Outer Hip Pain: Gluteal Tendinopathy, Bursitis or Pain From Somewhere Else?

Direct Answer

Outer hip pain is commonly associated with gluteal tendinopathy, with or without irritation of the nearby bursae. It is not always isolated “bursitis.” The diagnosis becomes more likely when lying on the affected side, prolonged standing, stairs or single-leg loading reproduce the pain. Hip arthritis, lumbar spine conditions and other disorders should be considered when the symptom pattern does not fit.

What is greater trochanteric pain syndrome?

The greater trochanter is the prominent bone at the outer side of the upper thigh. Several muscles, tendons and fluid-filled bursae are located around it.

Pain in this region is often described as greater trochanteric pain syndrome, or GTPS. This is an umbrella term rather than one single abnormality.

Potential contributors include:

• Gluteus medius tendinopathy
• Gluteus minimus tendinopathy
• Partial or full-thickness gluteal tendon tears
• Irritation of the trochanteric bursae
• Compression of the tendons against the greater trochanter
• Reduced strength or control during weight-bearing activities

The term allows clinicians to describe the pain region without assuming that an inflamed bursa is the only problem.

Is outer hip pain the same as bursitis?

Not always.

A bursa is a small fluid-containing structure that reduces friction between tissues. Several bursae are present around the outer hip.

Historically, much lateral hip pain was labelled “trochanteric bursitis.” However, imaging and clinical research suggest that gluteal tendon abnormalities are frequently involved, sometimes with bursal irritation and sometimes without it.

This matters because treatment directed only at reducing inflammation may not restore the tendons’ capacity to tolerate walking, stairs and single-leg loading.

“Bursitis” is not necessarily a completely incorrect description, but it may be incomplete.

What does gluteal tendinopathy feel like?

Gluteal tendinopathy commonly causes pain over the outer hip. It may spread slightly into the outer thigh or buttock.

Typical aggravating activities include:

• Lying on the painful side
• Lying on the opposite side without leg support
• Standing with most weight on one leg
• Crossing the legs
• Walking for prolonged periods
• Climbing stairs
• Walking uphill
• Running
• Getting out of a low chair
• Single-leg exercise
• Getting into or out of a car

Night pain is common, especially when direct pressure is placed on the affected hip.

Symptoms may begin gradually or appear after a change in walking, running, exercise or daily activity.

Why does lying on either side sometimes hurt?

Lying directly on the painful side compresses the tendons and bursae against the greater trochanter.

Lying on the opposite side can also aggravate symptoms if the painful upper leg drops across the body. This position may increase compression at the outer hip.

Some people find it more comfortable to:

• Sleep on their back
• Place a pillow between the knees and ankles
• Avoid allowing the upper leg to fall across the midline
• Use a mattress surface that does not create excessive pressure

These changes may reduce symptoms, but they do not replace rehabilitation when tendon capacity and strength need to improve.

Who develops gluteal tendinopathy?

It can affect adults of different ages and activity levels. It is particularly common among women in midlife and later life, although men can also be affected.

Possible contributing factors include:

• A sudden increase in walking or running
• More hills or stairs
• Reduced hip muscle strength
• Changes in pelvic control during walking
• Prolonged standing with weight shifted onto one leg
• Repeated positions that compress the outer hip
• Higher body weight
• Previous hip or lower-limb problems
• Coexisting lower-back or hip-joint conditions

These are possible contributors rather than proof of the diagnosis.

What else can cause outer hip pain?

Pain location alone does not identify its source. Conditions inside the hip joint, around the pelvis or in the lumbar spine may cause overlapping symptoms.

Hip osteoarthritis

Hip arthritis more commonly causes groin or front-of-thigh pain, stiffness and reduced hip rotation. It can, however, also cause pain in the buttock, outer hip or knee.

Features that may support hip-joint involvement include:

• Groin pain
• Difficulty putting on shoes and socks
• Reduced hip rotation
• Pain when getting into a car
• Joint stiffness
• Reduced walking tolerance
• Pain reproduced by moving the hip joint

Gluteal tendinopathy and hip arthritis can coexist.

Lumbar spine or nerve-related pain

Lower-back structures and irritated nerves can refer pain towards the buttock and outer hip.

Features that may suggest a spinal or neurological contribution include:

• Back pain
• Pain extending below the knee
• Numbness or tingling
• Burning or electric sensations
• Leg weakness
• Symptoms altered strongly by spinal movement
• Pain that is not reproduced by local hip loading

Not every person with referred spinal pain has back pain, so examination may still be needed.

Hip labral or impingement-related conditions

These conditions more commonly produce groin or front-of-hip symptoms. Clicking, catching or pain during deep hip flexion may occur.

Proximal hamstring tendinopathy

This usually causes pain near the sitting bone rather than directly over the outer hip. Prolonged sitting, running or bending at the hip may aggravate it.

Sacroiliac or pelvic-region pain

Pain from the pelvic joints and surrounding tissues may be experienced in the buttock or posterior hip rather than the typical lateral trochanteric region.

Stress fracture

A stress or insufficiency fracture may cause increasing pain with weight-bearing. Risk may be higher after a sudden increase in impact activity or in someone with reduced bone strength.

Osteonecrosis

Osteonecrosis affects the blood supply to the femoral head. It more commonly causes groin or deep hip pain but may present differently. Risk factors can include significant corticosteroid exposure, heavy alcohol use and certain medical conditions.

Inflammatory or systemic disease

Inflammatory arthritis, infection and other medical conditions are less common causes but should be considered when systemic features or an atypical presentation is present.

How is gluteal tendinopathy diagnosed?

Diagnosis is usually based on the symptom pattern and physical examination.

Pain location

The clinician may ask the patient to identify the most painful area with one finger. Local pain over the greater trochanter supports a lateral hip source but is not sufficient by itself.

Palpation

Pressure over the outer hip may reproduce familiar pain. However, local tenderness can be present in several conditions and should not be treated as a standalone diagnostic test.

Resisted muscle testing

The gluteal muscles move the leg away from the body and help control the pelvis during weight-bearing.

Pain or weakness during resisted hip movements may support gluteal tendon involvement.

Single-leg loading

Standing on one leg, stepping, walking or other controlled weight-bearing tasks may reproduce symptoms.

These tests help assess:

• Pain response
• Hip strength
• Pelvic control
• Balance
• Functional tolerance

No single test can prove gluteal tendinopathy. Clinicians often use a combination of findings while assessing the hip joint, spine and nearby structures.

Is imaging always necessary?

No.

When the pain location, symptom pattern and examination are typical, treatment can often begin without imaging.

Imaging becomes more useful when:

• The diagnosis remains uncertain
• Symptoms are severe or atypical
• There was significant trauma
• A gluteal tendon tear is suspected
• The person has marked weakness
• Hip-joint disease or a fracture is possible
• Symptoms are not improving with appropriate treatment
• An injection or operation is being considered
• The result is likely to change management

The presence of an abnormality on a scan does not automatically establish the source of pain.

What can an X-ray show?

A standard hip or pelvis X-ray can assess:

• Hip osteoarthritis
• Bone alignment
• Some fractures
• Calcification
• Other structural bone changes

An X-ray does not show the gluteal tendons in detail. A normal X-ray therefore does not exclude gluteal tendinopathy.

It can still be valuable when the clinical question includes possible arthritis or bone disease.

When is ultrasound useful?

Ultrasound can assess superficial tissues around the outer hip, including:

• Gluteal tendons
• Partial or full-thickness tendon tears
• Tendon thickening
• Bursal fluid
• Calcification
• Dynamic movement

It can also guide selected injections.

Limitations include operator dependence and the possibility of finding structural abnormalities that do not explain the symptoms.

When is MRI useful?

MRI may show:

• Gluteal tendon changes
• Partial or complete tendon tears
• Muscle changes
• Bursal abnormalities
• Hip-joint disease
• Bone stress injury
• Other soft-tissue problems

MRI may be considered when a substantial tendon tear or another diagnosis is suspected, or when persistent symptoms have not responded as expected.

It is not automatically necessary for every person with outer hip pain. The American College of Radiology recommends selecting subsequent imaging according to the suspected cause after clinical assessment and usually initial radiography for chronic hip pain. ACR Appropriateness Criteria: Chronic Hip Pain

What is the main treatment?

Education, reduction of aggravating compression and progressive exercise form the foundation of treatment for many patients.

Reduce unnecessary compression

Temporary changes may include:

• Avoiding standing with the hip pushed sideways
• Avoiding sitting with tightly crossed legs
• Using a pillow between the legs when side sleeping
• Reducing direct pressure on the painful side
• Modifying deep hip-adduction stretches
• Adjusting hill, stair or running volume

The aim is not to avoid every movement permanently. It is to reduce repeated irritation while rebuilding capacity.

Modify load rather than stop everything

Complete rest may temporarily reduce pain but can also reduce strength and tolerance.

Activity may be adjusted by changing:

• Walking distance
• Walking speed
• Frequency of stairs
• Running volume
• Hill exposure
• Exercise resistance
• Recovery time between sessions

The appropriate amount depends on the person’s symptoms and goals.

Strengthen progressively

Exercise may target:

• Hip abductor strength
• Hip extensor strength
• Pelvic control
• Lower-limb strength
• Balance
• Walking or running tolerance
• Functional tasks relevant to work or sport

A programme may progress from lower-load isometric exercises to more demanding resistance and functional activity.

Not every patient needs clamshells, bridges or the same standard exercise sheet. Exercises should be selected and progressed according to symptoms, strength and function.

What did research comparing exercise and injection find?

A major randomised clinical trial compared:

• Education plus exercise
• One corticosteroid injection
• A wait-and-see approach

At eight weeks, education plus exercise and corticosteroid injection both produced better outcomes than waiting. Education plus exercise performed better than injection on several outcomes.

At 52 weeks, education plus exercise produced better global improvement than corticosteroid injection, although pain intensity differences were less clear.

The study supports an approach that addresses tendon loading and compression rather than relying exclusively on short-term pain suppression. BMJ randomised clinical trial

This does not mean every patient responds identically or that injections are never appropriate.

Is pain during exercise acceptable?

Some discomfort may be acceptable during rehabilitation, but the response should be monitored.

The programme may need adjustment if:

• Pain becomes progressively sharper
• Movement quality deteriorates
• The person limps substantially
• Symptoms remain markedly elevated afterward
• Night pain becomes significantly worse
• Function declines over successive sessions

The goal is progressive adaptation, not repeated severe aggravation.

Does stretching help?

Stretching is not automatically beneficial for every case.

Some conventional hip stretches move the thigh across the body and compress the gluteal tendons against the greater trochanter. These positions may aggravate symptoms.

Mobility work may still be appropriate when a relevant restriction is identified, but it should not be prescribed merely because the hip hurts.

Can massage or manual therapy help?

Manual treatment may temporarily reduce discomfort or address movement restrictions in selected patients. It does not by itself rebuild tendon strength or loading tolerance.

Directly pressing or repeatedly rolling over a highly sensitive outer hip can increase compression and worsen symptoms for some people.

Passive treatment is best considered as an adjunct rather than a replacement for education and progressive exercise.

Does shockwave therapy help?

Shockwave therapy has been studied for greater trochanteric pain and gluteal tendinopathy. Some trials suggest that it may improve pain and function in selected patients, but evidence and protocols vary.

Important limitations include:

• It does not help everyone
• The optimal protocol is uncertain
• It should not replace rehabilitation
• The diagnosis should be established first
• A significant tendon tear may require a different plan

Shockwave may be considered as an adjunct when symptoms remain persistent despite an appropriate initial programme.

Are corticosteroid injections appropriate?

A corticosteroid injection into the trochanteric region may provide short-term pain relief for selected patients.

Potential advantages include:

• Temporary pain reduction
• Improved sleep
• Greater ability to participate in rehabilitation

Limitations and risks include:

• Benefits may diminish over time
• The injection does not restore tendon capacity
• Post-injection flare
• Infection
• Skin or fat changes
• Temporary blood-glucose elevation
• Concern about repeated exposure around tendon tissue

The decision should consider the diagnosis, medical history, previous treatment and how the injection fits into the broader rehabilitation plan.

What about PRP?

Platelet-rich plasma has been studied for gluteal tendinopathy, but the evidence remains limited and inconsistent.

Challenges include:

• Small studies
• Differences in PRP preparation
• Different injection techniques
• Variable patient selection
• Limited comparison with well-delivered rehabilitation
• Uncertainty about long-term cost-effectiveness

PRP should not be described as proven tendon regeneration or a guaranteed alternative to surgery.

When is surgery considered?

Most people with gluteal tendinopathy do not require surgery.

A surgical opinion may be considered when:

• A substantial gluteal tendon tear is present
• Weakness significantly affects walking
• Symptoms remain disabling despite comprehensive non-surgical care
• Imaging findings match the symptoms and examination
• The expected benefits justify the risks and recovery demands

Surgery is not indicated merely because a scan reports tendinopathy or bursal fluid.

What if physiotherapy is not working?

A lack of improvement should lead to reassessment rather than indefinite repetition.

Questions may include:

• Is gluteal tendinopathy the correct diagnosis?
• Is hip arthritis also contributing?
• Has the lumbar spine been assessed?
• Is there a significant tendon tear?
• Are the exercises repeatedly compressing the tendon?
• Is the exercise load too low or too high?
• Has strength objectively improved?
• Are walking, sleep and function improving?
• Would imaging change management?
• Is another treatment or referral now appropriate?

Physiotherapy should have measurable goals. Continuing the same exercises without progress is not the only available option.

When does outer hip pain require prompt assessment?

Seek timely medical attention when hip pain is accompanied by:

• Inability to bear weight after a fall
• A shortened or deformed leg
• Sudden severe pain
• Rapidly worsening weakness
• Fever or feeling systemically unwell
• A hot, red or markedly swollen area
• Persistent pain unrelated to position or activity
• Unexplained weight loss
• A history of cancer with new, persistent bone pain
• New numbness around the groin
• New loss of bladder or bowel control

These symptoms require assessment for conditions other than routine gluteal tendinopathy.

Practical considerations in Singapore

Assessment may begin with a polyclinic, general practitioner, private medical clinic or physiotherapist.

Where medically appropriate:

• X-ray may assess hip arthritis, fracture or bone changes.
• Ultrasound may assess the gluteal tendons and bursae.
• MRI may be considered for significant tears, stress injury or unclear persistent symptoms.
• Physiotherapy may address load management, strength and function.
• Referral may be arranged when another medical condition or a surgical problem is suspected.

Insurance coverage and referral requirements differ between policies. Patients intending to claim should verify whether a medical referral, pre-authorisation or supporting documentation is required.

Frequently Asked Questions

Is outer hip pain usually arthritis?

Not necessarily. Hip arthritis more often produces groin pain and restricted hip movement, while gluteal tendinopathy commonly causes local outer-hip tenderness and pain with side lying or single-leg loading. Both can coexist.

Is greater trochanteric pain syndrome the same as bursitis?

Greater trochanteric pain syndrome is a broader term covering pain around the outer hip. Gluteal tendon problems are frequently involved, sometimes with associated bursal irritation.

Should I avoid sleeping on the painful side?

Temporarily reducing direct pressure may help. A pillow between the legs can also reduce compression when lying on the opposite side.

Can I continue walking?

Many people can continue walking at a modified level. Distance, hills, speed and recovery may need adjustment if walking causes limping or prolonged symptom aggravation.

Should I stretch the painful hip?

Not automatically. Some stretches compress the gluteal tendons and may aggravate symptoms. Stretching should address an identified need and be monitored for its effects.

Is ultrasound better than MRI?

Ultrasound can assess superficial tendons dynamically and may be sufficient for many tendon questions. MRI gives a broader view of the hip, bone and deeper tissues. The appropriate test depends on what the clinician is trying to determine.

Does bursal fluid on MRI prove bursitis is causing the pain?

No. Bursal fluid and tendon changes may occur without matching symptoms. Imaging should be interpreted alongside pain location, examination and function.

How long does gluteal tendinopathy take to improve?

Meaningful improvement often takes several weeks to months. Recovery may be slower with long-standing symptoms, substantial weakness, coexisting hip or back conditions, or an unmodified activity load.

Can an injection cure the condition?

A corticosteroid injection may provide short-term relief, but it does not rebuild tendon capacity and may not provide durable improvement. Rehabilitation may still be required.

When is a second opinion reasonable?

A second opinion may be useful when the diagnosis is unclear, treatment is not producing progress, symptoms do not match imaging or an injection or operation has been proposed and you remain uncertain.

References

• Mellor R, et al. Education plus exercise versus corticosteroid injection versus a wait-and-see approach for gluteal tendinopathy. BMJ. 2018.
• American College of Radiology. ACR Appropriateness Criteria: Chronic Hip Pain.
• Grimaldi A, et al. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy. 2015.
• Gazendam A, et al. Treatment of gluteal tendinopathy: a systematic review and stage-adjusted treatment recommendation. Orthopaedic Journal of Sports Medicine. 2021.
• Fearon AM, et al. Greater trochanteric pain syndrome: defining the clinical syndrome. British Journal of Sports Medicine. 2013.

This article is for general education and does not replace an individual medical assessment. Diagnosis and treatment depend on symptoms, examination findings, medical history and personal circumstances. Urgent warning symptoms require prompt medical care. Evidence for emerging injections and procedures may still be developing, regulatory status varies, and some treatments may not be approved or routinely recommended in Singapore.

If outer hip pain remains persistent, the diagnosis is unclear or rehabilitation is not producing meaningful improvement, medical reassessment may help determine whether the treatment plan should be changed or whether X-ray, ultrasound, MRI or onward referral is appropriate. The Pain Relief Clinic provides assessment by a licensed medical doctor and in-house physiotherapy for integrated management where suitable.

Call or WhatsApp: +65 9068 9605

Reviewed by Dr Terence Tan, Founder of The Pain Relief Clinic — 19 September 2026