Chronic Hip Pain | Why MRI Findings Don't Tell the Full Story

Published March 7, 2026 · 8 min read

By Tauri Urbanik, Pain Science Researcher

The MRI showed something. But so does everyone's.

Your hip hurts. It has been hurting for months, maybe years. You got the imaging and there it was: a labral tear, some cartilage wear, maybe a bone spur. Your doctor pointed at the screen and the explanation seemed obvious. Something is torn. That is why it hurts.

But what if that explanation is incomplete? What if the thing on your MRI shows up in almost everyone, including people who feel perfectly fine?

That is exactly what the research shows. And it changes everything about how chronic hip pain should be understood.

73% of pain-free hips have "abnormalities" on MRI

Researchers put 45 asymptomatic volunteers through 3-Tesla MRI scans (the highest resolution available). These were people with zero hip pain. No complaints. No limitations. The scans told a very different story (Register et al., Am J Sports Med, 2012↗):

• 69% had labral tears
• 24% had chondral defects (cartilage damage)
• 73% had some kind of abnormality overall

Nearly three out of four pain-free hips looked "abnormal" on imaging. And this is not just an aging phenomenon. A separate study found labral tears in 38.6% of young asymptomatic volunteers with an average age of 26. Young, active, pain-free people. With torn labrums.

So when a doctor points to your labral tear and says "there's your problem," it is worth asking: is it?

The pattern that keeps showing up

This is not unique to hips. Across every joint researchers have examined, the story is the same.

The numbers are strikingly consistent. Roughly half to three-quarters of pain-free people have "damage" on imaging that would typically be blamed for pain. Structure does not reliably predict symptoms.

So what does predict pain?

Your brain is generating the signal

When structural damage does not explain chronic hip pain, the explanation is often central sensitization. Your brain's pain system has become overactive. It amplifies signals, interprets normal input as dangerous, and keeps producing pain even when the tissue is fine (Woolf CJ, PAIN, 2011↗).

This is not imaginary pain. It fires through the exact same neural pathways as pain from a fresh injury. The pain is real. But the cause is in the processing, not the joint.

Here is a simple question. Does your hip pain vary with your stress level? Does it get worse during difficult periods and ease up when you are relaxed? A labral tear does not respond to your emotional state. Your nervous system does.

How to spot the neuroplastic pattern in your hip

Look for these clues in your own experience:

The imaging doesn't match. Your MRI shows a "small labral tear" but your pain is a 7. Or the imaging looks dramatic but your pain is mild. When severity doesn't match, something other than structure is at work.

Pain moves around. It started in the right hip, then the left hip started up. Or the hip pain fades but your knee or back starts hurting instead. Structural damage stays in one place. Neuroplastic pain migrates.

Stress connection. Pain flares with deadlines, relationship conflict, or financial worry. Eases on days off or vacation. Your labrum does not know what day of the week it is.

Treatment helps temporarily. The injection worked for two weeks. PT helped while you were doing it. But nothing holds. This is the signature of a centrally maintained pain state.

When hip surgery doesn't resolve the pain

Hip replacement is one of the most successful surgeries in orthopedics. For many people with severe osteoarthritis, it provides dramatic relief. But not for everyone.

The pattern mirrors what researchers have found with knee replacements: when preoperative depression, anxiety, and pain catastrophizing are present, surgical outcomes are worse regardless of technical success. The brain's pain system was driving a significant portion of the pain, and replacing the joint could not address that.

This does not mean you should avoid surgery if it is clearly indicated. It means that when chronic hip pain persists after a good surgical outcome, or when the imaging does not justify the level of pain you feel, it is time to look at the brain.

J

James, 46

hip pain for 3 years

James was told his labral tear explained his hip pain. He did 6 months of physical therapy, tried two cortisone injections, and was considering arthroscopic surgery. Then his physical therapist mentioned something. His other hip had a similar tear on imaging from years ago. No pain on that side. James started paying attention to when the pain was worse. Always during busy seasons at his restaurant. Always better on his day off. He started treating it as a brain pattern rather than a joint problem. Within 10 weeks, he went from limping to pain-free hiking.

Composite story based on common patient patterns. Not a specific individual.

Understanding changes the pain

Simply learning how pain works has been shown to reduce pain, fear, and disability in research. The formal term is pain neuroscience education, and meta-analyses confirm its effectiveness across musculoskeletal conditions (Louw et al., Physiotherapy, 2016↗).

Reading this page is part of that education. Questioning whether your labral tear actually explains your pain is part of the process.

For chronic back pain (which shares the same central sensitization mechanism), Pain Reprocessing Therapy produced 66% pain-free rates in a randomized controlled trial (Ashar et al., JAMA Psychiatry, 2022↗). No hip-specific PRT trial exists yet, but the underlying mechanism, a brain that learned to generate pain and can unlearn it, applies across all joints.

Frequently asked questions

Can you have a hip labral tear and no pain?

Yes. A study using 3-Tesla MRI found labral tears in 69% of pain-free volunteers. Another study found labral tears in 38.6% of young asymptomatic adults with an average age of 26. Labral tears are far more common than most people realize and often cause no symptoms at all.

Why does my hip still hurt after surgery?

When the brain's pain system is generating the pain, repairing the physical structure may not resolve it. Similar to knee replacements, dissatisfaction after hip surgery often correlates more with preoperative psychological factors than with surgical technique.

Is chronic hip pain neuroplastic?

For many people with persistent hip pain, yes. When hip pain doesn't match imaging findings, fluctuates with stress, moves to the other side, or continues despite successful treatment of structural findings, the brain's pain system is likely involved.

Why does my hip MRI show problems but my doctor says it's normal?

Because 73% of pain-free hips show some kind of 'abnormality' on MRI. Labral tears, chondral defects, and other findings are an extremely common part of normal anatomy and aging. Your doctor may recognize that these findings don't necessarily explain your pain.

References

1. Register B, et al. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012;40(12):2720-2724.DOI: 10.1177/0363546512462124
2. Lee AJ, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2015.
3. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15.DOI: 10.1016/j.pain.2010.09.030
4. Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review. Physiotherapy. 2016;102(1):3-12.DOI: 10.1016/j.physio.2015.10.007
5. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23.DOI: 10.1001/jamapsychiatry.2021.2669
6. Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.DOI: 10.3174/ajnr.A4173