Pain on the bony point at the side of the hip, often worst when lying on that side at night, is one of the most common hip complaints in adults. For years it was called trochanteric bursitis, but we now know the real problem is usually a tendon issue, and that changes how it is best treated. Here is what gluteal tendinopathy is, why it happens, and what actually helps.
What gluteal tendinopathy is
Gluteal tendinopathy, the main cause of what is known as greater trochanteric pain syndrome, is an overload problem of the gluteus medius and minimus tendons where they attach to the bony point on the outside of the hip. The older name, trochanteric bursitis, is misleading, scans and tissue studies show the bursa is usually only a secondary player, and the tendon is the primary problem. It has been described as the hip's version of rotator cuff disease, because the arrangement of bone, tendon and bursa is so similar.
It is most common in women between about 40 and 60, affecting women around four times as often as men, and it accounts for a meaningful share of the hip pain people bring to their doctor. Understanding that this is a tendon under load, not an inflamed bursa, is what points to the right treatment.
What it feels like
The typical pattern is pain over the bony point at the side of the hip that can spread down the outer thigh. It is characteristically worse when lying on that side, which often disturbs sleep, when getting up after sitting for a while, and when climbing stairs, walking or running. The tender spot is usually well localised to that bony point. Night pain from rolling onto the hip is a common and telling feature.
Why it happens
The key driver is compression of the tendons against the bone, not simple overstretching. When the hip rolls inward or the pelvis drops, a band of tissue on the outside of the thigh tightens and squeezes the tendons against the bone underneath. Common contributors include:
- Weakness in the hip muscles that control the pelvis, which lets the hip drop and increases compression
- Postures that hold the hip across the body, such as sitting with the legs crossed, standing with the weight shifted onto one hip, or sleeping on the painful side
- The perimenopausal and postmenopausal years, when this becomes notably more common in women
- A higher body weight, and differences in hip and pelvis shape that raise the load at that point
- Coexisting low back pain, hip arthritis or knee problems that change the way you walk
How it is diagnosed
The diagnosis is clinical, anchored by focal tenderness over that bony point and pain reproduced by loading the tendons, for example by standing on the affected leg for half a minute, or with resisted movements of the hip. Weakness or a dropping pelvis on single-leg stance can suggest more advanced tendon involvement or a tear. Imaging is not always needed, but an ultrasound shows the tendon changes reliably, and an MRI is used where a tear or another cause inside the joint is suspected.
What else lateral hip pain can be
Most lateral hip pain is gluteal tendinopathy, but a few patterns point elsewhere. Hip osteoarthritis and problems inside the joint usually cause groin pain rather than pain on the side, and limit the way the hip rotates. Pain referred from the lower back can project to the side of the hip, so the back is screened as part of the assessment. In runners, or anyone with thinning bones, deep groin or hip pain that worsens with every step raises the possibility of a femoral neck stress fracture, which needs checking before the hip is loaded further. Marked weakness with a limp can indicate a significant tendon tear. This is why an accurate diagnosis comes first, rather than treating every side-of-hip pain the same way.
How gluteal tendinopathy is treated
The good news is that most people improve with the right plan, and it rarely needs surgery. The foundation is reducing the compression on the tendon and rebuilding the strength of the muscles that support the hip.
Load and posture management
Because compression is the main driver, simple changes to daily positioning make a real difference: not crossing the legs, avoiding standing with the weight slumped onto one hip, placing a pillow between the knees when sleeping on your side, and easing off the activities that flare it while you recover. Understanding the compression mechanism is itself part of the treatment, because it guides dozens of small daily choices.
Strengthening the hip abductors
The core treatment is a progressive strengthening programme for the hip muscles that control the pelvis, starting with gentle holds and building to heavier loading, while keeping the hip out of the positions that compress the tendon. This has good evidence and works better than passive treatment over time. It is the part that builds lasting capacity and reduces the chance of the problem returning.
Where shockwave therapy fits
When lateral hip pain has been present for a while and has not settled with loading and posture changes, shockwave therapy is a well-supported next step. The landmark trial using radial shockwave showed better results over the medium and long term than a corticosteroid injection, which tends to help only in the short term and does not address the tendon itself. Shockwave works by stimulating a stalled healing response, and it works best as an adjunct to the loading programme, not as a replacement for it. You can read more about how shockwave therapy works and the conditions it suits.
Warning signs to watch for
- Marked weakness in the hip, a noticeable limp, or a sense that the hip gives way, which can indicate a significant tendon tear that should be assessed
- Deep groin or hip pain that worsens steadily with every step, especially in a runner or someone with thinning bones, which raises the possibility of a hip or femoral neck stress fracture and should be checked before loading it further
- Pain that travels down the leg with pins and needles, numbness or weakness, which suggests the back or a nerve is involved rather than the tendon alone
- Hip pain with fever, feeling unwell, or a hot swollen joint, which needs urgent attention to exclude infection
- Pain that is constant, present at rest and through the night regardless of position, or accompanied by unexplained weight loss, which should always prompt a review
What to expect from treatment
The outlook is good. Most people improve with a structured strengthening and load-management plan, though recovery is often measured in months, and the condition can be stubborn where the compressive postures continue or where there is a significant tendon tear. Addressing hip strength and daily positioning is what reduces the chance of it coming back, which is why the plan focuses on both, not just on settling the pain.
Common questions
Is it really bursitis?
Usually not. Although it was long called trochanteric bursitis, scans and tissue studies show the tendon is the primary problem and the bursa is usually only secondary. That is why treatment aimed at the tendon, rather than just the bursa, works better.
Why is it worse at night?
Lying on the affected side compresses the tendons against the bone, and sleeping with the top leg falling across the body adds to it. A pillow between the knees and, where possible, sleeping off the painful side often helps.
Should I stretch it?
Aggressive stretching that pulls the hip across the body can increase the compression that drives the problem, so it often makes things worse. Strengthening the hip muscles, while keeping out of those compressive positions, is the more reliable path.
Is shockwave therapy worth it for hip pain?
For lateral hip pain that has not settled with loading and posture changes, shockwave is well supported, and the key trial showed it outperforming a cortisone injection over the medium and long term. It works best combined with a strengthening programme rather than on its own.
If lateral hip pain is disturbing your sleep or getting in the way of daily life, or it is not settling the way you would expect, it is worth having it properly assessed so the right plan can be put in place. Book a visit and we will work out what is driving it and how to settle it.
