Hip pain when hiking: uphill and downhill, the outer hip, the groin, the pack, poles and what helps

What nobody has countedEmerging evidence

No survey of hikers gives a share for hip pain. On the Appalachian Trail, 36% of 280 long-distance hikers reported acute joint pain, and 61% of 1,295 reported a muscle or joint complaint, 28% from overuse; on the John Muir Trail, pack strap pain was the third commonest complaint (46%). Across 7 studies of 17,757 injured hikers, the legs were the commonest injured site in every study, and most injuries were minor; in 5,665 hikers who fell in the Austrian Alps, 37.8% of non-fatal injuries were to the ankle and foot.

So the map on this page is built from lab studies of slopes, packs and poles, mostly in healthy young adults, military load carriage, studies of the conditions, and NHS, NHS inform and NICE pages, not from counts of hikers, and it says so.

Sources 1, 2, 3, 4, 5

Uphill is hip workEmerging evidence

In 20 adults, the hip's pushing work more than doubled from level ground to a 9 degree slope, and on an 18 degree ramp it rose almost six times. In 9 adults on steep slopes, the extra effort going up came mainly from the hip extensors (the buttock and back of the hip), and in 11 men the hip bent further at each step as the slope steepened. Uphill walking raised the modelled forces through every leg joint as the slope steepened in 18 men.

So climbs ask the buttock muscles to push and the front of the hip to bend further, step after step. A front of the hip or a buttock that aches on a long climb is usually muscles and tendons working harder than usual (our reading).

Sources 6, 7, 8, 9, 10

Downhill is mostly the knee, a little more for the hipEmerging evidence

In 12 people, the turning forces at the hip were only slightly larger walking downhill, while the knee's were much higher. Modelling in 18 men found downhill walking raised the force through the hip and the work of the big buttock muscle, while the knee took a larger share of the braking. The only measured hip forces come from 6 people with instrumented hip replacements: the peak was 300% of body weight walking on a flat treadmill, 319% on a 10% climb and 335% on a 10% descent.

Descents matter for another reason: 75.3% of hikers who fell in the Austrian Alps fell on the way down.

Sources 11, 10, 12, 7, 13, 5

The pack, the hip belt and long daysEmerging evidence

In a computer model of 6 Marines carrying 38 kg, a pack raised the forces through the hip joint, and they were similar whether the weight hung from the shoulders or the hip belt. In 9 men carrying 15 to 25 kg, a tighter hip belt didn't change how they walked. In 15 women hikers carrying up to 40% of their body weight over 8 km, the way they walked changed to absorb the load and became less stable at 30% and 40%; the authors suggested a 30% limit, a ceiling rather than a target. In soldiers, hip belts take pressure off the shoulders and add comfort, and load carriage injuries cluster in the legs.

A long day with a hip belt can also squeeze the skin nerve of the outer thigh: 10 of 280 Appalachian Trail hikers had it, and 98% of the numbness and tingling on that trail had settled at follow-up. The nerve only carries feeling, so there is no weakness.

Sources 14, 15, 16, 17, 18, 19, 20, 21

How the causes are told apartEmerging evidence

A pulling ache at the front of the hip on climbs, as you lift the knee, is usually the hip flexors; a consensus lists hip flexor-related groin pain among the defined causes of groin pain in athletes. A deep pinch in the groin on high steps in a younger active adult can be hip impingement, which needs symptoms, examination signs and imaging together. A deep groin, buttock or front-of-thigh ache from mid-life, stiff after sitting and for less than 30 minutes in the morning, is often hip arthritis, which NICE diagnoses without imaging; hip joint pain was felt in the buttock in 71% of 51 people and never in the lower back.

The bony point on the outside of the hip, sore after long days, on sloping paths and to lie on at night, is usually the gluteal tendons, with pain on standing on one leg, stairs and walking; squeezing the tendons and the knee drifting across are key factors. A burning or numb patch on the outer thigh under the belt is a squeezed skin nerve. The inner thigh after a slip is usually an adductor strain, and a lump in the groin can be a hernia; a femoral hernia is a small lump at the top of the thigh, in the groin. Thighs and buttocks sore for a few days after a big descent are muscle soreness; a short downhill walk a week before cut the damage by 47% to 64% in young men.

Groin or front-of-hip pain that built up after far more walking than usual, hurting with every step or at night, can be a stress fracture of the hip: rare, but a high index of suspicion is needed, a normal X-ray doesn't rule it out, and in military recruits pelvic stress fractures were far commoner in women. A calf, thigh or buttock ache that goes within minutes of standing still can be narrowed arteries. A swollen, throbbing calf or thigh after a long day or a journey of more than 4 hours can be a blood clot. A child or teenager with hip, thigh or knee pain or a limp needs checking: the NHS says a limp with no obvious cause should always be checked by a GP, and a slipped growth plate at the hip usually happens between 11 and 17.

Sources 22, 23, 24, 25, 26, 27, 21, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38

When a scan helps, and how it usually goesStrong evidence

Not at first for most: NICE diagnoses hip arthritis without imaging, gluteal tendon pain is diagnosed by examination, and impingement needs symptoms and examination first, with imaging to confirm. A suspected stress fracture needs imaging the same day, and an MRI (magnetic resonance imaging) scan if the X-ray is normal. A fall with severe pain needs an X-ray, and a groin lump needs a GP to examine it.

The NHS asks for a GP visit if hip pain hasn't improved after 2 weeks at home, and NHS inform says most new hip problems begin to settle within 6 weeks. Muscle soreness after a descent fades within days. Outer hip pain is slower: in the LEAP trial, education and exercise was still ahead of an injection at a year (51 of 65 against 36 of 63 rated a success). For hip-related pain in active adults, exercise should last at least 3 months. Belt numbness almost always settles. No one can promise a date.

Sources 24, 26, 23, 31, 39, 40, 41, 29, 42, 43, 20

Pace, step length and poles: lab readings, untested against hip painEmerging evidence

No trial has tested a change to hiking for hip pain. In 192 people with and without hip pain, every hip moment rose with walking speed, and on the flat the hip's work more than doubled from 1.0 to 1.5 metres a second, so slowing down on climbs is the best-supported change. In the one study of step length, cadets carrying 20 kg on the flat found their own step length safest, and in women recruits slower marches at their own step length, with other changes, cut pelvic stress fractures from 11.2% to 0.6%.

Poles: on a steep descent they cut knee loads by 12% to 25% in 8 men; with packs of 15% and 30% of body weight they lowered the turning forces at every leg joint, the hip included, though the study's summary gives no size; after a walk up and down Snowdon they reduced soreness and strength loss; and in 10 people with hip arthritis they lowered the outer hip muscle's work (about 41% to 45% of its maximum against 55%). But on the flat they didn't unload the knee, and in 6 people with hip replacements fitted with sensors, poles didn't lower the peak force through the hip on the flat or on 10% slopes. A review concludes they reduce leg loading but cost a little more effort, and help most with a heavy pack. A stick held in the hand opposite a painful arthritic hip cut the side-to-side hip load by about a quarter and walking pain from 42 to 26 out of 100. In a survey of 1,295 long-distance hikers, poles or sticks and training beforehand went with fewer complaints, an association rather than proof.

Sources 44, 6, 45, 33, 46, 47, 48, 49, 50, 51, 13, 52, 53, 2

Outer hip pain: education and exercise beat an injectionStrong evidence

In the LEAP trial of 204 people aged 35 to 70 with outer hip (gluteal tendon) pain, education plus exercise (14 physiotherapy sessions over 8 weeks) was a success at 8 weeks for 51 of 66, against 38 of 65 after a steroid injection and 20 of 68 with wait and see, and stayed ahead of the injection at a year. The education focused on avoiding positions that squash the tendons against the bony point of the hip and on building load gradually; a review names cutting down sustained or repeated hip adduction (the knee drifting across) as one target.

Sources 42, 26

Hip arthritis: exercise is safe and recommended, with small average benefitsMixed evidence

NICE says offer exercise tailored to everyone with osteoarthritis, warns that joint pain may rise when you start, and suggests considering walking sticks. The 2026 Cochrane update of 18 trials (1,368 people) found exercise probably improves hip arthritis pain and function slightly, by amounts unlikely to be clinically meaningful. In 152 people aged 60 and over, supervised Nordic walking (walking with poles) improved function more than strength training or home exercise, with gains to 12 months. So walking and hiking with poles is a sensible, tested way to stay active with hip arthritis, not a cure.

Sources 24, 54, 55

Front-of-hip and groin pain in active adults: give exercise 3 monthsEmerging evidence

A consensus of hip specialists recommends exercise-based treatment for at least 3 months for hip-related pain in young and middle-aged active adults, and says physical activity, which may include sport, is recommended. For impingement, conservative care, rehabilitation and surgery are all options. Our hip flexor, hip impingement and groin strain guides cover their plans.

Sources 43, 23

Soreness and descents: practise firstEmerging evidence

In young men, 5 minutes of downhill walking a week before a 40-minute descent cut strength loss, soreness and markers of muscle damage by 47% to 64%, and a 20-minute descent protected for more than 4 weeks in another trial; poles reduced soreness after a mountain walk. These are small trials in young adults, and they measured the thigh rather than the hip.

Sources 29, 56, 48

The pack: lighter is better, but the evidence is mixedMixed evidence

In 128 long-distance hikers, heavier packs went with more numbness and tingling (35% with 4.5 to 9 kg, 69% with more than 14 kg) but not with more joint pain or sprains. A heavier pack for your body weight went with injury on 12-day treks in 1,206 mostly teenage trekkers, but pack weight didn't predict injury on outdoor leadership courses, and a higher base pack weight went with illness or injury on the John Muir Trail. No trial sets a safe pack weight; the 30% ceiling comes from one lab study of 15 women.

Sources 57, 58, 59, 3, 17, 14

Hiking doesn't wear out hipsEmerging evidence

Across 25 studies, hip and knee arthritis affected 3.5% of recreational runners, whose hips take more load than hikers', against 10.2% of inactive people. In 85,706 UK adults wearing activity monitors, more time in brisk activity went with slightly less new hip or knee arthritis. The raised risk is with years of heavy lifting and carrying at work (about 1.6 times the odds), and the evidence on walking at work is very weak. These are observational studies, so they can't show cause.

Sources 60, 61, 62

Your hike for now (written steps)

Our 3D figure can't show poles, pace, step length, the route or your pack. These steps come from lab studies of slopes, packs and poles, military load carriage, NHS pages, a UK mountaineering body's technique page and our hiking guides; where a step is our suggestion or our reading, it says so. None has been tested against hip pain in hikers. Keep what passes the pain rule.

• 1. Route: shorter, flatter routes and shorter days for now; split a long walk into two, and choose paths without big steps or long, steep climbs (our suggestion, as in our knee pain when hiking guide).
• 2. Pace: slow down on climbs, where the hip does most of the work, because hip moments rise with speed. A pace where you can talk but not sing is moderate, as the NHS describes it.
• 3. Step length: your own natural step, not overstriding (our reading). No study has tested shorter steps downhill for the hip.
• 4. Poles: two poles, on climbs and especially descents. On steep steps down, the British Mountaineering Council's technique is to place your hands on top of the handles, lean forward with the poles below the step, put some weight on them and step down lightly. Poles lowered hip moments downhill with packs and outer hip muscle work in hip arthritis, though they didn't lower measured hip force in people with hip implants. With a sore hip and one pole or stick, hold it in the opposite hand (our reading of a cane study; our hip pain when walking guide says the same).
• 5. Big steps and stiles: step up with the stronger leg and down with the sore one, using a pole or a hand on a rock, and go round rather than over where you can (our suggestion).
• 6. The pack: as light as you can, packed close to your back, the hip belt fastened snugly on the bony rim of the pelvis but not crushed. The belt eases the shoulders but not the hip joint, and a tight belt can squeeze the thigh's skin nerve, so loosen or move it if the outer thigh burns or goes numb (our suggestion).
• 7. Rests: stop before the hip gets sore, not after, and sit higher rather than low on a rock with your knees crossed, because crossing the legs squeezes the outer hip tendons (our suggestion, from the LEAP education).
• 8. Overnight, with outer hip pain: a thicker sleeping mat, a pillow or rolled jacket between the knees, and not lying on the sore side (our suggestion, from the LEAP education).
• 9. Before a big trip: train first, since hikers who didn't train beforehand reported more injuries in a survey, and practise a short descent a week or two before.
• 10. Getting there: on long drives, flights or train journeys, get up and move about every hour or so and drink plenty of fluids, as the NHS advises to lower the risk of a clot.
• 11. Safety: carry a phone, tell someone your route, and in an emergency dial 999 or 112 and ask for the Police, then Mountain Rescue.

Sources 44, 6, 65, 66, 47, 49, 53, 18, 14, 21, 42, 2, 29, 35

How hikes come back (written steps)

No study has tested how hiking comes back after hip pain, so these steps are our suggestion unless a source is named, following our knee pain when hiking guide's order.

• 1. Distance on the flat, with poles.
• 2. Gentle climbs at a slow, steady pace.
• 3. Gentle descents, then longer climbs and descents.
• 4. Rough ground and scrambles.
• 5. The pack, starting light and adding weight or distance, never both at once, as our hiking and rucking guides say.
• 6. Back-to-back long days last, as our hike training guide suggests before a multi-day trip. A week or so before a long descent, add a short downhill walk or a few minutes of slow step-downs, which protected thighs in small trials. If a hike flares your hip, go back a step, not to none.

Sources 29, 56