Pain on the outside of your hip, worse lying on that side, is usually what doctors used to call hip bursitis. Today it’s more often called greater trochanteric pain syndrome, named after the bony point on the side of your hip (the greater trochanter).
The name changed because scans showed the problem is mostly in the GLUTEAL TENDONS, the tendons of the buttock muscles that attach to that bony point. The fluid sac (bursa) is often a bystander.
The treatment with the best evidence is learning which positions squash the tendons, plus exercise that gets gradually harder. In a large trial, this beat a cortisone shot at one year. Most people improve, but it often takes a few MONTHS, not a few weeks.
Symptoms
- Pain on the side of the hip: right over the bony point, sometimes spreading down the outside of the thigh toward the knee
- Pain lying on that side: often waking you at night. Lying on the other side can hurt too, as the top leg drops across
- Pain crossing your legs or sitting in a low chair
- Pain climbing stairs or hills, or standing on one leg to put on pants
- Tender to touch over the bony point
- Stiff and sore getting up after sitting, easing once you get going
It’s most common in women over 40, and often starts after a jump in walking, a new exercise class, weight gain or a period of standing with your weight on one hip.
Is it bursitis or something else?
- Pain in the groin rather than the side, and stiffness putting on socks, points more to the hip joint itself. See hip arthritis
- Pain that starts in the back or buttock and travels below the knee, with tingling or numbness, may be coming from your back. See sciatica
- Your scan saying “bursitis” doesn’t settle it either way. Tendon changes are common on scans, including on the side that doesn’t hurt
What helps
A large trial compared three approaches for people with side-of-hip pain lasting at least three months: education plus exercise, a single cortisone shot, and wait-and-see.
- Education plus exercise: about 8 in 10 people felt better at two months, and still about 8 in 10 at one year
- A cortisone shot: about 6 in 10 felt better at two months, and about 6 in 10 at one year. It eased pain early, but it didn’t match exercise over time
- Wait-and-see: about 3 in 10 felt better at two months, rising to about 5 in 10 at one year. So time helps some people, just more slowly
A cortisone shot can still be useful if pain is stopping you sleeping or exercising. Treat it as a way to get started, not the whole plan. See how long a cortisone shot lasts.
The tendon doesn’t need rest. It needs to stop being squashed and start being loaded.
The education part: stop squashing the tendon
- Don’t cross your legs when sitting or lying
- Don’t hang on one hip when standing. Stand with weight even on both feet
- Avoid low, soft chairs and car seats where your knees end up higher than your hips. A cushion helps
- Skip side-lying stretches that pull the leg across your body. They press the tendon against the bone
- Break up long walks and stairs for a while, then build back gradually
The exercise part
- Start gentle: squeezing your buttock muscles and holding, bridges, and sit-to-stands from a chair
- Build up: standing on one leg with the pelvis level, step-ups, and side steps
- Be patient: tendons respond over weeks to months. Expect to keep going for about three months
- Use the pain rule: mild discomfort during exercise is fine if it settles by the next morning
Sleeping with outer hip pain
- Sleep on your back if you can, with a pillow under your knees
- On the good side: put one or two pillows between your knees so the top leg doesn’t drop across
- On the sore side: try a soft foam topper or an egg-crate mattress layer to take pressure off the bony point
- Don’t curl up tightly. Keep the top hip only slightly bent
What about surgery?
Surgery is rarely needed. It’s usually only considered for a large tear of the gluteal tendon that hasn’t improved after months of proper exercise, often with a limp or weakness that won’t go away.
Get seen today if
- The hip is hot, red and swollen, or you have a fever or feel unwell. It could be infected
- You fell and can’t put weight on the leg, or the leg looks shorter or turned out. It could be a fracture
- You have new numbness around your groin or bottom, or trouble controlling your bladder or bowels. Go to the emergency department
Get it checked if
- Pain hasn’t improved after three months of exercise
- You have a new limp or the hip feels weak, not just sore
- Pain at night doesn’t change with position, or you have a history of cancer, weight loss or night sweats
- Pain is moving into the groin, or down the leg with tingling
Stop squashing the tendon, start strengthening it, and give it three months.