What Causes Hip Pain Radiating Down the Leg to the Knee?

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Hip pain is bad enough on its own, but when it decides to get really aggressive, you may notice it radiate down the leg to the knee.

The tough part then is to figure out what is causing this hip pain and knee pain connection? Can hip pain cause knee pain?

Sometimes you can experience what is called referred pain, meaning one area of the body is causing pain to another area. The second area isn’t necessarily the source of the problem, more so an innocent by-stander.

This is exactly the case with hip pain radiating down leg to knee. Now, the question remains what causes referred pain from the hip to knee?

Most Common Causes for Hip Pain Radiating Down to the Knee

most common causes for hip pain radiating down to the knee

There are a few possibilities to consider when trying to determine the cause of hip pain radiating to the knee. This includes a variety of hip disorders and even considers the sacral and lumbar spine.

It can be helpful to received professional medical advice for this issue to differentiate painful conditions and begin the best treatment for the right diagnosis.

1. Hip Osteoarthritis

hip osteoarthritis


Hip osteoarthritis is a severe form of hip arthritis that causes degenerative wear and tear in the hip joint.

When this aggressive type of arthritis occurs, it causes the ball and socket joint to significantly wear down, which increases friction forces in the hip joint.

This will affect the harmony of the attaching soft tissues, leading to hip pain. If severe enough, this hip pain can radiate down the leg to the knee.

Common Symptoms of Hip Osteoarthritis:

Common symptoms associated with hip osteoarthritis include the following:

  • Deep hip joint pain
  • Groin pain
  • Joint stiffness, especially in the mornings and with prolonged sitting
  • Muscle weakness
  • Decreased range of motion
  • Clicking or grinding sound when moving the hip joint

Hip stiffness upon standing is incredibly common with hip osteoarthritis. While recommended stretches will be discussed further below, take a look at this video for a quick way to stretch the hip when you stand up to help relieve that stiffness.

It’s not uncommon for most with severe hip osteoarthritis, who eventually develop “bone on bone” pain, to require a total hip replacement surgery.

While this procedure inserts a new artificial hip joint, pain relief takes time to occur due to the post-op recovery process.

Physical therapy is required after a total hip replacement to assist in pain management and mobility training.

Many will still experience hip and leg pain during recovery, which can include hip pain radiating down to the knee. This will eventually subside, but can take the first full year after surgery to recover.

2. Hip Bursitis

There are many bursae in the body. These are small fluid-filled sacs that help to cushion and support the areas between bones and soft tissues, such as muscles, tendons, and ligaments.

If a bursa develops inflammation for any reason, then pain will usually follow. This inflammation is most commonly from repetitive physical activity or vigorous activities, such as running and biking.

The two most common types of hip bursitis include trochanteric bursitis and iliopsoas bursitis.

a. Trochanteric Bursitis

A bony prominence on the outer side of the hip, called the greater trochanter, is the location of the greater trochanter bursa.

trochanteric bursitis

Pain in this area of the hip can cause radiating leg pain down to the knee. Common symptoms associated with trochanteric bursitis include the following:

  • Tenderness with direct pressure over the greater trochanter
  • Radiating leg pain down the outer thigh
  • Outer hip and leg pain
  • Pain with walking and/or running

b. Iliopsoas Bursitis

The bursa situated under the iliopsoas muscle can become inflamed and lead to iliopsoas bursitis. Besides radiating leg pain from the hip to the knee, the following symptoms may also occur:

  • Deep pain in the groin region
  • Catching or snapping sensation in the hip

3. Snapping Hip Syndrome

snapping hip syndrome

Snapping hip syndrome is a type of pain in the hip that is primarily known for an audible snapping sensation in the hip while in motion. This snapping can sometimes be palpated, or felt with the hands, during the motion as well.

The snapping sensation can occur inside or outside the hip joint, although occurrence outside of the hip joint is more common.

The two primary types of snapping hip pain are called external snapping hip and internal snapping hip.

a. External Snapping Hip Pain

External snapping is usually related to snapping at the iliotibial band and its motion over the greater trochanter.

Other possible soft tissues involved with external snapping include attachments to the proximal hamstrings tendon, psoas tendon, gluteus maximus tendon, or the tensor fascia latae.

It’s not uncommon to experience outer hip pain radiating down the outside of the thigh to the knee.

b. Internal Snapping Hip Pain

The iliopsoas tendon is most commonly involved with internal snapping hip pain. In addition to a snapping pain and sensation in the groin area, pain may also radiate down the leg.

4. Hip Impingement

hip impingement

Femoroacetabular impingement is a hip disorder that can commonly create radiating pain down to the knee.

With femoroacetabular impingement, the tissues in the hip become pinched in the joint itself. This will usually cause groin pain that can radiate down the thigh.

It’s no uncommon for this to occur with hip arthritis and other hip injuries, such as a hip labral tear.

Common Symptoms of Hip Impingement

Besides radiating hip and leg pain, the following symptoms may also occur:

  • Pain getting in and out of the car
  • Pain with excessive hip bending or flexion
  • Deep pain in the groin region
  • Pain when standing after prolonged sitting

5. Labral Tear

labral tear

The hip labrum is necessary to support the joint, and securely connect the ball of the thigh bone into the hip socket.

A hip labral tear is a common sports injury, especially with contact sports, but can also occur due to wearing down of other structures within the joint.

Common Symptoms of Hip Labral Tear

While imaging and certain special tests will confirm a hip labral tears, the following are normal symptoms that can occur:

  • Dull or sharp pain in the hip
  • Groin pain
  • Radiating pain down the leg to the knee
  • Pain with extended sitting, standing or walking
  • Leg pain with placing weight on the affected leg

6. Avascular Necrosis

avascular necrosis

Avascular necrosis of the hip will occur when there is a lack of blood flow to the area. This causes the bone tissue to die.

Those with avascular necrosis are more susceptible to experience a complete collapse of the joint.

Common causes of this particular hip disorder may be some type of trauma, such as a hip fracture or dislocation, causing blood flow obstruction.

Common Symptoms of Avascular Necrosis

The following symptoms are normal to experience with this issue:

  • Progressive hip pain with weight bearing
  • Gradual worsening of pain intensity
  • Pain location in any part of the hip area
  • Pain that radiates down the leg to the knee or foot

7. Pinched Nerve

pinched nerve


It’s important to remember that radiating pain down to the knee may actually be originating from the lumbar spine or sacroiliac joint.

A pinched nerve is a very common culprit behind radiating pain down the leg.

The most well-known pinched nerve that most experience is from the sciatic nerve, causing sciatica pain. Keep in mind though, any nerve in the lumbar or sacroiliac region has the potential to become pinched.

Common Symptoms of Pinched Nerve

Nerve pain tends to stand out a bit more with regards to the quality and characteristics of the pain. This can include any of the following:

  • Leg numbness and/or tingling
  • Burning sensation in the hip
  • Radiating pain down to the knee or ankle and foot
  • Weakness in the leg
  • Low back or sacral pain

The exact location symptoms present along the leg will depend on which nerve is being pinched.

Treatment Options for Hip Pain Radiating Down to the Knee

treatment options for hip pain radiating down to the knee

As you can see, there are quite a few possible causes behind hip pain radiating down the leg to the knee.

More importantly now, how can these issues be treated?

While the recommended treatment options will vary, depending on the exact diagnosis, promoting the right self care to the hip joints not only can help with pain relief, but also with pain prevention.

A great option for this is hip stretches. If you’re in physical therapy for your pain, a physical therapist will normally include an exercise regimen to your visit and home program.

This will usually involve a variation of stretches to improve and promote optimal spine and leg range of motion.

We’ll go over a few very basic stretches that can be helpful to reduce your hip and leg pain.

Hamstring Stretch

A hamstring stretch is best performed in either sitting or laying on your back, depending which position is easiest and most productive for you.

a. Seated Hamstring Stretch

seated hamstring stretch
exercise for hip pain radiating down the leg to the knee
  • Seated in a chair, place the leg to be stretched extended in front of you (the knee should be straight).
  • Keeping a straight back, bend forward via hinging at the hips.
  • Once you feel a tolerable stretch behind the back of the leg, hold for at least 30 seconds or up to 1 minute.

b. Supine Hamstring Stretch

supine hamstring stretch step 1
supine hamstring stretch step 2
  • Lay on your back on your floor, bed or couch.
  • Position the leg to be stretched straight in front of you.
  • Using a non-elastic strap, wrap it around the foot on the leg to be stretched.
  • The opposite leg can be bent with the foot on the surface to best support the back.
  • Pull the leg up until you feel a tolerable pull behind the back of the leg (keep the knee straight).
  • Hold for at least 30 seconds or up to 1 minute.

Piriformis Stretch

A piriformis stretch is particularly useful if your pain from the hip to the knee is from the sciatic nerve being pinched under the piriformis muscle, also known as piriformis syndrome.

piriformis stretch step 1
piriformis stretch step 2
  • Lay on your back on your floor, bed or couch.
  • Bend both knees so the feet are flat on the surface.
  • Cross the leg to be stretched over the opposite thigh, so that it’s fully resting on that leg.
  • Take the opposite hand and place it on the outside of the thigh on the leg to be stretched.
  • Gently pull the thigh towards the opposite hip (avoid allowing the hip and/or back to lift off the surface).
  • Hold for at least 30 seconds or up to 1 minute.

Hip External Rotation Stretch

A hip external rotation stretch can be performed a couple different ways. We’ll key in on a Figure 4 position, which can be performed either seated or laying down.

a. Seated Hip External Rotation

seated hip external rotation
seated hip external rotation
  • Seated in a chair, cross the leg to be stretched over the opposite thigh. The ankle should be touching the thigh.
  • Keep a nice, straight back.
  • Place the same side hand on the inside of the thigh on the leg to be stretched.
  • Gently press the thigh down in the direction of the floor.
  • Hold for at least 30 seconds or up to 1 minute.

b. Supine Hip External Rotation

supine hip external rotation step 1
supine hip external rotation step 2
  • Lay on your back on the floor, bed or couch.
  • Position the legs so that the knees are bent and feet are flat on the surface.
  • Cross the ankle on the leg to be stretched over the opposite thigh.
  • Place the same side hand on the inside of the thigh on the leg to be stretched.
  • Gently press the thigh down towards the floor.
  • Hold for at least 30 seconds or up to 1 minute.

Hip Flexor Stretch

As the hip flexors in the front of the hips tend to become tight, this is a great stretch to do on a regular basis.

This stretch also can be done in a few different positions, but we’ll focus on one of the most simple positions that you can do with the leg hanging off the bed.

hip flexor stretch step 1
hip flexor stretch step 2
  • You’ll be laying on your back on your bed. Lay on the same side of the bed as the leg you’ll be stretching.
  • Position the leg NOT receiving the stretch with the knee bent and foot flat on the bed to support the back.
  • Allow the leg to be stretched to slowly hang off the side of the bed.
  • Make sure to avoid hyperextending the back.
  • Hold this stretch for at least 30 seconds or up to 1 minute.

If you’re looking for a more advanced stretch that combines stretching both the hip flexors and hip external rotators, then you should try the pigeon pose.

All yoga fans will recognize this one, but for those not as familiar with yoga, here’s a video demonstration!

Knee to Chest Stretch

The knee to chest stretch is a great stretch to open up both the hips and the spine. You can perform a Double Knee to Chest Stretch or Single Knee to Chest Stretch.

a. Double Knee to Chest Stretch

double knee to chest stretch
double knee to chest stretch
  • Lay on your back on your floor, bed or couch.
  • Hugging around the back of the thighs, pull the knees into the chest for a gentle stretch.
  • Hold this stretch for at least 30 seconds or up to 1 minute.

b. Single Knee to Chest Stretch

single knee to chest stretch
  • Lay on your back on your floor, bed or couch.
  • Hug around the back of one thigh, pulling that knee into your chest.
  • The opposite leg can either be flat on the surface for an additional stretch to the front of the hip, or for better support of the back you can keep that knee bent and the foot flat on the surface.
  • Hold this stretch for at least 30 seconds or up to 1 minute.

If you love foam rolling, then you should compliment these stretches with foam rolling the spine.

Do keep in mind that if you have a more stiff spine, then foam rolling the back may be a little intense. If you have difficulty getting on and off the floor, then you may want to hold off on this one.

If you don’t have any concerns for the above, then check out this video that shows how to use a foam roller to stretch the back!

Tips

As previously mentioned, gentle exercise, which usually will include a combination of stretching and strengthening exercises, are good to do regularly to maintain healthy hip joints.

If you begin experiencing this specific hip pain radiating down the leg to the knee, and it’s not going away, consider consulting with a healthcare professional.

This may include an assessment from your primary care physician, an orthopedic specialist, or a physical therapist.

Remember, you don’t have to suffer with long term pain. Relief is possible!

FAQ:

What is the best position to sleep in for radiating hip pain?

For best pain relief, try to either lay on your back with a pillow or two under the knees or lay on the opposite hip with a pillow between the legs.

Can I walk with radiating hip pain?

As long as your pain does not get worse with walking, then continuing to walk is fine. Try to keep your walks a shorter duration though to avoid further irritating pain.

How long should I wait to have my hip evaluated by a medical professional?

If your pain continues without relief for 1-2 weeks, make sure to consult with your medical doctor or a hip pain specialist.

Wondering What's Next?

Discover 11 Easy, At-Home “Stretch Exercises” for Stronger, Pain-Free Joints (click below)

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