By Rick Porter, Physiotherapist and certified JEMS practitioner
Published: 4 August 2026 · Last reviewed: 4 August 2026
Outer hip pain, the ache and tenderness over the bony point at the side of the hip, is usually gluteal tendinopathy rather than the “hip bursitis” it is often labelled. It is a load-related change in the gluteal tendons where they attach to the top of the thigh bone, and the most effective treatment is a progressive strengthening programme, not rest or an injection. Most cases improve steadily over a few months once the right loading starts.
The usual cause is more load and compression through those tendons than they can currently tolerate, from a sudden increase in walking or hills, long spells sitting with the legs crossed, or standing hanging on one hip. It is far more common in women over 40, which is a genuine pattern rather than a coincidence.
The first steps are practical. Ease off the positions that compress the tendon, crossing the legs, hanging on one hip, and lying on the sore side, and begin gentle, graded strengthening of the hip muscles. If the pain has lasted more than a few weeks or is disturbing your sleep, an assessment gets you a loading plan matched to the tendon.
This guide explains why outer hip pain is usually gluteal tendinopathy, what causes it, why it hurts most at night, and what treatment actually works.
Why outer hip pain is usually gluteal tendinopathy, not bursitis
Outer hip pain is usually gluteal tendinopathy, a load-related tendon problem, rather than bursitis, because research over the past twenty years shows the bursa is rarely the main driver.
Pain on the outside of the hip was for years labelled trochanteric bursitis, on the assumption that an inflamed fluid sac was the problem. Better imaging changed that. The tendons of the gluteus medius and minimus, which attach to the greater trochanter, are now understood to be the primary source in the great majority of cases, and the umbrella term greater trochanteric pain syndrome, or simply gluteal tendinopathy, has replaced the old bursitis label. This is not a pedantic distinction. Bursitis implies rest and anti-inflammatories, whereas a tendinopathy needs progressive load to rebuild capacity, so the wrong label sends people down the wrong treatment path.
What causes gluteal tendinopathy, and who gets it
Gluteal tendinopathy is caused by more compression and load through the gluteal tendons than they can tolerate, and it is far more common in women over 40.
The load story has two parts: tensile load, from the tendons working hard during walking, running and stairs, and compressive load, from positions that press the tendon against the bone. Crossing the legs, standing with your weight slung onto one hip, sitting in low chairs, and sleeping positions all add compression. A sudden increase in walking, hill work or running is a common trigger. The condition is roughly two to four times more common in women, particularly around and after the menopause, when changes in hip width and hormones alter how the tendons are loaded. Runners of any age get it too, often when mileage or hills climb quickly. The movement-quality angle matters here: how well you control the pelvis on a single leg changes how much compression the tendon takes, which is one reason the same principles in our post on cycling knee and hip pain carry across to the hip.
Why gluteal tendinopathy hurts most lying on that side at night
Gluteal tendinopathy hurts most lying on the affected side because that position compresses the tendon directly against the bone, and lying on the other side can pull it into compression too.
Night pain is one of the most consistent things patients describe, and it is rarely explained well. When you lie on the sore hip, your body weight presses the greater trochanter and its tendons into the mattress. When you lie on the good side with the top knee dropping forward onto the bed, the upper hip falls into an adducted position that also compresses the tendon. The result is a hip that wakes you whichever way you turn. The practical fix is to unload it: a firm pillow between the knees to stop the top leg dropping across, and avoiding lying on the painful side while it settles. This single change often improves sleep within a week or two, well before the tendon itself has fully recovered.
What effective treatment involves, and why loading beats injections
Effective treatment is progressive gluteal loading combined with managing compressive positions, and education plus exercise outperforms corticosteroid injections and rest.
This is the clearest evidence point in the whole condition. A randomised trial published in the BMJ in 2018, known as the LEAP trial, compared education and load-management exercise against a corticosteroid injection and against a wait-and-see approach in people with gluteal tendinopathy. The exercise group did best: around 77 per cent were at least moderately better at eight weeks, compared with 58 per cent after injection, and the advantage held up better over the following year. An injection can quieten the pain for a few weeks, but it does not rebuild the tendon’s capacity, which is why the problem so often returns. A good programme starts by settling the most provocative compression, uses isometric holds for pain relief, then builds progressive hip abductor and gluteal strengthening, alongside work on single-leg control so the pelvis stops loading the tendon so heavily. A first assessment for sports physiotherapy confirms the diagnosis and sets the loading plan, and the longer reconditioning runs as structured physiotherapy rehabilitation. If you are unsure whether your hip pain fits this pattern, the NHS hip pain page covers the general signs that warrant review.
Common questions about gluteal tendinopathy
Is hip bursitis the same as gluteal tendinopathy?
Not quite. What used to be called hip or trochanteric bursitis is now understood, in most cases, to be gluteal tendinopathy, a load-related problem of the gluteal tendons rather than an inflamed bursa. The bursa can be involved, but it is rarely the main driver, which is why loading-based treatment works better than rest and anti-inflammatories.
What can be mistaken for hip bursitis?
Gluteal tendinopathy is the most common condition mistaken for hip bursitis, because they share the same location on the outside of the hip. Referred pain from the lower back and, less often, hip joint arthritis can also produce outer hip symptoms, which is why an assessment that tests the tendon and screens the back is worthwhile.
Why does my outer hip hurt more at night?
Lying on the affected side presses the gluteal tendon against the bone, and lying on the other side with the top knee dropping forward compresses it too. That is why the hip can wake you whichever way you turn. A pillow between the knees and avoiding the sore side usually improves sleep within a week or two.
How long does gluteal tendinopathy take to recover?
Most cases improve steadily over three to six months with a progressive loading programme, though pain and sleep often improve much sooner. Recovery follows the tendon’s biology, so it cannot be rushed, but managing compression early and loading consistently gives the fastest reliable route.
Do injections help gluteal tendinopathy?
A corticosteroid injection can ease pain for a few weeks, but the LEAP trial found education plus exercise gave better results at eight weeks and held up better over a year. Injections do not rebuild tendon capacity, so symptoms often return. They are best reserved for cases where pain is limiting the ability to start loading.
About the author
Rick Porter is a physiotherapist and certified JEMS practitioner with twenty years in elite sport, including roles with England women’s rugby, Manchester City ladies, Sale Sharks and McLaren F1, and he lectures at university level. He treats patients across Woodford, Poynton, Marple and the surrounding towns, and you can read more on his practitioner page.
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