A very common story in physiotherapy clinics goes like this: pain on the outside of the hip that has crept up over months, wakes you when you roll onto that side, makes the first steps after sitting stiff and sore, and is worse climbing stairs or walking uphill. You may have been told it is bursitis, perhaps had an injection that helped for a few weeks, and found the pain came back.
This pattern has been studied closely over the last decade, and our understanding of it has changed. This article explains what the condition really is, why some well-meaning advice makes it worse, and the approach that has the best evidence for lasting relief.
What is causing the pain
On the outside of your upper thigh is a bony prominence called the greater trochanter. Two important hip muscles, gluteus medius and gluteus minimus, attach to it via tendons. These muscles stabilise your pelvis every time you stand on one leg — which means every step you take. There are also several bursae, small fluid-filled sacs, in the area.
Pain in this region is called greater trochanteric pain syndrome. It used to be blamed on an inflamed bursa, but imaging studies show that the gluteal tendons are the main source in most cases, with bursa thickening often occurring alongside. This is important because treatment aimed only at the bursa misses the underlying tendon problem.
Typical symptoms
The pain pattern is fairly characteristic, and often the history alone strongly suggests the diagnosis.
- Aching on the outside of the hip, sometimes spreading down the outer thigh toward the knee.
- Pain lying on the affected side, and often on the other side too, because the top leg drops across.
- Pain getting up after sitting, especially from low chairs.
- Pain climbing stairs or walking uphill.
- Pain standing on one leg, such as when dressing.
- Tenderness when pressing on the bony point of the outer hip.
- Pain sitting with legs crossed.
Compression: the hidden aggravator
Tendons cope well with tension but poorly with compression combined with load. The gluteal tendons wrap around the greater trochanter, and certain positions press them hard against the bone. This compression is a major driver of symptoms, and it occurs in some very ordinary habits.
Crossing your legs, sitting with knees together and low, hanging your weight on one hip while standing, and lying on your side with the top knee dropped to the bed all increase compression. So, unfortunately, does the classic stretch that pulls the knee across the body to 'stretch the outer hip'. Many people with this condition have been stretching diligently for months and making it worse.
| Aggravating position | Better alternative |
|---|---|
| Crossing your legs when sitting | Feet flat, knees hip-width apart |
| Standing with weight on one hip | Weight evenly on both feet |
| Low chairs and soft sofas | Higher seat, or a cushion to raise it |
| Side-lying with top knee dropped | Pillow between the knees, or lie on your back |
| Stretching knee across the body | Stop this stretch; strengthen instead |
Who gets it
Gluteal tendinopathy is most common in women between about 40 and 60. The hormonal changes around menopause affect tendon health, and the wider pelvis may increase compression around the hip. Other risk factors include a sudden increase in walking, running or hill work, weakness of the hip muscles, higher body weight, and lower back problems. It also frequently follows a period of reduced activity, when the tendons lose capacity, followed by a return to normal loads.
Ruling out other causes
Pain in the outer hip can also come from the lower back, from the hip joint itself, or less often from a stress fracture. Hip joint problems such as osteoarthritis typically cause pain in the groin and stiffness turning the leg inward, while referral from the back may come with back stiffness and pain extending further down the leg. A careful examination distinguishes these.
Seek prompt medical assessment for hip pain with fever, unexplained weight loss, a history of cancer, inability to bear weight after a fall, or night pain that is constant regardless of position.
Treatment that works
A large randomised trial published in the BMJ in 2018, known as the LEAP trial, compared three approaches for gluteal tendinopathy: education with a targeted exercise programme, a single steroid injection, and a wait-and-see approach. At eight weeks and at one year, education plus exercise produced better outcomes than wait-and-see and was superior to injection at eight weeks, with similar or better results at one year. The injection helped in the short term but its benefit faded.
The education component is about load management — reducing compressive positions and spikes in activity, as described above. The exercise programme starts with isometric holds for the hip abductors, often lying on your back or standing, which can reduce pain. It then progresses to functional strengthening such as bridges, sit-to-stand, step-ups and single-leg exercises, gradually increasing the load the tendons can tolerate.
What else can help
Manual therapy and soft-tissue treatment can ease pain and muscle guarding, making it easier to exercise. Shockwave therapy has evidence for persistent gluteal tendinopathy that has not responded fully to exercise and can be added to a programme. Weight loss, if relevant, reduces load on the tendons. Walking poles, a shorter stride and avoiding steep hills temporarily can make walking more comfortable while strength is rebuilt.
Sleeping more comfortably
Night pain is often the most distressing part. Lying on your back with a pillow under your knees is usually most comfortable. If you prefer side-lying, place a firm pillow between your knees and ankles so the top leg stays level with the hip, and consider a soft mattress topper to reduce pressure on the bottom hip. These small changes often improve sleep within a week or two.
How long it takes
Tendons adapt slowly. Most people notice less night pain within a few weeks of changing their positions, and meaningful improvement in function within two to three months of consistent exercise. Some cases take longer, particularly if symptoms have been present for years. The exercises should continue at a maintenance level after symptoms settle, because the condition can return if the hip muscles lose strength again.
Walking, running and the gym
You do not have to give up exercise while the tendon recovers, but the type and amount may need to change for a while. Flat walking at a comfortable pace is usually well tolerated; long hill walks, stair climbing machines and steep trails tend to provoke symptoms and are best reduced temporarily rather than stopped forever.
Runners often do well by shortening their stride slightly, avoiding a crossover gait where the feet land on a midline, and reducing hill and camber running. In the gym, side-lying leg lifts with the top leg crossed forward, deep lunges and wide-stance exercises can compress the tendons and are often swapped for bridges, step-ups and supported single-leg work until the hip settles. Cycling and swimming, apart from breaststroke kick, are usually comfortable alternatives for maintaining fitness.
Common mistakes that slow recovery
A few patterns come up again and again in people whose hip pain has dragged on for a long time, and spotting them is often the turning point.
- Stretching the outer hip daily in the belief that tightness is the problem.
- Foam rolling hard over the bony point of the hip, which adds more compression.
- Resting completely for weeks, then returning to a long walk or run all at once.
- Relying on repeated injections without addressing strength and load.
- Stopping the exercises as soon as the pain eases.
Hip pain treatment in Woodbridge
At Med Wellness in Woodbridge, our physiotherapists assess outer hip pain including the lower back and hip joint, explain the load and posture changes that reduce compression, and design a progressive strengthening programme. We add manual therapy and shockwave therapy where they are useful.
No referral is needed in Ontario and most extended health plans cover physiotherapy. Call +1 (905) 605-8889 to book an assessment.
References
Written by Sandip Dhameliya, Registered Physiotherapist · Clinically reviewed by Paramjeet Kaur Bassi · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
