Pain on the outer side of the hip is most often gluteal tendinopathy — a load-related irritation of the gluteus medius and minimus tendons where they attach to the bony point (the greater trochanter). It sits under the umbrella term greater trochanteric pain syndrome (GTPS) and is frequently — and unhelpfully — labelled "hip bursitis."
Understanding it as a tendon capacity problem, not simple inflammation, is what changes the outcome: it explains why rest and injections give only temporary relief, and why progressive loading is what actually works.
Tendinopathy, not just inflammation
A healthy tendon adapts to load. A tendinopathy develops when load outpaces the tendon's capacity to adapt — often after a change in activity, a period of weakness, or repeated compression of the tendon against the bone. The tissue becomes painful and less tolerant, but it isn't simply "inflamed," which is why anti-inflammatory strategies alone don't resolve it.
Key distinction: If rest alone resolved your lateral hip pain, and it came back when you returned to activity, you're dealing with a capacity problem — not just inflammation. The solution isn't more rest; it's the right loading.
For more on why the "bursitis" label is usually inaccurate, see our guide to hip bursitis and what it's often confused with.
Symptoms of gluteal tendinopathy
Pain directly over the bony point on the outer hipSometimes radiating down the outer thigh — rarely past the knee
Worse lying on that sideA hallmark that often disturbs sleep — one of the most common complaints
Worse with single-leg loadingStairs, hills, standing on one leg to get dressed
Worse after compression positionsSleeping on it, sitting with legs crossed, standing with weight dumped on one side
Why compression is the hidden driver
Tendons dislike being compressed against bone under load. Three everyday habits keep gluteal tendinopathy going — often without the person realising:
Sleeping on the painful side
Or with the top leg dropped across the body — a surprisingly common perpetuator that people rarely connect to their pain.
Crossing the legs or knees together
When seated, bringing knees together-and-out compresses the gluteal tendons against the greater trochanter.
Standing "hip-hanging"
Dumping all your weight to one side when standing — common while waiting, cooking, or chatting — compresses the tendon on that side.
Hip-hanging vs neutral stance diagram
Left: hip-hanging — weight dropped to one side, compressing the gluteal tendon. Right: neutral stance — weight evenly distributed.
A surprising amount of progress comes simply from removing these compression positions so the tendon can settle enough to be loaded properly. That's the first — and most under-rated — step in rehabilitation.
What the evidence says about treatment
The strongest evidence comes from the LEAP randomised trial (BMJ 2018) — a high-quality study that compared three approaches for GTPS:
Education + targeted exercise outperformed injections at one year
The LEAP trial found that a corticosteroid injection gave short-term pain relief but the education-plus-exercise group had significantly better outcomes at 12 months — less pain, better function, and fewer recurrences.
Read the LEAP trial →A specialist rehabilitation plan for gluteal tendinopathy typically follows this sequence:
Reduce compression
Address sleep position, sitting habits, and standing posture — remove the daily aggravators so the tendon settles.
Isometric loading first
Controlled holds that the tendon tolerates without compressing it — builds baseline capacity and calms irritability.
Progressive abductor strengthening
Gradual introduction of load that challenges the tendon without overwhelming it — building real capacity over weeks.
Graded return to activity
Walking, running or sport reintroduced systematically once the tendon tolerates the load — not just when pain eases.
Injections may help a stubborn flare in the short term but don't build capacity — which explains why the recurrence rate is high when injections are used without rehabilitation. Surgery is rarely required.
General information only. Loading must match your specific presentation — what works for one person may not be right for another. A specialist assessment identifies your individual compression patterns, irritability level, and capacity so the programme fits.
What makes gluteal tendinopathy worse — common mistakes
Foam-rolling or ITB release directly over the bony point
Putting sustained pressure over the greater trochanter adds more compression to an already compressed tendon — it's the opposite of what it needs.
Deep cross-body glute stretches
Pulling the leg across the body stretches the gluteal tendons directly into compression against the bone — another unintentional aggravator.
Ramping activity back up when pain eases
Doing too much, too soon because the pain has settled — the tendon wasn't given time to adapt to load, so the cycle repeats.
When to see a specialist
Consider a specialist hip assessment if outer-hip pain has:
Lasted more than a few weeks and isn't improving
Disrupted your sleep — a hallmark of GTPS and a significant quality-of-life issue
Not responded to generic physio or injections only helped briefly
You're unsure of the diagnosis — and want to know the actual cause, not just a label
Rebuild the tendon properly — not just calm it down
John Gravenall offers specialist hip and groin assessments in London, the Midlands, and online.
Book a specialist hip assessment →Frequently Asked Questions
Is gluteal tendinopathy the same as hip bursitis?
They overlap — most "hip bursitis" is actually gluteal tendinopathy, both falling under the term GTPS (greater trochanteric pain syndrome). The tendon, not the bursa, is usually the primary driver.
What's the best treatment for gluteal tendinopathy?
Reducing tendon compression plus progressive loading. Research (the LEAP trial, BMJ 2018) found education plus targeted exercise outperformed both cortisone injection and "wait and see" at one year.
Why does lying on my side hurt with gluteal tendinopathy?
Side-lying compresses the gluteal tendons against the bone of the greater trochanter — a hallmark feature of GTPS. Many people unknowingly aggravate it every night while sleeping.
How long does gluteal tendinopathy take to recover?
Often a few months with consistent, appropriate loading. It varies and commonly recurs if compression positions and tendon capacity aren't addressed.
Should I stretch a gluteal tendinopathy?
Deep cross-body stretching usually makes it worse by compressing the tendon against the bone. Loading the tendon progressively — with the right type and amount — is more effective than stretching.