Lateral Hip Pain: Causes, Symptoms and Treatment

Understanding pain around the outside of the hip, including greater trochanteric pain syndrome, gluteal tendinopathy and bursitis.

Pain around the outside of the hip is a common problem that can affect people of all ages. It can make walking uncomfortable, cause difficulty climbing stairs and make sleeping particularly difficult, especially when lying on the affected side. Some people describe a deep ache around the bony prominence on the side of their hip, which can sometimes extend down the outside of the thigh towards the knee.

One of the most common diagnoses associated with this type of pain is Greater Trochanteric Pain Syndrome (GTPS). You may also have heard it described as trochanteric bursitis or gluteal tendinopathy. Although these terms are sometimes used interchangeably, there are several different structures around the hip that can contribute to symptoms. Understanding the potential causes is important because treatment needs to address the underlying problem rather than simply the location of the pain.

Understanding the anatomy of the outer hip

The greater trochanter is the prominent bony area on the outside of the upper thigh bone (femur). If you place your hand on the side of your hip, you can usually feel it quite easily. Several important muscles and tendons attach around this area, particularly the gluteus medius and gluteus minimus.

These muscles play an important role in stabilising the pelvis when standing, walking and climbing stairs.

There are also small fluid-filled sacs called bursae which sit between the tendons and the underlying bone. Their job is to reduce friction and help structures glide smoothly against one another. The iliotibial band (IT band), a strong strip of connective tissue running down the outside of the thigh, also passes over this region. Because so many structures sit close together, identifying the exact source of pain can sometimes be challenging.

Please note: These images are intended to simplify anatomical concepts and make them easier to understand. Some anatomical details may therefore be simplified or not entirely accurate. For precise anatomical information, please refer to recognised anatomical textbooks or other authoritative clinical references.

Greater Trochanteric Pain Syndrome (GTPS)

Greater Trochanteric Pain Syndrome is an umbrella term used to describe pain arising from the soft tissues surrounding the greater trochanter. It is one of the most common explanations for persistent pain around the outside of the hip.

Historically, this condition was frequently diagnosed as trochanteric bursitis, with the assumption that inflammation of the bursa was the main source of pain. However, our understanding has developed, and research suggests that problems affecting the gluteal tendons are often the primary contributor, sometimes alongside irritation of the surrounding bursae.

People with GTPS commonly experience tenderness directly over the bony prominence on the side of the hip. Pain may extend down the outside of the thigh, sometimes reaching the knee. Lying on the affected side can be particularly uncomfortable, as can walking uphill, climbing stairs, standing on one leg or getting up from a low chair.

GTPS can develop gradually over time or follow a change in activity, such as increasing walking distances, starting a new exercise programme or spending more time on your feet. It is more common in women, particularly between the ages of 40 and 60, although it can affect anyone.

Gluteal tendinopathy

Gluteal tendinopathy is one of the main causes of GTPS. The gluteus medius and minimus muscles are essential for controlling the pelvis during walking and other weight-bearing activities. Their tendons attach to the greater trochanter, helping to stabilise the hip and maintain pelvic control.

Tendinopathy occurs when a tendon becomes painful and less able to tolerate the loads placed upon it. This can involve changes in the structure of the tendon rather than simply inflammation.

Symptoms often include a persistent ache around the outside of the hip, tenderness over the greater trochanter and pain during activities that place increased demand on the gluteal muscles.

One particularly common feature is pain when standing on one leg. This might happen when getting dressed, putting on shoes or stepping into the bath. Walking for longer distances, climbing hills and repeatedly using stairs can also aggravate symptoms.

Tendinopathy does not necessarily mean that a tendon has been torn or seriously damaged. However, it does suggest that the tendon may need a period of carefully managed loading and strengthening to improve its capacity. Complete rest is rarely the answer, and a gradual rehabilitation programme is generally more beneficial in the longer term.

Trochanteric bursitis

A bursa is a small fluid-filled sac that helps reduce friction between tissues as they move against one another. There are several bursae around the greater trochanter. When a bursa becomes irritated, it can cause pain and tenderness around the outside of the hip. This is known as trochanteric bursitis.

Symptoms can be very similar to gluteal tendinopathy. People may experience pain when lying on the affected side, walking or climbing stairs. Direct pressure over the bony prominence can also be particularly uncomfortable. Bursal irritation can occur alongside gluteal tendinopathy rather than being a completely separate problem.

It is worth remembering that not all lateral hip pain is caused by bursitis. Isolated bursitis appears to be much less common than was traditionally thought. This is why simply treating the area as an inflamed bursa may not address the underlying problem.

Iliotibial band irritation and snapping hip

The iliotibial band is a thick strip of connective tissue that runs down the outside of the thigh, from the pelvis towards the knee. As the hip moves, the IT band passes across the greater trochanter. In some people, this movement can produce irritation or a noticeable snapping sensation. This is sometimes called external snapping hip syndrome.

People may notice a clicking or snapping sensation around the outside of their hip when walking, running or repeatedly bending and straightening the hip. It may or may not be painful. In some cases, repeated friction and compression can irritate the surrounding soft tissues and contribute to lateral hip pain.

Hip osteoarthritis

Although hip osteoarthritis is more commonly associated with pain in the groin or front of the thigh, it can sometimes produce discomfort around the outside of the hip. Osteoarthritis involves changes to the joint cartilage and surrounding structures. As the condition develops, people may experience stiffness, reduced movement and discomfort during walking and weight-bearing activities.

There can also be some overlap between hip osteoarthritis and gluteal tendinopathy. Having one condition does not necessarily exclude the other. If someone has lateral hip pain alongside groin discomfort, difficulty putting on socks and shoes, or reduced hip rotation, it is worth considering whether the hip joint itself is contributing to their symptoms.

Referred pain from the lower back

Not all pain felt around the hip actually originates from the hip itself. Problems affecting the lumbar spine can sometimes produce referred pain into the buttock, outer hip and thigh. Irritation of spinal nerves can also cause pain, tingling or altered sensation extending down the leg.

This can sometimes be difficult to distinguish from a local tendon or bursal problem. Clues that the lower back may be involved include accompanying back pain, symptoms extending below the knee, tingling or numbness, and pain that changes with particular spinal movements or positions. A thorough assessment should therefore consider both the hip and lower back rather than concentrating exclusively on the painful area.

Other possible causes

There are some less common causes of lateral hip pain that should also be considered. These include muscle or tendon injuries following a fall or sudden movement, more significant tears of the gluteal tendons, and stress fractures, particularly in runners or people who have suddenly increased their activity levels. Problems involving the pelvis, sacroiliac region and surrounding muscles can also sometimes produce pain around the outside of the hip.

The important point is that pain in the same location does not necessarily mean everyone has the same condition. A proper assessment can help establish the likely source of symptoms and guide appropriate treatment.

What makes lateral hip pain worse?

There are several common activities and positions that can aggravate pain around the greater trochanter. For people with gluteal tendinopathy and GTPS, symptoms are often aggravated by compression of the gluteal tendons against the greater trochanter. This can happen when lying directly on the affected hip, crossing the legs or standing with the hip pushed out to one side.

Standing on one leg, walking uphill and climbing stairs can also increase the load through the gluteal muscles and tendons. This is an important distinction because people sometimes assume that stretching the outside of the hip will help. However, repeatedly stretching into positions that compress the tendons can actually make symptoms worse.

What can you do to help relieve lateral hip pain?

There are several things you can try at home to help manage symptoms. The most important principle is to reduce unnecessary irritation while maintaining as much comfortable movement as possible. The aim is not to stop using the hip altogether, but to allow painful structures to settle before gradually rebuilding strength and activity levels.

Modify activities and allow the hip to settle

If your hip is particularly painful, temporarily reducing activities that aggravate it can be helpful. This might include longer walks, steep hills, repeated stair climbing, prolonged standing or exercises that involve repeated loading of the painful hip. You don't necessarily need to stop these activities completely, but reducing their frequency, duration or intensity can help.

A short period of relative rest can be useful during a flare-up, particularly if symptoms have increased following a busy period or an increase in activity. However, prolonged bed rest or complete inactivity is unlikely to help. Keeping gently mobile and maintaining comfortable everyday activities will help prevent further stiffness and muscle weakness.

Sleeping positions and getting comfortable at night

Pain around the outside of the hip can make sleeping difficult, particularly when lying on the affected side. Pressure from the mattress can compress the sensitive tissues around the greater trochanter, aggravating the gluteal tendons and surrounding bursae.

If possible, try sleeping on your back with a pillow underneath your knees to provide support and make the position more comfortable. Alternatively, if you prefer sleeping on your side, try lying on your unaffected side with a reasonably thick pillow between your knees. This helps keep your upper leg supported and prevents it dropping forwards and across your body, which can increase compression around the outer hip.

A longer body pillow can be particularly useful as it supports the upper leg along its length, rather than just between the knees. Try to avoid sleeping directly on the painful hip, particularly if this consistently aggravates your symptoms. If both hips are uncomfortable, sleeping on your back may be the best position to try.

If you wake during the night with discomfort, changing position rather than trying to sleep through increasing pain may help. Remember that the aim is to reduce pressure and irritation around the hip rather than finding one perfect sleeping position. Experiment with pillows and positioning to find what feels most comfortable for you.

Try ice to help settle pain

Applying a cold pack to the painful area may help provide temporary pain relief, particularly if symptoms have flared up following activity. Wrap an ice pack or a bag of frozen peas in a damp towel and apply it to the outside of the hip for approximately 10–15 minutes. Never apply ice directly to the skin, and check the skin regularly to avoid irritation or cold injury. Avoid using ice where sensation or circulation is significantly reduced.

Ice is not a treatment for the underlying tendon problem, but some people find it useful for managing discomfort.

Consider suitable pain relief

Simple pain relief may help make everyday activities more comfortable while the hip settles.

Paracetamol may be appropriate for some people, provided it is safe for them to take and used according to the instructions.

Anti-inflammatory gels, such as Voltarol (diclofenac), can sometimes help with localised musculoskeletal pain. However, they aren't suitable for everyone. Check with your GP or pharmacist before using them, particularly if you take other medication, have a history of stomach ulcers, kidney or heart problems, asthma triggered by anti-inflammatory medication, or are taking anticoagulants such as warfarin or other blood-thinning medication. Topical anti-inflammatory medication has lower systemic absorption than tablets, but it is not without risks. Follow the product instructions and don't apply it to broken skin.

Avoid prolonged compression around the hip

Small changes to everyday habits can sometimes make a considerable difference. Try to avoid sitting with your legs crossed for prolonged periods, standing with your weight resting on one hip or repeatedly allowing your pelvis to drop to one side when standing. These positions can increase compression around the gluteal tendons.

If you have to stand for long periods, try to distribute your weight evenly between both legs and change position regularly. When getting dressed, consider sitting down rather than balancing on one leg if this aggravates your symptoms.

Gradually rebuild strength

Once symptoms are more settled, strengthening the muscles around the hip becomes an important part of recovery. The gluteus medius and minimus muscles help stabilise the pelvis and control the position of the hip during walking and other weight-bearing activities.

A physiotherapist can recommend suitable exercises based on your symptoms and current strength. These may initially involve gentle static muscle contractions before progressing towards standing hip strengthening, controlled squats and step-ups. Exercises should be introduced gradually, with the difficulty and resistance increased as your tolerance improves.

It is important not to push through significant pain. Mild discomfort during rehabilitation may be acceptable, but pain should not become substantially worse afterwards or remain aggravated into the following day. If it does, the exercise intensity or volume may need to be reduced.

How is lateral hip pain assessed?

A physiotherapy assessment can help establish which structures are likely to be contributing to the symptoms. This usually begins with a discussion about when the pain started, how it behaves and which activities make it better or worse. Previous injuries, changes in exercise levels, walking habits and medical history can all provide useful information.

The physiotherapist will then assess hip movement, muscle strength, walking pattern and pelvic control. Specific tests may include resisted hip abduction, single-leg standing and other movements that load the gluteal tendons. Palpation around the greater trochanter can also help identify areas of tenderness.

It is important to assess the lumbar spine and hip joint where appropriate, particularly if symptoms extend down the leg or there are other associated symptoms. Most cases can be assessed clinically without needing an immediate scan. Ultrasound or MRI may be considered when symptoms are persistent, the diagnosis is uncertain or a significant tendon tear is suspected.

How can physiotherapy help?

Physiotherapy is often an important part of managing lateral hip pain, particularly when gluteal tendinopathy or GTPS is involved. The aim is not simply to reduce pain but to improve the strength and load-bearing capacity of the muscles and tendons around the hip.

Treatment will usually involve a combination of advice, activity modification and an individual exercise programme. Initially, this may focus on reducing irritation and improving comfortable movement. As symptoms settle, rehabilitation can progress towards strengthening the gluteal muscles, improving balance and restoring confidence with everyday activities.

For people who have developed weakness or reduced mobility, improving walking, stair climbing and general functional ability can also be important goals. Recovery needs to be progressive, as doing too much too soon can aggravate symptoms, but avoiding activity altogether can lead to further weakness and reduced function.

How long does recovery take?

Recovery varies depending on the underlying cause, how long symptoms have been present and the severity of the problem. Some people improve within a few weeks with appropriate activity modification and rehabilitation. However, gluteal tendinopathy can be more persistent, and meaningful improvements in strength and function may take several months.

Consistency with rehabilitation is important. Tendons generally respond to gradual, progressive loading rather than prolonged rest. If symptoms aren't improving, further assessment may be needed to reconsider the diagnosis and treatment approach.

When should you seek further medical advice?

Although most lateral hip pain is related to muscles, tendons and other soft tissues, there are occasions when further medical investigation is important. Seek medical advice if you experience severe or rapidly worsening pain, significant difficulty putting weight through the leg, pain following a fall or injury, unexplained weight loss, fever or feeling generally unwell.

Sudden severe hip pain, an inability to bear weight following an injury, or a hot, swollen hip with fever requires urgent assessment. New or progressive weakness, significant numbness or other neurological symptoms should also be medically assessed.

How Physio at Home can help

Lateral hip pain can be frustrating, particularly when it affects walking, sleeping and everyday activities. At Physio at Home, we provide private physiotherapy in your own home across Mid Cornwall, including Falmouth, Penryn and Truro.

We can assess your hip, help identify the likely source of your symptoms and develop an individual rehabilitation programme to improve strength, mobility and confidence. Whether your pain is related to gluteal tendinopathy, GTPS, bursitis or another underlying problem, understanding the cause is an important first step towards recovery.

If you're experiencing persistent hip pain, get in touch with Physio at Home to discuss how we can help.