Lateral Hip Pain: A Physio’s Perspective

Lateral hip pain can be surprisingly frustrating. It may hurt when walking, climbing stairs, exercising, standing on one leg or simply lying on your side in bed.

It is also an area where the language has changed considerably over time. Pain on the outside of the hip was once routinely labelled “hip bursitis”. We now understand that lateral hip pain is often more complex than an irritated bursa, with the gluteal tendons frequently playing an important role.

The broader term commonly used is greater trochanteric pain syndrome (GTPS). GTPS describes pain arising from the tissues around the outside of the hip, particularly the gluteus medius and gluteus minimus tendons and, in some cases, the nearby bursae.

Importantly, having lateral hip pain does not automatically mean that something is damaged beyond repair. The structure seen on a scan, the amount of pain someone experiences and how well their hip functions do not always match neatly.

A good physiotherapy assessment therefore looks beyond a scan or a single painful structure and considers the person's symptoms, activity levels, hip strength, movement, training load and the demands they need their hip to tolerate.

Understanding the Hip and Gluteal Tendons

The hip is one of the body's largest weight-bearing joints. It is a ball-and-socket joint formed by the head of the femur sitting within the acetabulum of the pelvis.

Surrounding the hip is a large network of muscles and tendons that help produce movement and provide stability when we walk, run, climb, jump and stand on one leg.

Two particularly important muscles in lateral hip pain are the gluteus medius and gluteus minimus.

Their tendons attach onto a bony prominence on the outside of the femur called the greater trochanter. These muscles help control the pelvis and hip during activities such as walking, running and standing on one leg.

There are also several small fluid-filled sacs called bursae around this region. Their role is to help reduce friction between the tendons, bone and surrounding tissues.

So Is Lateral Hip Pain Actually Bursitis?

Sometimes the bursa may be involved, but calling all lateral hip pain “bursitis” is probably too simplistic.

Research over the past couple of decades has increasingly identified abnormalities of the gluteus medius and minimus tendons in people with persistent lateral hip pain. This is why the term GTPS has largely replaced trochanteric bursitis as the general diagnosis.

GTPS is best thought of as an umbrella term. Different people may have different combinations of:

• Gluteus medius or minimus tendinopathy.
• Partial or, less commonly, substantial gluteal tendon tears.
• Irritation of one or more of the local bursae.
• Reduced capacity of the hip muscles.
• Sensitivity to compression around the lateral hip.
• Changes in how much load the hip is being asked to tolerate.

This is one reason our approach to hip and groin pain focuses on the individual presentation rather than simply treating whatever structure appears abnormal on imaging.

What Does Gluteal Tendinopathy Feel Like?

Gluteal tendinopathy commonly produces pain around the bony point on the outside of the hip.

The pain can sometimes spread down the outside of the thigh and may become particularly noticeable during activities where the hip is repeatedly loaded or compressed.

Common symptoms include:

• Pain when lying on the affected side.
• Pain when lying on the opposite side if the painful leg drops across the body.
• Pain walking longer distances.
• Discomfort climbing stairs or walking uphill.
• Pain when standing on one leg.
• Pain getting up after sitting for a prolonged period.
• Pain during or after running.
• Tenderness when pressing over the outside of the hip.
• Pain after a sudden increase in walking, running or exercise.

Night pain can be particularly frustrating and is often one of the reasons people eventually seek treatment.

Why Do the Gluteal Tendons Become Painful?

It is tempting to look for one simple cause, such as weak glutes, poor posture or a tight muscle. In reality, tendinopathy is usually more complicated than this.

Tendons are designed to accept load. Problems can arise when the amount or type of load being placed through a tendon exceeds what it is currently able to tolerate.

This might occur after:

• A sudden increase in running or walking volume.
• Starting hills or stairs after previously training on flat ground.
• Increasing gym loading too quickly.
• A return to exercise after a period of reduced activity.
• A substantial change in work or daily activity.
• Repeatedly loading the hip in positions that are already provocative.

One particular consideration with the gluteal tendons is compression.

The gluteal tendons wrap around the greater trochanter. When the hip moves substantially across the body's midline into adduction, these tendons can be compressed against the underlying bone.

This does not mean hip adduction is inherently bad or needs to be avoided forever. It does mean that when the tendons are already irritable, repeatedly spending time in highly provocative positions can make symptoms harder to settle.

Who Gets Greater Trochanteric Pain Syndrome?

GTPS can occur in both men and women and across a range of ages, although it is particularly common in middle-aged women.

It is also frequently seen alongside other musculoskeletal problems, particularly lower back pain and knee osteoarthritis.

That does not necessarily mean one condition directly caused the other. It does highlight why lateral hip pain needs to be assessed in the context of the whole person rather than simply focusing on one painful tendon.

Hip strength and movement control may also be relevant. Some people with GTPS demonstrate reduced hip abductor strength or altered control during single-leg tasks, but again, these findings are better considered as pieces of the overall clinical picture rather than a single explanation for why pain developed.

How Is Lateral Hip Pain Diagnosed?

Gluteal tendinopathy and GTPS are primarily clinical diagnoses.

A detailed history is important. Your physiotherapist may ask about:

• Exactly where your pain is located.
• When the symptoms began.
• Recent changes to walking, running or training load.
• Whether lying on the hip is painful.
• How symptoms respond to stairs, hills and single-leg activities.
• Whether you also have groin, back or knee symptoms.
• Your current exercise and activity goals.

The physical examination will then assess the hip and surrounding areas.

There is no single perfect test for GTPS. Current research supports using a combination of findings rather than relying on one movement alone.

For example, tenderness over the greater trochanter combined with pain during resisted hip abduction can substantially increase the likelihood that GTPS is contributing to someone's lateral hip pain.

The assessment may also include hip movement, muscle strength, walking, single-leg control and tests designed to distinguish lateral hip pain from conditions involving the hip joint or lumbar spine.

Do You Need an MRI or Ultrasound?

Not necessarily.

For many people, lateral hip pain can be diagnosed and managed appropriately without imaging.

This is particularly important because abnormalities on MRI do not always explain how much pain someone is experiencing.

A 2025 analysis of more than 200 people with clinically diagnosed gluteal tendinopathy found a substantial number had tendon tears or abnormalities on MRI. However, the severity of those MRI changes was not associated with the person's level of pain, function or disability.

Imaging may still be useful when:

• The diagnosis remains unclear.
• Symptoms are not behaving as expected.
• There is substantial weakness.
• A significant tendon tear is suspected.
• There has been trauma.
• The symptoms are not improving despite appropriate management.
• Another hip condition needs to be investigated.

In these situations, your physiotherapist or doctor may discuss whether an X-ray, ultrasound or MRI would add useful information.

How Is Gluteal Tendinopathy Treated?

The current evidence supports a combination of education, load management and progressive exercise as the core approach to gluteal tendinopathy.

This is an important shift from simply trying to reduce inflammation around the hip.

One of the best-known clinical trials in this area compared physiotherapy-led education and exercise with corticosteroid injection and a wait-and-see approach. Education plus exercise produced better short-term outcomes and greater overall improvement than corticosteroid injection at one year.

More recent systematic reviews continue to support exercise as a first-line treatment for GTPS, although the exact exercise program still needs to be individualised.

Should You Stretch a Painful Gluteal Tendon?

This is another area where management has changed.

Stretching can feel intuitive when the outside of the hip feels tight. However, many traditional gluteal and iliotibial band stretches move the hip into significant adduction and therefore increase compression of the gluteal tendons against the greater trochanter.

For an irritable tendon, repeatedly pushing hard into these positions may actually aggravate symptoms.

This does not mean stretching is universally bad. It simply means that stretches should have a clear purpose and should be selected according to the individual rather than prescribed automatically because the hip feels tight.

What About Cortisone Injections?

Corticosteroid injections can reduce pain for some people with GTPS, particularly in the short term.

However, the longer-term picture is less convincing.

Clinical trials and systematic reviews suggest that while corticosteroid injection can provide short-term pain relief, education and exercise provide better overall improvement over the longer term.

This does not mean cortisone is never appropriate. There may be circumstances where an injection is considered as part of the management plan, particularly where pain is significantly limiting sleep or rehabilitation.

The important point is that an injection does not rebuild the capacity of the tendon. Even if symptoms settle after an injection, addressing loading and restoring physical capacity generally remains important.

How Long Does Lateral Hip Pain Take to Improve?

There is no universal timeline.

Someone with a recent increase in activity and relatively mild symptoms may improve considerably faster than someone who has had pain for several years, substantial weakness, significant sleep disturbance or multiple other musculoskeletal problems.

Tendons also tend to respond to changes in loading over weeks and months rather than overnight.

This is why successful rehabilitation is often less about finding a quick fix and more about identifying the amount of load the hip can currently tolerate, then progressively moving that ceiling upwards.

Importantly, some discomfort during rehabilitation does not automatically mean the tendon is being damaged. Pain response needs to be interpreted alongside the exercise performed, the amount of load, symptoms later that day and how the hip feels over the following 24 hours.

Returning to Running and Sport

For active people and athletes, rehabilitation eventually needs to progress beyond isolated hip strengthening.

The hip may need to tolerate:

• Longer periods of walking or running.
• Faster running speeds.
• Hills.
• Acceleration and deceleration.
• Jumping and landing.
• Change of direction.
• Repeated high-load efforts.

The exact progression depends on the activity you want to return to.

Our Sports Physiotherapy approach aims to progressively rebuild the physical qualities required for sport rather than simply waiting until the hip is pain-free before returning to activity.

When Should You See a Physio for Lateral Hip Pain?

Lateral hip pain is common, but persistent symptoms do not need to simply be accepted as part of getting older.

An assessment can be useful if:

• Your hip pain is persisting rather than gradually improving.
• You are repeatedly waking because you cannot lie comfortably on the hip.
• Walking, stairs or exercise are becoming increasingly limited.
• You cannot return to running or sport without symptoms recurring.
• You have noticed significant weakness.
• You are unsure whether your symptoms are coming from the hip, lower back or another area.

The aim of assessment is not simply to give the painful area a label. It is to understand why the hip is currently struggling with the loads being placed upon it and what needs to change to move forward.

You can read more about our approach to hip and groin pain, our broader Physiotherapy services, or Sports Physiotherapy for people returning to running and sport.

Author in the know

Sam Donaldson

Director, APA titled Sports and Exercise Physiotherapist. Sam loves to treat athletes with lower limb injuries and has a special interest in knees of all ages; adolescent knee pain, athlete with knee pain, ACL injuries, ACL rehabilitation, Knee Osteoarthritis and Knee Replacement recovery. He is a Dad, Football enthusiast and loves to move. BAppSci (HMS), MPhtyStudies, MPHTY (Sports)