| What We Treat
Gluteal Tendinopathy (Greater Trochanteric Pain Syndrome)
Pain on the bony point of your hip that stops you lying on that side at night? This is the most common cause of lateral hip pain — usually labelled bursitis, usually not bursitis, and highly responsive to the right loading.
Overview
What Is Greater Trochanteric Pain Syndrome?
The gluteus medius and minimus tendons attach onto the greater trochanter, the bony point at the side of your hip. For decades this was called trochanteric bursitis, but imaging studies consistently show tendon pathology with or without bursal change — which matters, because tendons respond to progressive loading whereas bursitis is treated with rest and injection. Gluteal tendinopathy is degeneration and irritation of these tendons where they attach.
Tap a structure, or use the buttons, to see what drives the pain.
The Gluteal Tendons
Gluteus medius and minimus attach onto the outer hip and are essential for controlling the pelvis when you stand on one leg. Tendinopathy here produces well-localised pain over the bony point, tenderness to lie on, and weakness that is often not noticed until it’s tested.
Symptoms
How It Tends to Feel
Lateral hip pain has one of the most consistent presentations in musculoskeletal practice:
Pain on the Bony Point
Well localised over the greater trochanter, often with a small area you can point to precisely.
Can’t Lie on That Side
Night pain when lying on the affected side is the single most characteristic feature.
Painful Lying on the Other Side Too
The top leg falling forwards compresses the tendon, which is why both sides can be uncomfortable.
Worse on Stairs
Climbing stairs loads the tendon heavily and reliably reproduces symptoms.
Worse Standing on One Leg
Putting trousers on, or standing with weight shifted onto that hip, is often uncomfortable.
Pain Down the Outer Thigh
Referral down the outside of the thigh is common, though it rarely goes past the knee.
Causes & Risk Factors
What Drives It
Compression and load are the two central mechanisms, and both are modifiable.
Compressive Positions
Sitting cross-legged, standing hip-dropped, and side-lying with the top leg forward all compress the tendon against the bone.
Gluteal Weakness
Reduced strength in the hip abductors means each step and each stair loads the tendon more heavily.
A Change in Activity
Increased walking, hill work or running volume, or a return to activity after a break, commonly precipitates it.
Menopause
Incidence rises markedly in women around and after the menopause, likely reflecting hormonal effects on tendon tissue.
Raised Body Weight
Associated with increased incidence, through greater load through the hip abductor mechanism.
The Programme
How Treatment Progresses
This condition responds well, but the sequence matters. Removing compression comes before loading, and loading comes before anything else.
Remove compression
Stop provoking the tendon
- Stop sitting with legs crossed or knees together
- Sleep with a pillow between the knees, and avoid the top leg falling forwards
- Stop standing with the hip dropped to one side
- Avoid stretching the outer hip — it compresses the tendon and commonly makes things worse
Tap through the stages. Removing compression first is what makes the loading work.
How We Can Help You
Treatment & Management
Education about positions plus progressive loading outperforms injection in the medium term. It takes months rather than weeks, but the results are durable.
What the evidence says
The LEAP randomised trial compared education plus exercise, corticosteroid injection, and a wait-and-see approach for gluteal tendinopathy. Education plus exercise produced the best outcomes at both eight weeks and twelve months, and clearly outperformed injection at one year.
Imaging studies consistently show tendinopathy of gluteus medius and minimus as the primary pathology in lateral hip pain, with bursal change usually secondary — which is why the diagnostic label has shifted away from bursitis.
When to Seek Help
Red Flags — Don’t Ignore These
Lateral hip pain is usually tendon-related. Seek assessment if you notice:
⚠ Seek prompt medical assessment if you notice:
- Inability to weight-bear after a fall, particularly in an older adult (possible hip fracture — attend A&E)
- A hot, red, swollen area with fever or feeling generally unwell (possible infection — seek emergency care)
- Sudden loss of power lifting the leg sideways, or a marked limp appearing abruptly (possible tendon tear)
- Numbness or pins and needles in the leg, or symptoms travelling below the knee
- Constant night pain unrelated to position, with unexplained weight loss or a history of cancer
These symptoms can point to a cause that needs medical rather than physiotherapy assessment. Please don’t wait for a physiotherapy appointment — contact your GP, call 111, or attend A&E as appropriate.
Common Questions
Frequently Asked Questions
Why shouldn’t I stretch my outer hip?
Because stretching into hip adduction — pulling the knee across your body — compresses the tendon against the bone, which is the exact mechanism causing the pain. It often feels like it should help. It reliably doesn’t, and it’s one of the most common reasons people get worse.
Isn’t this bursitis?
That was the standard label for decades, but imaging shows the tendon is the primary problem in the great majority of cases, with bursal change usually secondary. It matters because bursitis implies rest and injection, whereas tendinopathy needs progressive loading.
Should I have an injection?
The LEAP trial found that education plus exercise beat injection at twelve months. Injections give useful short-term relief and can occasionally create a window for rehabilitation, but as a standalone treatment they tend to disappoint.
How long will the night pain last?
This is usually the first thing to improve once the compressive positions are removed — often within two to four weeks. Full resolution of the condition takes longer, typically three to six months of consistent loading.
Get Your Nights Back
The positional changes that stop provoking the tendon, and the loading programme that has the best evidence behind it.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.