Understanding Lateral Hip Pain and What Physio Can Do

Pain on the outside of the hip, and what sits behind it

Understanding lateral hip pain starts with getting specific about where it sits and what aggravates it. Pain over the bony bump on the outside of the hip, often worse lying on that side at night or after a long drive, usually points to one diagnosis group: Greater Trochanteric Pain Syndrome, or GTPS. It's one of the more common hip presentations we see at the clinic, in runners and in people who don't run at all.

GTPS is an umbrella term covering two closely related structures.

Gluteal tendinopathy involves the tendons of gluteus medius and minimus, where they attach to the greater trochanter. These tendons stabilise the pelvis every time you stand on one leg, which is roughly every second step you take. When load outpaces the tendon's capacity to adapt, the tissue becomes irritated and sensitive to compression.

Trochanteric bursitis describes irritation of the fluid-filled bursa that sits between the tendon and the bone. Imaging often shows changes in both structures at once, which is part of why the broader GTPS label is now more commonly used than "bursitis" alone. The distinction matters less than you'd think, because the aggravating positions and the management principles overlap heavily.

Who tends to get it

GTPS shows up across ages and activity levels, but it's most frequently reported in women aged roughly 40 to 60. Changes in tendon structure with age, hormonal changes around menopause, and pelvic width all appear to contribute.

The other group we see often is runners, particularly after a jump in weekly volume, a switch to hill work or a return to training after time off. Walkers who suddenly add distance, people who've started a new gym program with heavy squats or lunges, and anyone recovering from a fall onto the side of the hip can all present the same way.

What it typically feels like

• Pain over the outer hip, sometimes spreading down the outside of the thigh toward the knee

• Difficulty sleeping on the affected side, and sometimes on the opposite side with the sore leg dropping forward

• Pain with stairs, hills, standing on one leg to put on socks, or getting out of a low chair

• Aching after prolonged sitting, especially with legs crossed or knees together

• Tenderness when you press directly over the greater trochanter

The pattern is often worse first thing in the morning, eases with gentle movement, then builds again with sustained load. Night pain is one of the more distinctive features and one of the more frustrating for people living with it.

What else it could be

Outer hip pain isn't always coming from the outer hip. A physiotherapy assessment is partly about ruling other things in or out:

• Lumbar spine referral. L4/L5 irritation can refer pain into the lateral hip and thigh, and can mimic tendon pain closely.

• Hip joint pathology. Osteoarthritis or a labral issue more often produces groin pain and stiffness with rotation, but presentations overlap.

• Sacroiliac or pelvic pain, particularly post-partum.

• Referred pain from proximal hamstring or piriformis structures, especially when pain sits further back.

• Stress-related bone injury in high-volume runners, which changes the plan significantly and needs a different pathway.

What assessment involves

A first appointment usually runs 40 to 60 minutes and starts with your history: when it began, what you were doing in the weeks before, what makes it worse, how you're sleeping, and what you're trying to get back to.

The physical assessment typically includes palpation over the greater trochanter, single-leg stance testing (often held for 30 seconds to see whether pain builds), hip strength testing in abduction, and positions that compress the tendon such as bringing the leg across the body. We look at how you control your pelvis in single-leg tasks, and screen the lumbar spine and hip joint. For runners and walkers, we'll often look at gait, including step width, hip drop and cadence.

Imaging isn't needed for most cases. Ultrasound or MRI can be useful where the diagnosis is unclear, where symptoms aren't shifting, or where a bone-related issue is on the list.

What management looks like

Physiotherapy for GTPS is built around reducing compressive load on the tendon while gradually rebuilding its capacity.

Load management and education. Practical changes come first because they often make the biggest difference to day-to-day symptoms. That can mean sleeping with a pillow between the knees, avoiding sitting cross-legged, not standing with weight hanging on one hip, avoiding hip stretches that pull the leg across the body, and temporarily reducing hills, stairs or running volume rather than stopping activity altogether.

Progressive strengthening. This is usually the core of the plan. Many programs begin with isometric hip abduction holds in a neutral position, then progress to loaded work such as bridges, split squats, step-ups and side-lying or standing abduction against resistance. Progression is guided by symptom response over 24 hours rather than by a fixed calendar.

Movement retraining. Adjusting running or walking mechanics, step width, and how you load stairs and hills can reduce repeated compression at the trochanter.

Adjunct treatment. Soft tissue work, dry needling or shockwave therapy are sometimes used alongside exercise to help manage symptoms. They're supportive rather than the main event. Where pain is severe and persistent, a GP or sports physician may discuss injection options, which sit outside physiotherapy scope.

Realistic expectations

Tendons adapt slowly. Progress with gluteal tendinopathy is generally measured in months rather than days, and it's common for symptoms to fluctuate along the way, especially night pain, which can be one of the last things to settle. Some people notice change in the first few weeks with load changes alone; others take considerably longer. Flare-ups after a busy weekend don't mean the plan has failed.

When to get it assessed

Worth booking in if outer hip pain has lasted more than two or three weeks, is disturbing your sleep, is limiting stairs or walking distance, or keeps returning each time you build your running back up. Sooner is better if it followed a fall, if you can't weight-bear properly, or if you have pain that wakes you and doesn't ease with position changes at all.

If you would like it assessed, you can book a free injury assessment.