Gluteal Tendinopathy (Lateral Hip Pain): why it hurts, daily triggers, and what helps

By Emma Glynn - APA Titled MSK Physio

The Hip & Knee Physio

This article provides general information only. It is not personal medical advice

Do you suffer from outer hip pain when walking, climbing stairs, or lying on your side? You're not alone.

This frustrating condition, often mislabelled as "hip bursitis," is actually more likely to be gluteal tendinopathy. It affects active women aged 45+, especially those who love walking, Pilates, or gym but notice their hip flaring up during everyday tasks. The good news? It’s manageable with the right guidance (Grimaldi & Fearon, 2015).

Let’s break it down.

What it feels like (the usual pattern)

• Achy pain on the outer side of the hip (near the bony bump - greater trochanter)

• Worse with single-leg tasks: walking, stairs, getting out of the car

• Pain lying on the affected side (or even the opposite side)

• Sharp tenderness to press over the outer hip

• No pins and needles or true nerve symptoms

Why it happens

The key culprit? Compression + load.

Gluteal tendons, particularly the gluteus medius and minimus, don’t like being compressed repeatedly. That’s what happens when you:

• Walk with long strides or uphill

• Hang on one hip while standing

• Sleep without support between your knees

• Cross your legs

Over time, the tendons get irritated and inflamed. Unlike a tear, this is usually a loading issue, not damage (Grimaldi & Fearon, 2015).

Irritators:

• Lying on painful side

• Standing hip dropped (hanging on one leg)

• Deep stretches/adduction

• Long strides or hills

Supportive choices:

• Side-sleep with pillow between knees

• Stand with weight even

• Controlled stride

• Strength-based rehab

Is it bursitis or gluteal tendinopathy?

Many people are told they have "hip bursitis" but studies show most of these cases are actually tendon-related. There can be some bursa involvement (e.g. if the tendon has been angry long enough), but targeting the tendon (via education and movement changes) is what improves outcomes (Mellor et al., 2018).

Do I need a scan?

Not usually.

If your symptoms match the classic pattern, a scan rarely changes first-line treatment. Scans are useful if:

• You’re not improving after several weeks of good care

• There’s night pain that doesn’t ease with position change

• You’re unsure if it could be referred from your back or hip joint

In most cases, your physiotherapist can make a confident diagnosis without needing imaging (NICE, 2022).

Daily triggers you can change this week

Without needing a rehab program, you can reduce irritation with a few practical shifts:

Sleeping:

• Sleep on your non-painful side with a pillow between your knees (Grimaldi & Fearon, 2015)

• Avoid lying on the painful side until symptoms improve

Standing:

• Avoid "hip hanging" (where one hip drops and the pelvis leans)

• Even weight distribution helps offload the tendon

Walking:

• Temporarily reduce walking distance, camber, or hills

• Try smaller strides

Gym/Pilates:

• Early on, avoid deep adduction or loaded hip stretches (e.g. crossover lunges)

• Ask your physio for modifications if unsure

What usually helps

The three pillars of management:

1. Reduce aggravators

   • This buys time for symptoms to settle

2. Movement cueing

   • Keep hips level on stairs, walking, and single-leg tasks

3. Strength progression

   • Start in side-lying or double-leg strength positions

   • Build toward single-leg glute capacity over time (Grimaldi & Fearon, 2015)

Other tools:

• Taping can reduce compression short-term

• Shockwave therapy: modest effect in some cases

• Injections (e.g. corticosteroid): may help severe pain short-term but don’t replace rehab. Evidence shows education + exercise has better medium-term outcomes (Mellor et al., 2018).

What doesn’t help: Repeated stretching of the outer hip, lying on the sore side, avoiding all activity, or chasing passive treatments alone.

When to get help (or re-checked)

Book a consult if:

• You’re still struggling to sleep on either side

• Pain is interfering with walking or stairs

• You’re not sure if it’s coming from the hip or spine

• You want a tailored plan and support

FAQs

1. What’s the best sleeping position with gluteal tendinopathy?

   Side-sleep on your non-painful side, with a pillow between your knees to reduce tendon compression (Grimaldi & Fearon, 2015).

2. Is walking good or bad for lateral hip pain?

   It depends on the stage. If pain flares during or after walks, reduce stride length, camber, or duration temporarily.

3. How do I tell bursitis vs gluteal tendinopathy?

   The pain pattern is nearly identical, most cases involve the tendon (Mellor et al., 2018). Your physio can differentiate and guide treatment.

4. How long does gluteal tendinopathy take to settle?

   With good care, most improve steadily over 6–12 weeks, though it varies by severity and activity level.

5. Should I stretch the outside of my hip?

   No. Stretching often worsens symptoms. Tendons prefer strength, not stretch (Grimaldi & Fearon, 2015).

If you’re not sure what’s right for your hip, book with a hip physiotherapist in Camberwell for a targeted assessment.

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You Don’t Have to Guess

Lateral hip pain is one of the most common presentations in active adults over 45 and it’s usually very manageable with the right strategy.

Want help figuring out whether it’s gluteal tendinopathy or something else?

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The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan.

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References:

• Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P. Education plus exercise versus corticosteroid injection use versus a wait and see approach on lateral hip pain: a randomised clinical trial. BMJ. 2018;361:k1662.

• Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910–22.

• National Institute for Health and Care Excellence (NICE). Musculoskeletal conditions: principles for imaging. NICE Guidance. 2022.