Lateral Hip Pain or Hip Bursitis
Understanding causes, diagnosis, symptoms and treatments
What is Lateral Hip Pain?
- Lateral hip pain is a broad term to describe pain that originates from soft tissues on the outer side of the hip.
- Other common names for this type of pain are ‘gluteal tendinopathy’ or ‘greater trochanteric pain syndrome’ or ‘trochanteric bursitis’.
- Pain usually relates to changes in the tendons of the gluteal (buttock) muscles attaching to the hip bone. Less commonly, pain could be due to the bursa – a fluid filled pocket sitting between or over the tendons.
What is a tendon and a bursa?
A tendon connects muscle to bone.
A bursa is a small, fluid-filled sac that acts like a cushion. It helps reduce friction between bones and soft tissues.
- In some people, this condition can be disabling and have a major impact on everyday activities such as walking, sleeping and rising from a chair.
What are the common symptoms associated with lateral hip pain?
It’s typical to have pain or deep ache over the outside of your hip. Pain can be triggered by activities that load or compress the soft tissues on the side of the hip.
For Example:
- Walking uphill or upstairs.
- Rising from a chair and on the first few steps after rest.
- Sitting in a low seat or sitting with legs crossed.
- Standing on one leg.
- Lying on the painful side. Lying on the opposite hip can also cause discomfort by stretching and compressing the tendon.
What does lateral hip pain feel like?
Often describes as a deep ache or burning sensation on the outside of the hip (see image).
Pain can travel down the side of the thigh or into the buttock.
How is lateral hip pain diagnosed?
- Usually, a diagnosis can be made based on the activities that aggravate your symptoms, in combination with a physical exam by a doctor or physiotherapist.
- If the diagnosis is unclear, an x-ray can help rule out hip osteoarthritis. An ultrasound can sometimes help to aid the diagnosis. Usually, an MRI scan does not add any extra information.
Do I need an MRI scan?
No. MRI scans give us a very detailed look at the hip, but this level of detail is usually unnecessary.
Unless you’ve experienced a specific injury (e.g. a fall), an MRI report can be confusing, as it’s hard to tell if the changes reported are causing your pain or simply the normal aging process.
Lateral hip pain is best diagnosed with a clinical examination.
Why have I developed this type of hip pain?
There is often not a single cause or event. It can be a combination of small changes over time that affects the health of the hip tendons.
- With age or a more inactive lifestyle, hip muscles can become weaker. This can result in changes in how we walk and move, ultimately changing the load through our hip tendons.
- Gradual weight gain around the waist is common in middle-age and can contribute
- A new exercise regime can involve an increase in hip tendon load (for example an increase in walking/running uphill)
- People who already have lower back pain or hip osteoarthritis are more likely to develop this condition.
What is the link between oestrogen and lateral hip pain?
Oestrogen is an important hormone for maintaining tendon health in women.
The drop in oestrogen levels with menopause has been linked with:
- Lower tendon strength
- Reduced ability of the tendon to repair and regenerate
This increases the risk of developing lateral hip pain.
What to expect with lateral hip pain? Will it get better?
2
3
- The good news is the outlook is positive, and this condition generally improves gradually over time for most people, especially if you follow the treatment advice below.
- If your symptoms are mild, then your recovery may only take a few weeks.
- Sometimes it takes longer for symptoms to settle. A gradual improvement typically occurs over about a 6-month period.
- Not everyone recovers completely in this time. One reason for a delayed recovery can be the presence of a tear to the gluteal muscles.
Treatments for Lateral Hip Pain
You should see your GP or a physiotherapist to help explain your treatment options and create a treatment plan.
Learning more about how to manage the load on your hip tendons (load management), combined with an exercise programme to strengthen the muscles on the outside of the hip (gluteal muscles) is the most effective treatment approach.
Exercises are best prescribed by a physiotherapist, because technique is important.
Understanding why certain positions and postures can aggravate your hip symptoms and what you can do will put you more in control of your symptoms.
Load
Management
Exercise Programme
Other
treatments
Load Management for Lateral Hip Pain
What is it?
- Tendons adapt to the load they bear on a regular basis. Too little load can cause the tendon to weaken, and too much load can also be a problem.
- Load management is about understanding the amount of activity and load your hip tendons will tolerate. It involves making gradual changes to improve tendon health and strength.
Tips on Load Management for Lateral Hip Pain
Stay active - activities like a stationary bike or swimming may be better tolerated
Learn more about what positions and postures tend to aggravate the tendon ( table below)
Learn how to monitor your response to exercise and activity (see the diagram below)
An exercise programme will increase the ability of the hip tendons to tolerate load
Rest tends to weaken tendons and decreases their ability to take load
It’s important to cut back temporarily on activities that aggravate your pain
Pushing into moderate to severe pain that continues for extended times and disturbs sleep is not helpful
Avoid sudden changes in tendon load. Take a gradual approach to any new exercise or activity
What are the Do’s and Don’ts for body positioning?
Certain day-to-day positions we adopt can stretch and compress the lateral hip tendons and aggravate pain. Reducing or avoidance of these postures will provide pain relief and reduce the load on your tendon.
Postures and Positions to Relieve Lateral Hip Pain
Sitting
Sleeping
- Sleep on your back
- If side-lying, lie with affected hip uppermost. Use a pillow to separate knees and ankles and reduce stress on the gluteal tendon (Image A)
- If sleeping on the affected hip, roll well forwards to position yourself half-way between your tummy and your side. Tuck a pillow underneath to distribute your weight (Image B)
- Use an eggshell mattress topper to help distribute load and relieve pressure
- Avoid lying on your side (lying on either side can be painful)
- Don’t let the upper knee drop below your painful hip
Standing
In standing, do distribute your weight over both feet
Avoid standing with legs crossed or ‘hanging on one hip’, with weight mainly on one side
Stairs
- On stairs, do place your foot directly under your hip as you step up
- A small forward lean may help
- Use the banister for support
- On stairs, don’t let your knees fall inwards if possible
- Avoid swinging your hips side to side as you transfer weight
Postures and Positions to Relieve Lateral Hip Pain
Sitting
Sleeping
- Sleep on your back
- If side-lying, lie with affected hip uppermost. Use a pillow to separate knees and ankles and reduce stress on the gluteal tendon (Image A)
- If sleeping on the affected hip, roll well forwards to position yourself half-way between your tummy and your side. Tuck a pillow underneath to distribute your weight (Image B)
- Use an eggshell mattress topper to help distribute load and relieve pressure
- Avoid lying on your side (lying on either side can be painful)
- Don’t let the upper knee drop below your painful hip
Standing
In standing, do distribute your weight over both feet
Avoid standing with legs crossed or ‘hanging on one hip’, with weight mainly on one side
Stairs
- On stairs, do place your foot directly under your hip as you step up
- A small forward lean may help
- Use the banister for support
- On stairs, don’t let your knees fall inwards if possible
- Avoid swinging your hips side to side as you transfer weight
How should I monitor my hip pain during activity?
What else can I do to help?
2
3
- Lifestyle changes that improve your overall health will also improve tendon health.
- Aiming for a healthier body weight will have a positive impact on how this condition fares overtime. Weight loss is a challenge, particularly when hip pain is present. Talk to your GP about getting help and support. To read more about how our understanding of obesity and weight loss has advanced, click here.
- Smoking has been shown to affect tendon health, so stopping smoking will help.
- Changes to the tendon are only part of the story. Pain is complex and is influenced by our both our body and mind. Having a more positive and optimistic outlook and addressing negative thoughts and emotions about your hip also reduces pain.
- Our mood, stress, and sleep quality, through their impact on our immune and pain systems, play a role in hip tendon pain onset and recovery. Remember pain is designed to protect us and is part of the body’s alarm system. By looking after all aspects of our health, that ‘pain’ alarm system is less likely to trigger.
Exercise for Lateral Hip Pain
Tips for exercising with lateral hip pain
- Exercise helps most people in the short and long term.
- Start with a small amount of exercise (10 minutes of walking) and gradually increase as your pain improves.
- When walking for exercise, avoid hills and keep steps/inclines to a minimum.
- Try using walking poles.
- When walking for exercise, take shorter steps and land with a ‘soft’ heel.
- Try cycling or exercising in the pool as an alternative to walking.
- Stretching the gluteal muscles or tendons is generally not recommended. It tends to aggravate symptoms.
The simple exercises below are designed to help settle your pain and make a start on building the capacity of your hip tendons to tolerate load and activity. For more advanced exercises or to progress beyond these it is recommended you are guided by a physiotherapist.
What if I experience a setback?
2
3
Experiencing a setback or ‘flare up’ of pain after starting a new exercise programme or activity can be normal and does not mean you have caused harm or damage. Stay calm, temporarily cut-back on exercise and use ice or pain medication until symptoms improve.
How many exercises?
2
3
The number of suggested exercise repetitions below is something to aim for. Everyone will have a different starting point. Starting with just a few exercise repetitions is fine. You could repeat these more than once a day. When you’ve increased the repetitions, perform the exercises once a day or every other day.
Monitoring your pain
2
3
Some discomfort or minor pain during exercise is okay, once the symptoms are acceptable to you. Any pain should settle quickly after you cease the activity. You should wake up the next day with your hip feeling no worse. We’ve provided some tips for monitoring hip pain during activity and exercise in the graphic in the Load Management section.
Preparing to exercise
2
3
Warm up if you can by walking or ‘marching on the spot’ for 3 to 4 minutes before you start your exercises. This will help your muscles prepare for the activity by increasing your circulation.
Level 1 Lateral Hip Pain Exercise Programme
Level 2 Lateral Hip Pain Exercise Programme
Level 1
Exercise Video
Gluteal Contractions with BeltLying with belt/strap above your knees. Tighten belt so your feet are about hip distance apart. Press your legs apart into the belt’s resistance. Hold this tension in the buttock muscles for 10 secs and relax. Press about 50% of your full effort. Repeat 10 times (x 2 sets).
BridgingLying with knees bent and feet apart. Slowly lift your buttocks off the floor. Hold the position for 5 secs. Keep your shoulder blades on the floor. Slowly lower your hips back to the floor “Slowly up, hold, 2, 3, 4, 5, slowly down” Build up to 15 times x 2 sets (total 30).
Sideways Leg Press Against WallLying with knees bent and feet apart. Slowly lift your buttocks off the floor. Hold the position for 5 secs. Keep your shoulder blades on the floor. Slowly lower your hips back to the floor “Slowly up, hold, 2, 3, 4, 5, slowly down.” Build up to 15 times x 2 sets (total 30).
Level 2
Exercise Video
Side SteppingStand up tall, feet wider than hip distance apart. Push from the unaffected leg on to the affected side. With weight on the affected leg, toe touch the opposite foot for support. Push back onto the unaffected leg. Some pressure or discomfort at the affected hip is normal. Continue until you've completed 10 repetitions to each side.
Chair StandStand with arms outstretched, feet parallel and hip distance apart. Sit down with a slow and very controlled movement and return to standing “Down, 2, 3, 4, up, 2, 3, 4”. Keep knees in line with your toes. Repeat 15 times. Build up 3 sets (total of 45 reps). Tip: As you get stronger, during each repetition try to barely touch the seat with your bum, before you stand back up.
Sliding Backward LungeRest hands lightly on a chair for support. Put your weight on the affected leg. Place your other foot lightly on a sliding surface (a cloth or duster) and slide foot backwards. Bend the knee of the front leg until thigh nearly parallel to the floor. Return to the starting position by sliding foot forwards. Keep your torso upright throughout. Repeat 10 times with each leg. Build up to 3 sets of 10 reps.
other treatments
Shockwave Therapy
- Extra Corporeal Shockwave Therapy (ECST) is a procedure where shockwaves are passed through the skin to the painful tendon. Mechanical shockwaves are audible, low-energy sound waves. In theory, this energy works by increasing blood flow to the injured area, influencing inflammation and nerve fibres involved in pain.
- A course of 3 treatments is usually required with each session 1 week apart.
- ECST is offered to patients who have chronic and severe symptoms and have not responded to exercise.
- This procedure has been deemed safe, although it does not always work for everyone.
Injections and Surgery
- Corticosteroid injections can offer short-term relief. They are recommended only in severe cases or after other options have been tried.
- Repeated use of injections can cause further weakening of the tendon and are not advised.
- There is no proof from research studies to support the use of platelet rich plasma injections for this condition.
- Surgery is rarely indicated in people with this condition.
Now you have an understanding of all treatment options for lateral hip pain, check out some of the other resources:
- Go to the Irish Resources section for more help on your journey,
- Learn about another joint condition.
The information in this website page was informed by the following sources/references:
Scientific Publications
- Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med. 2012;46(3):163-168.
- Mellor R, Bennell K, Grimaldi A, et al. Eduation plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;360:K1662.
- Grimaldi A, Mellor R, Nicolson P, Hodges P, Bennell K, Vicenzino B. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. British Journal of Sports Medicine 2017;51(6):519-524.
- Ganderton, C., Semciw, A., Cook, J. and Pizzari, T., 2017. Demystifying the Clinical Diagnosis of Greater Trochanteric Pain Syndrome in Women. Journal of Women’s Health, 26(6), pp.633-643.
- Fearon AM, Scarvell JM, Neeman T, Cook JL, Cormick W, Smith PN. Greater trochanteric pain syndrome: defining the clinical syndrome. British Journal of Sports Medicine 2013;47:649-653.
- Stephens, Gareth, O’Neill, Seth, Mottershead, Claire, Hawthorn, Catrin, Yeowell, Gillian and Littlewood, Chris (2020) “It’s just like a needle going into my hip, basically all of the time”. The experiences and perceptions of patients with Greater Trochanteric Pain syndrome in the UK National Health Service. Musculoskeletal Science and Practice, 47. ISSN 2468-7812.
- Fearon, A. et al. (2017) ‘Pain, not structural impairments may explain activity limitations in people with gluteal tendinopathy or hip osteoarthritis: A cross sectional study’, Gait and Posture. doi: 10.1016/j.gaitpost.2016.12.005.
- Rhim, HC et al. (2024). Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials. JBJS Reviews 12(8):e24.00091. | DOI: 10.2106/JBJS.RVW.24.00091.
Patient Websites/Resources
- Hip Pain Help Website. Hip Pain Professionals (Dr Alison Grimaldi) https://hippainhelp.com.