Pain on the Side of Your Hip? It's Probably Not Just Bursitis

Pain on the outside of the hip is extremely common, especially in middle age and beyond, and it usually gets a quick label: bursitis. The standard response is rest and perhaps a cortisone injection. Then, often enough, the pain comes back. The reason is that the label is usually only part of the story, and the real driver changes what actually helps.

What is really going on

For years, lateral hip pain was attributed to inflammation of the bursa, a small fluid-filled cushion on the side of the hip, hence the term bursitis. But research over the past couple of decades has reshaped that understanding. The primary problem in most cases is gluteal tendinopathy, an irritation of the gluteal tendons where they attach to the bony point on the side of the hip, called the greater trochanter. Any bursa irritation that is present is usually secondary to the tendon problem.

This matters because the modern, accurate term for this cluster of symptoms is greater trochanteric pain syndrome, and the tendon is the centre of it. It sits within the broader group of bursitis and tendinitis problems we treat, but recognizing the tendon as the lead actor is what points to the right treatment.

How it shows up

Gluteal tendinopathy has a recognizable pattern. The pain sits over the bony point on the side of the hip and typically worsens with:

• Lying on that side, which is why it so often disturbs sleep.
• Climbing stairs or hills, which loads the gluteal tendons.
• Standing on one leg or standing for long periods, especially with the weight shifted onto one hip.

Many people first notice it as an inability to sleep on the affected side, which is a strong clue. The pain can also refer down the outside of the thigh, which sometimes leads people to worry it is coming from the back, though the source is the hip itself.

Why rest and injections disappoint

Treating this as simple bursitis leads to rest and injections, and both tend to disappoint over time.

Complete rest does not help a tendon problem and can leave the tendon weaker, so the pain returns the moment normal activity resumes. This is the same trap we describe with other tendons, such as in our piece on tennis elbow loading versus cortisone, where rest and injections settle things briefly but do not build the tendon's capacity.

A cortisone injection can reduce the pain in the short term, but if the underlying tendon problem is not addressed, the relief often fades and symptoms return. The tendon needs progressive loading to build tolerance, and an injection provides none of that. Injections may have a limited role in calming a very irritable tendon enough to begin loading, but they are not a stand-alone cure.

What actually works

Effective treatment has two pillars, and they work together.

Manage the compressive loads. Certain positions compress the gluteal tendon against the bone and keep it irritated. Crossing your legs, standing with your weight slumped onto one hip, sitting low with knees together, and lying directly on the painful side all add compression. Reducing these, especially early on, is one of the most important and often overlooked parts of settling the problem.

Load the tendon progressively. As with every tendinopathy, the tendon gets better when you build its tolerance through progressive strengthening of the gluteal muscles. We start at a level the tendon can handle and build from there, paced to how it responds.

The combination of removing the compressive aggravators and loading the tendon is what reliably settles gluteal tendinopathy, where rest and injections alone fall short. This is the same loading philosophy that runs through our approach to hip pain and lower-limb tendon problems generally.

A realistic timeline

Like other lower-limb tendinopathies, gluteal tendinopathy is often slow, improving over a few months with consistent loading and load management rather than in a couple of weeks. The timeline depends on how irritable the tendon is and how long it has been there before treatment starts. The single biggest factor in progressing steadily is consistently avoiding the compressive positions that aggravate it, because a tendon that gets re-irritated every night by sleeping on it cannot settle no matter how good the loading program is.

We reassess against function, your ability to climb stairs, stand, and sleep on the side comfortably, rather than chasing the pain day to day.

When to get it assessed

If you have pain on the outside of your hip that flares when you lie on it, climb stairs, or stand on one leg, an assessment confirms whether it is gluteal tendinopathy and builds a plan that addresses the tendon rather than just chasing inflammation. If rest and an injection have already failed to give lasting relief, that is a strong sign the tendon was the issue all along.

Book a 30-minute appointment and we will assess the hip, identify the compressive loads aggravating it, and build a loading and load-management plan to settle it for good.

This article is general information about gluteal tendinopathy and lateral hip pain. It is not personal medical advice. A regulated practitioner can confirm whether the patterns described apply to you.

Sources

• Mellor et al. — Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy (LEAP trial), BMJ (2018)
• Grimaldi et al. — Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management, Sports Medicine (2015)
• College of Physical Therapists of BC (CPTBC)

This article is for general information only and does not constitute medical advice, diagnosis, or treatment. Individual presentations vary — assessment findings and treatment plans differ from person to person. If you are experiencing severe symptoms, neurological changes (numbness, weakness, bowel or bladder changes), or a significant trauma, contact your physician or emergency services. Care at Medstar Sport Physio & Health is provided by practitioners registered with their respective British Columbia regulatory colleges.