for.

Keep a healthy weight, but know it cuts more than one way

Weight at the hip is more interesting than the simple "lose weight" message that fits the knee. For the adult hip joint itself, weight is only a modest driver: each 5 kg/m2 rise in body mass index raised osteoarthritis risk by about 11%, far less than at the knee, and one large population cohort found body mass index made no difference at all to the lifetime risk of symptomatic hip osteoarthritis [2] [1]. It matters more for arthritis severe enough to need surgery than for arthritis on an X-ray.

But weight becomes decisive at the two ends of life. In teenagers, excess weight is the dominant cause of a slipped growth plate, with risk rising steeply as weight rises and severe obesity at age 11 to 12 carrying up to seventeen times the risk [24]. And in older adults the danger reverses: being underweight more than doubled the risk of a hip fracture in both sexes, and obesity did not reliably protect once bone density was taken into account [20]. So the honest hip message is to keep weight in a healthy range in both directions, not simply to lose it.

For soft-tissue hip pain, load and education beat injections

Much outer hip pain is not the joint at all but gluteal tendinopathy, a load problem in the tendons on the side of the hip, and it is common, especially in women after menopause. The best trial evidence here is clear and practical: a programme of education about managing load and avoiding compression of the tendon, combined with exercise, outperformed a corticosteroid injection, and the advantage over injection was still there a year later [15]. The injection gave short-term relief but was not the better long-term choice. The wider lesson for soft-tissue hip pain is to treat it as a tendon and load problem to be managed over time, rather than something to inject and forget.

The myths worth dropping

Running does not harm your hips

As at the knee, recreational running does not appear to cause hip osteoarthritis and may even slightly protect against it. Across pooled studies, osteoarthritis was present in about 3.5% of recreational runners against 10.2% of non-running controls, with only very high-volume competitive running carrying a higher signal [12]. These figures pool hip and knee and show association rather than proof, but the reassurance for the recreational runner is sound: running is compatible with healthy hips.

Supplements do not protect the hip

Glucosamine is one of the most widely taken joint supplements, and when the raw data from industry-independent placebo-controlled trials were pooled, it was no better than placebo for pain or function at three months or at two years, and no better in any subgroup [13]. Adding chondroitin does not rescue it: pooled trials of glucosamine, chondroitin, and their combination found no clinically meaningful effect and no effect on joint-space narrowing [14]. Money spent here is better spent elsewhere.

An abnormal scan is not a diagnosis

Hip imaging findings are common in people with no pain. Cam morphology was present in about 37% of pain-free hips, and labral injury appeared on scans in about 68% of the pain-free hips that were examined [8]. A shape or a labral tear on a scan, in someone without symptoms, is often an incidental finding, which is why no good evidence supports preventive surgery for these shapes in people who have no pain [9]. Findings have to be read alongside symptoms and examination, never on imaging alone.

Some hip pain should not wait

Most hip pain is not urgent, but a few patterns are, and they are easy to miss. Three are worth knowing.

In an overweight child or teenager, knee or thigh pain can actually be coming from the hip, from a slipped growth plate. Children who presented with knee pain waited a median of 161 days for the diagnosis, compared with 20 days for those with hip pain, so an adolescent's knee pain deserves a look at the hip [25]. In an endurance athlete, dancer, or military recruit, deep groin or hip pain that eases with rest can be a femoral neck stress fracture, which matters because, unrecognised, it can progress to a displaced fracture with serious complications, so it needs prompt assessment [26]. And in anyone on long-term or high-dose steroid treatment, new groin or hip pain can be early bone death in the femoral head. Steroids are the main driver, with heavy alcohol use another [23], and it is worth catching early because at that stage it can sometimes be managed without surgery [27]. None of these should be waited out.

Find your hip: the detailed guides

This overview covers what is common across the hip. For the specifics of your problem, including who is affected, what raises risk, and what the evidence says you can do, use the detailed guide that fits:

The structural hip: osteoarthritis, impingement, and dysplasia. The worn hip joint and the two shapes behind much of it, with the strongest evidence on what raises risk and what does not. (Guide: hip osteoarthritis and impingement prevention.)
Lateral and deep hip pain: gluteal tendinopathy and deep gluteal syndrome. Outer hip pain and deep buttock pain that can mimic sciatica, where load management and exercise do most of the work. (Guide: hip and buttock pain prevention.)
Hip bone health: fractures, bone stress, and osteonecrosis. The hip fracture of later life, the stress fracture of the athlete, and bone death in the femoral head, united by bone strength and early recognition. (Guide: hip fracture and bone health prevention.)
The young hip: slipped growth plate and pelvic avulsions. The adolescent hip, where weight, growth, and sport matter and fast diagnosis prevents lasting harm. (Guide: hip pain in adolescents.)

The bottom line

For everyone: the hip rewards a different short list from the knee. Understand the shape of your hip, protect your bone at every age through strength, balance, and enough fuel, and keep your weight in a healthy range in both directions rather than only downwards. Treat outer hip pain as a tendon problem to manage, not to inject and forget. Ignore the supplements, do not fear running, and do not treat a scan finding as a diagnosis. And take the few urgent patterns seriously, because a slipped hip, a stress fracture, or early bone death all do better when caught early.

For clinicians: the hip prevention evidence is genuinely strong for falls prevention and osteoporosis treatment, for the structural link between cam morphology or dysplasia and later osteoarthritis, and for load-based management of gluteal tendinopathy, and genuinely thin for deep gluteal syndrome and pelvic avulsions. Messaging should be confident where the evidence is and humble where it is not, should reframe weight at the hip as a lifespan issue that runs in both directions rather than a simple reduction target, and should keep the can't-miss presentations, the slipped epiphysis presenting as knee pain, the tension-sided femoral neck stress fracture, and steroid-related osteonecrosis, in clear view. Condition-specific questions belong in the detailed guides.

References

Frequently asked questions

What is the best way to prevent hip problems?

There is no single trick, and the hip rewards a different list from the knee. Protect your bone at every age through balance and strength work and, in athletes, enough fuel for your training. Keep your weight in a healthy range in both directions. Treat outer hip pain as a tendon and load problem to manage over time. And understand that the shape of your hip, which largely forms in adolescence, is a big part of your long-term risk.

Does running ruin your hips?

No. Recreational runners do not appear to have more hip osteoarthritis than non-runners, and may have slightly less, with only very high-volume competitive running carrying a higher signal. For most people, running is compatible with healthy hips rather than a threat to them.

Is weight as important for the hips as for the knees?

Not in the same way. For the adult hip joint, weight is only a modest driver of osteoarthritis, much less than at the knee. But it becomes decisive at the extremes of life: in teenagers, excess weight is the main cause of a slipped growth plate, and in older adults, being underweight more than doubles the risk of a hip fracture. A healthy weight in both directions is the goal.

I have a cam or labral tear on my scan. Do I need surgery?

Not on the scan alone. Cam shapes and labral tears are very common in people with no hip pain at all, so they are often incidental findings, and no good evidence supports operating on these shapes in someone without symptoms. Imaging findings have to be interpreted alongside your symptoms and examination.

My hip hurts. Which guide should I read?

If you have gradual groin or deep hip pain or stiffness, start with the structural hip guide on osteoarthritis and impingement. If your pain is on the outer hip or deep in the buttock, read the hip and buttock pain guide. If you are an older adult concerned about fractures, or an athlete with bone-related pain, see the hip bone health guide. If the person affected is a child or teenager, read the adolescent hip guide. And remember that this is educational information, not a diagnosis.

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About the author

Dr Isa Waheed

MBBSMFSEMBSc (Hons)DipMSKDipExMedDipTCPGCertFHEA

NHS doctor and sport and exercise medicine clinician, translating injury prevention research into guidance people can act on.

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Educational information only. Not medical advice and not a substitute for assessment by a qualified clinician. Seek prompt medical assessment for a hip that cannot bear weight, for sudden or severe hip pain, for groin or hip pain during heavy training, for new hip pain during or after steroid treatment, and for knee or thigh pain in a child or teenager, which can come from the hip.