19. June 2026
That nagging pain on the outside of your hip — the one that flares when you lie on it at night or climb the stairs — is very often not "bursitis" at all, but an overloaded tendon that responds well to the right exercise. Pain over the bony point at the side of the hip is one of the most common hip complaints in mid-life, especially in women between 40 and 60. For years it was labelled "trochanteric bursitis", implying an inflamed sac that needs rest and an injection. The modern understanding is different, and it matters: in most people the problem is gluteal tendinopathy — an overloaded gluteal tendon — sitting under the umbrella term greater trochanteric pain syndrome (GTPS). This guide explains what is really going on, what the best evidence (including the landmark LEAP trial) says actually works, the exercises that help and the ones to avoid, where shockwave therapy fits in, and the red flags that mean you should see a doctor first. It is written for adults across Hanwell, Ealing and West London.
Is it "hip bursitis" or gluteal tendinopathy?
In the great majority of cases, lateral hip pain is driven by the gluteal tendons, not by an inflamed bursa — which is why "trochanteric bursitis" is now considered a misleading label. The gluteus medius and gluteus minimus muscles attach by tendons onto the greater trochanter, the bony bump you can feel at the side of your hip. Over the last twenty years, imaging and surgical studies have shown that the dominant problem in symptomatic patients is a tendinopathy of these gluteal tendons — a load-related change in the tendon — with any bursal swelling usually a secondary finding. On scans, true bursitis appears in only a minority of cases, while gluteal tendon changes are far more common.
This is why clinicians now prefer the umbrella term greater trochanteric pain syndrome (GTPS), which covers gluteal tendinopathy with or without bursal involvement. The shift is not just semantics. If you think the problem is an inflamed bursa, rest and anti-inflammatories seem logical. But if the real issue is a tendon that has lost its capacity to tolerate load — much like Achilles tendinopathy or plantar fasciitis — then the treatment that works is gradual, structured loading, not prolonged rest.
What causes outer hip pain?
Gluteal tendinopathy develops when the load on the tendon outstrips its capacity, and a key culprit is compression of the tendon against the bone when the hip drops into adduction. Adduction is when the thigh moves across the midline of your body — it happens when you cross your legs, stand with your weight "hanging" on one hip, or lie on your side. The iliotibial band, a strong sheet of tissue running down the outside of the thigh, presses the gluteal tendons against the greater trochanter, and that compression rises sharply in these adducted positions. Repeated tensile and compressive load is what tips a healthy tendon into a painful one.
Two patterns commonly set this off. The first is a sudden increase in load in an active person — ramping up walking or running mileage, or returning to exercise too quickly. The second is the opposite: a relatively sedentary lifestyle with weak hip abductors, so the tendons are deconditioned and easily overwhelmed by ordinary demands. Weak gluteal muscles allow the pelvis to drop and the hip to fall into adduction during single-leg tasks such as walking and stair-climbing, exaggerating the very compression that drives the problem. Runners are also vulnerable, particularly when training on cambered roads or banked tracks, which load the two hips unevenly — one reason this fits within our wider running injuries guide.
Who gets it — and why women in mid-life especially
GTPS is around three times more common in women than men and peaks between the ages of 40 and 60, with peri- and post-menopausal changes thought to play a part. In a large study of adults aged 50–79, roughly one in six met the criteria for GTPS, and the condition was markedly more frequent in women. The leading explanation combines anatomy and hormones: a wider pelvis tends to increase the angle at which the gluteal tendons wrap over the greater trochanter, raising compression, while the fall in oestrogen around menopause may reduce tendon stiffness and resilience, making the tendon more vulnerable to load.
It rarely travels alone. GTPS is strongly associated with low back pain, with iliotibial band problems, and with hip and knee osteoarthritis. A higher body weight and a leg-length difference can add to the load on the lateral hip. Because these conditions interact, a good assessment looks beyond the painful hip itself to the lower back, the opposite leg and the way you move — treating only the sore spot tends to disappoint.
What does outer hip pain feel like?
The hallmark is pain over the bony point on the side of the hip that is worst when you lie on it at night and when you load it on one leg. The ache sits over the greater trochanter and often spreads down the outside of the thigh, sometimes as far as the knee. People typically describe trouble sleeping on the affected side, pain when standing on one leg to dress, and discomfort climbing stairs, walking uphill or rising from a low, soft chair or a car seat. Many notice stiffness and soreness in the first few steps after sitting, which eases a little as they get going — a classic tendon behaviour.
Unlike hip osteoarthritis, which tends to cause groin pain and stiffness with reduced movement, GTPS usually leaves the hip's range of movement fairly well preserved and the pain firmly on the outside. The sleep disruption is often what tips people into seeking help — lying on the painful hip, or even on the "good" side without support, can be enough to wake you. A simple change such as placing a pillow between the knees often takes the edge off, because it stops the top leg dropping into adduction.
How a physiotherapist diagnoses GTPS
GTPS is mainly a clinical diagnosis — a good history and a handful of targeted tests usually confirm it without the need for scans. Your physiotherapist will press over the greater trochanter to locate the tender spot, then use loading tests to reproduce your familiar pain. The most useful is the single-leg stance test: standing on the affected leg for up to 30 seconds frequently brings on the lateral hip pain and is a strong pointer to GTPS. Resisted hip abduction, a resisted external de-rotation test, and watching a single-leg squat for the pelvis dropping or the hip caving inwards all help confirm the diagnosis and reveal the abductor weakness behind it.
Imaging is reserved for cases that do not improve, or where the picture is unusual. Ultrasound and MRI can show tendon thickening, tears and bursal fluid, but here is the catch: these changes are common in pain-free older adults too, so a scan finding only means something when it fits your symptoms. That is also why a careful physiotherapist screens for the conditions that masquerade as GTPS — hip osteoarthritis, referred pain from the lower back, and, importantly, a femoral neck stress fracture — before settling on a diagnosis. The table below shows how the three most common sources of this pain typically differ.
| Feature | GTPS / gluteal tendinopathy | Hip osteoarthritis | Lumbar / sciatica |
|---|---|---|---|
| Pain location | Outer hip over the bony point, may spread down the outer thigh | Groin and deep buttock, sometimes outer thigh | Lower back and buttock into the leg, can go below the knee |
| Worst with | Lying on the side, single-leg stance, stairs, getting up from low seats | Weight-bearing, twisting, putting on shoes and socks | Sitting, bending, coughing or sneezing |
| Night pain | Classic — lying on the affected side; eased by a pillow between the knees | Deep aching, not specifically side-lying | Variable, often with back pain |
| Examination | Point tenderness, pain on single-leg stance, weak abductors, near-normal hip movement | Reduced and painful hip rotation, stiffness | Nerve signs, positive straight-leg raise, less focal tenderness |
Red flags: when outer hip pain needs a doctor, not a physio
Physiotherapy is for mechanical, load-related hip pain — not for pain that signals something more serious. Contact your GP, NHS 111, or attend A&E if your hip pain comes with any of the following:
- A hot, red, very swollen and tender hip with fever or feeling unwell — possible infection of the bursa (septic bursitis), which needs urgent medical treatment
- Significant groin pain, pain at rest or at night, and pain when hopping or standing on the leg — especially with osteoporosis or a recent big increase in activity (possible femoral neck stress fracture, which must not be "run through")
- Pain following a significant fall or injury, or an inability to bear weight
- A history of cancer with new, unexplained or progressively worsening pain
- Numbness around the back passage, or loss of bladder or bowel control, with back and leg pain — seek emergency care
- Known gout or rheumatoid arthritis with a sudden hot, painful hip
These are uncommon, but they matter. A chartered physiotherapist is trained to screen for them and will refer you on promptly if anything doesn't fit a straightforward tendon problem.
What the evidence says works: treatments ranked
The strongest evidence by far backs education plus a progressive exercise programme — and shows it outperforms steroid injection for lasting relief. The landmark study is the LEAP trial, published in the BMJ in 2018, which randomised 204 people with confirmed gluteal tendinopathy to one of three approaches: education plus exercise with a physiotherapist, a single corticosteroid injection, or a "wait-and-see" approach. At 8 weeks, education plus exercise produced significantly better improvement and lower pain than both other groups. Crucially, at 52 weeks the exercise group held onto its gains, while the injection's early benefit had faded to roughly the same as doing nothing. Here is how the main options stack up by weight of evidence:
- Education + load management + progressive exercise — the clear first-line treatment. Best short-term and long-term outcomes; addresses the actual cause.
- Corticosteroid injection — short-term relief only. Can settle severe pain enough to start rehab, but the benefit is not durable and repeated injections may weaken the tendon. An adjunct, not a cure.
- Shockwave therapy (ESWT) — for stubborn, chronic cases. A useful non-invasive option when good rehab has not resolved things (more below).
- NSAIDs and simple painkillers — supportive. May ease symptoms in a flare but do not fix the tendon; use under guidance, especially in older adults.
- Manual therapy and soft-tissue work — helpful add-ons. Can reduce pain short-term but should never be the only treatment.
- PRP and surgery — reserved for refractory cases. Evidence for platelet-rich plasma is weak; surgery is considered only after 6–12 months of thorough conservative care has failed.
The headline for patients is reassuring: most people get better without injections or surgery, provided the loading programme is done properly and the aggravating positions are managed alongside it.
Exercises for gluteal tendinopathy (and what to avoid)
The right exercises load the gluteal tendon gradually to rebuild its capacity — and the wrong "stretches" can make things worse by squashing the tendon against the bone. Rehabilitation generally starts with gentle isometric holds for pain relief and a base of strength, progresses to slow, controlled strengthening through useful ranges, and builds towards the demands of your daily life or sport. The staples below are what your physiotherapist is most likely to prescribe; start comfortably and let pain be your guide — a little discomfort that settles is fine, a lasting flare is a sign to ease off.
| Exercise | How | Typical dose |
|---|---|---|
| Isometric hip abduction | Stand tall and press the outer thigh gently into a wall or belt without moving, keeping the pelvis level | Hold 20–45s × 4–5, once daily |
| Bridging | Lie on your back, feet flat, lift the hips by squeezing the buttocks; progress to single-leg as able | 8–12 reps × 2–3, most days |
| Sit-to-stand & step-ups | Stand from a chair, or step onto a low step, keeping the knee tracking over the foot — no inward collapse | 8–10 reps × 2–3, most days |
| Standing band abduction | With a band around the legs, take controlled sideways steps keeping the trunk upright | 10–12 each way × 2–3 |
What to avoid, at least early on: stretches that pull the knee across the body or up towards the opposite shoulder, sitting with crossed legs, standing with your weight slung onto one hip, and lying on the painful side. All of these push the hip into adduction and compress the very tendon you are trying to settle. Counter-intuitively, "stretching the ITB" tends to aggravate GTPS rather than help it — strengthening, not stretching, is the lever that works.
Where shockwave therapy fits in
Extracorporeal shockwave therapy (ESWT) is a non-invasive option for chronic gluteal tendinopathy that has not settled with a good loading programme. It uses focused acoustic pressure waves, delivered through a handheld probe, to stimulate the tendon's healing response and modulate pain. A 2024 systematic review and meta-analysis found that a course of three weekly sessions — particularly with focused shockwave — offered worthwhile short-term pain relief at two to four months in people with GTPS. It is not a first-line treatment and not a substitute for rehabilitation; it works best layered on top of an ongoing strengthening programme for the stubborn cases.
In the UK, NICE supports the use of shockwave therapy for refractory greater trochanteric pain syndrome under specific clinical governance, which is why it is more often available privately or in specialist clinics than as a routine NHS first option. CK Physiotherapy has shockwave therapy on-site — a meaningful advantage for West London patients stuck with long-standing outer hip pain who want a non-invasive alternative to repeated injections.
How long does outer hip pain take to settle?
Most people improve steadily over a few months of consistent rehabilitation, though tendons are slow healers and recovery is rarely a straight line. Early wins often come from managing the aggravating positions — sleep posture in particular — while the strengthening programme does its slower work of rebuilding tendon capacity. The trajectory below is typical; longstanding cases, or those alongside hip osteoarthritis or back pain, take longer and benefit from a more gradual approach.
The biggest predictor of a good outcome is sticking with the programme and respecting the aggravating positions while the tendon rebuilds. The biggest cause of relapse is stopping the strengthening once the pain settles — the capacity you have built needs to be maintained.
How CK Physio treats outer hip pain
Our approach is assessment-led and evidence-based: confirm the source, rule out anything serious, then treat with a progressive loading programme — with shockwave therapy on hand for the stubborn cases. At CK Physiotherapy, our HCPC-registered, CSP-member chartered physiotherapists start with a thorough assessment to confirm the pain is genuinely coming from the gluteal tendons and to screen for hip osteoarthritis, back-related pain and the red flags above. From there, treatment blends education and load management, a tailored gluteal strengthening programme you can do at home, manual therapy where it helps, and shockwave therapy for chronic cases that have not settled with rehabilitation alone.
We have served Hanwell, Ealing and the surrounding West London area for over 22 years. Sessions run from £65 to £95, we are recognised by BUPA and AXA PPP, and we offer flexible early-morning, evening and Saturday appointments. If getting to the clinic is difficult — a painful hip, limited mobility, or an elderly parent you care for — our home-visit physiotherapy service brings the same assessment and treatment to you, which is often the easier option when outer hip pain makes travelling uncomfortable.
Frequently asked questions
Is hip bursitis the same as gluteal tendinopathy?
Mostly, they are now considered the same problem under a better name. What used to be called "trochanteric bursitis" is, in the large majority of people, a gluteal tendinopathy — an overloaded tendon — rather than an inflamed bursa. Clinicians use the umbrella term greater trochanteric pain syndrome (GTPS). The distinction matters because it changes treatment: a tendon problem responds to gradual strengthening and load management, not to prolonged rest or repeated anti-inflammatory injections.
What is the fastest way to relieve outer hip pain?
Start by removing the positions that compress the tendon: don't lie on the painful side, place a pillow between your knees at night, avoid crossing your legs, and stop standing with your weight slung onto one hip. Gentle isometric holds for the hip abductors can ease pain early on. These steps calm symptoms, but lasting relief comes from a progressive strengthening programme — the evidence shows exercise gives better long-term results than a quick fix such as a steroid injection.
Should I get a steroid injection for hip bursitis?
A corticosteroid injection can provide useful short-term relief, which may help if pain is severe enough to stop you starting rehabilitation. However, the landmark LEAP trial showed that education plus exercise gave better results at both 8 weeks and 52 weeks, while the injection's benefit faded over time. Repeated injections may also weaken the tendon. For most people, an injection is best viewed as an occasional adjunct, not the main treatment.
What exercises should I avoid with gluteal tendinopathy?
Avoid stretches and positions that pull the hip into adduction — the thigh moving across the body. That means no pulling the knee across to the opposite shoulder, no aggressive "ITB stretches", no sitting cross-legged, and no standing hanging on one hip. Lying on the painful side at night is another common aggravator. These positions compress the gluteal tendon against the bone. Strengthening the hip abductors, rather than stretching them, is what actually helps.
Does shockwave therapy work for outer hip pain?
It can help, particularly for chronic cases that have not responded to a good exercise programme. A 2024 meta-analysis found that a course of three weekly focused shockwave sessions gave worthwhile short-term pain relief at two to four months in greater trochanteric pain syndrome. NICE supports its use for refractory cases under specific governance, which is why it is usually offered privately or in specialist clinics. It works best alongside ongoing strengthening rather than on its own. CK Physio offers shockwave therapy on-site.
Why is my hip pain worse at night?
Lying on the affected side compresses the gluteal tendon directly against the greater trochanter, and even lying on the "good" side lets the top leg drop across the body into adduction, which also loads the tendon. That is why night pain and disturbed sleep are such a hallmark of GTPS. Lying on your back, or on the non-painful side with a firm pillow between your knees to keep the top leg supported, usually reduces it.
How long does greater trochanteric pain syndrome take to heal?
Most people improve over a few months with consistent rehabilitation, with many substantially better by 6 to 12 weeks. Tendons adapt slowly, so progress is gradual rather than instant, and longstanding cases or those alongside hip osteoarthritis or back pain can take longer. The keys to a full recovery are doing the strengthening programme consistently and managing the aggravating positions while the tendon rebuilds its capacity.
Put an end to that nagging outer hip pain
If pain on the side of your hip is disturbing your sleep or slowing you down, a chartered physiotherapy assessment can pinpoint the cause and set you on the right programme. Clinic appointments and home visits across Hanwell, Ealing and West London. Call 020 8566 4113.
Book an assessment Ask us a questionAbout the author. Written by the clinical team at CK Physiotherapy, a West London practice established in 2003. Our physiotherapists are registered with the Health and Care Professions Council (HCPC) and members of the Chartered Society of Physiotherapy (CSP). This article is for general information and is not a substitute for individual assessment, diagnosis or treatment. If you are worried about your hip pain, please seek professional advice.
Sources: Mellor et al., Education plus exercise versus corticosteroid injection versus wait-and-see for gluteal tendinopathy (LEAP trial), BMJ 2018; Grimaldi et al., Gluteal tendinopathy: mechanisms, assessment and management; Williams & Cohen, greater trochanteric pain syndrome: review of diagnosis and management; Segal et al., GTPS epidemiology and associated factors; Chen et al., shockwave therapy for GTPS, systematic review and meta-analysis 2024; NICE: extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome; NHS Royal Devon GTPS patient information; Septic bursitis, StatPearls.
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