Lateral Hip Pain Assessment: What to Expect Before Rehab Starts

By Emma Glynn - The Hip & Knee Physio

If you are booking a lateral hip pain assessment, there is a good chance you already know the pain pattern well. It may hurt to lie on your side, walk up hills, climb stairs, stand on one leg, sit for too long, or get moving after rest. You may have been told it is hip bursitis, gluteal tendinopathy, greater trochanteric pain syndrome, or simply “tight glutes”.

The problem is that those labels are not always used consistently. Lateral hip pain can involve the gluteal tendons, the bursa, the hip joint, the lower back, or a mix of factors.

That is why I do not like starting with a generic exercise sheet and hoping for the best.

A good lateral hip pain assessment should clarify what is most likely driving your symptoms before deciding which exercises, load changes, or treatment options make sense.

I am Emma Glynn, an APA Titled Musculoskeletal Physiotherapist. I work with hip and knee conditions, and I regularly assess active adults over 40 with persistent pain on the side of the hip. If you want more background on this condition before booking, I have also written a detailed guide to lateral hip pain and gluteal tendinopathy.

A lateral hip pain assessment starts with your symptom pattern

Before I test anything, I want to understand how your hip behaves in real life. This tells me more than a single strength test or scan report ever could.

The story of your symptoms helps separate gluteal tendon pain from other possible causes of lateral hip pain.

In the first part of the appointment, I usually ask about:

• Where the pain sits and whether it travels down the thigh

• Whether it hurts to lie on the painful side

• Whether stairs, hills, walking, running, gym, or Pilates aggravate it

• Whether standing on one leg makes symptoms worse

• Whether sitting, crossing your legs, or getting out of a car changes the pain

• What happens later that day or the next morning after activity

• What treatments you have already tried

• Whether injections, imaging, rest, massage, or previous exercises changed anything

This matters because lateral hip pain is not one single diagnosis. Greater trochanteric pain syndrome is an umbrella term that can include gluteal tendinopathy, trochanteric bursitis, and other causes around the outside of the hip (Pianka et al., 2021).

If your main question is whether this is “bursitis” or tendon-related pain, I explain that distinction more clearly in this article on bursitis versus gluteal tendinopathy

I check whether it behaves like gluteal tendinopathy

Many people still use the term “hip bursitis”, but persistent lateral hip pain in adults is often linked with gluteal tendon pathology rather than an isolated bursa problem. The bursa may still be involved, but it is not always the main driver.

The aim is not just to name the sore structure, but to understand why that structure is irritated and what it can currently tolerate.

During the physical assessment, I may look at:

• Hip range of motion

• Pain with single-leg standing

• Pain with resisted hip abduction

• Hip abductor strength in different positions

• Tenderness around the greater trochanter

• Functional tasks such as step-ups, squats, stairs, or walking patterns

• Whether symptoms are reproduced by positions that increase compression around the lateral hip

Gluteal tendinopathy is often sensitive to a combination of load and compression. This is one reason some people flare with positions such as side-lying, standing with the hip dropped to one side, or stretching the painful leg across the body (Cook & Purdam, 2012).

For a broader explanation of why the tendon can become sensitive, what commonly aggravates it, and what usually helps, you can read my guide to gluteal tendinopathy and lateral hip pain.

A lateral hip pain assessment should also rule out other causes

Not every pain on the outside of the hip is gluteal tendinopathy. This is where a careful assessment matters.

If the diagnosis is wrong, the rehab plan is usually wrong as well.

Depending on your symptoms, I may also consider whether the pain could be influenced by:

• Hip osteoarthritis

• Lumbar spine referral

• Femoroacetabular impingement

• Significant gluteal tendon tear

• Iliotibial band or external snapping hip presentations

• Recent trauma or overload

• Other medical causes that need further review

This does not mean every person needs a scan or a referral. It means the assessment should be specific enough to decide whether the presentation fits a typical lateral hip pain pattern or whether something else needs to be investigated.

If your pain is broader than the side of the hip or you are unsure whether it fits a tendon pattern, the hip physiotherapy page may help you understand the other hip conditions I commonly assess in Camberwell.

Imaging may help, but it does not replace assessment

If you already have an ultrasound or MRI, bring it to the appointment. Imaging can be useful when symptoms are severe, unusual, not improving as expected, or when we need to assess for tendon tearing or other hip pathology.

A scan finding only becomes clinically useful when it matches your symptoms and examination findings.

This is important because imaging changes around the lateral hip can appear in people who do not have the same pain pattern. A report may describe bursitis, tendinopathy, tendon thickening, or tearing, but it still does not tell us how much load your hip can tolerate today.

In practical terms, imaging does not answer:

• Which movements currently provoke your pain

• Whether your hip joint or lower back is contributing

• How reactive your symptoms are

• What exercise level is appropriate to start

• How quickly your walking, running, gym, or Pilates should be progressed

That is why I treat the scan as one piece of information, not the whole decision. If you are already at the point where you want individual assessment rather than more guessing, you can book an in-person hip and knee physiotherapy appointment.

The first plan should reduce repeated irritation

Once I have a clearer working diagnosis, the first step is usually not a massive strengthening program. If the hip is highly reactive, we need to stop repeatedly stirring it up.

Early rehab often starts by changing the positions and loads that keep provoking the lateral hip.

For many people, this includes practical changes to:

• Side-lying position at night

• Sitting posture, especially crossing legs

• Standing posture, especially hanging into one hip

• Walking volume, hills, and stairs

• Exercise selection in Pilates or gym sessions

• How often the tendon is being loaded without recovery

This does not mean avoiding movement completely. Tendons usually need load to adapt, but the dose has to match the current tolerance. Tendinopathy is influenced by load capacity, pain sensitivity, and tendon response over time (Millar et al., 2021).

If walking is one of your main triggers, this article on walking with outer hip pain gives practical changes you can consider while you are waiting for assessment.

Exercise should be matched to your starting point

A common issue I see is that people are given exercises that are not wrong in theory, but are wrong for their current stage. Side-lying leg lifts, band walks, step-downs, lunges, or single-leg loading can all be useful at the right time. They can also flare symptoms if introduced too early or too aggressively.

The right starting exercise is one your hip can tolerate during the session and over the next 24 hours.

Depending on your presentation, early exercise may include controlled hip abductor loading, isometric options, supported standing work, or modified strength exercises. As symptoms become less reactive, the plan usually progresses toward heavier and more functional loading.

Exercise and education have evidence supporting their use in gluteal tendinopathy and greater trochanteric pain syndrome. A randomised trial found education plus exercise had better global improvement than corticosteroid injection at 52 weeks in people with gluteal tendinopathy (Mellor et al., 2018). A 2024 systematic review also supported exercise as a first-line option for greater trochanteric pain syndrome, while noting that certainty varies across outcomes (Kjeldsen et al., 2024).

What you should leave the assessment with

A lateral hip pain assessment should give you more than a diagnosis label. It should give you a clear starting plan.

You should leave knowing what we think is driving the pain, what to change first, and what level of exercise your hip appears ready for.

After the first session, my goal is for you to understand:

• The most likely working diagnosis

• Whether gluteal tendinopathy, GTPS, bursitis, hip joint, or back-related factors seem most relevant

• Which daily positions may be contributing to symptoms

• Which activities may need temporary modification

• Which exercises are appropriate to start with

• What signs suggest the plan is on track or needs adjusting

• Whether imaging, GP review, or further investigation should be considered

The plan is not set in stone. It should change as your symptoms, strength, and activity tolerance change.

If you have been trying to manage this for a while and keep flaring the same pain, it may also be useful to read about the common mistakes people make when rehabbing gluteal tendinopathy

When to book an in-person assessment

If your pain has been present for more than a few weeks, keeps returning, or has not improved with a generic approach, it is worth having it assessed properly.

Persistent pain on the side of the hip deserves a clear explanation, not another random list of glute exercises.

You may benefit from an in-person assessment if:

• You cannot sleep comfortably on either side

• Walking, hills, stairs, or standing keep flaring the pain

• You have been told it is bursitis but the plan has not helped

• You have had an injection and symptoms have returned

• You are unsure whether it is your hip, tendon, bursa, or lower back

• You want to keep exercising but need clearer boundaries around what is appropriate

If you are looking for a lateral hip pain assessment in Camberwell, you can book an in-person assessment with me at The Hip and Knee Physio. I will assess your symptoms, explain what I think is driving the pain, and help you start with a plan that matches your current capacity.

Emma

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References

Cook, J. L., & Purdam, C. (2012). Is compressive load a factor in the development of tendinopathy? British Journal of Sports Medicine, 46(3), 163–168. https://doi.org/10.1136/bjsports-2011-090414

Kjeldsen, T., Hvidt, K. J., Bohn, M. B., Mygind-Klavsen, B., Lind, M., Semciw, A. I., & Mechlenburg, I. (2024). Exercise compared to a control condition or other conservative treatment options in patients with greater trochanteric pain syndrome: A systematic review and meta-analysis of randomized controlled trials. Physiotherapy, 123, 69–80. https://doi.org/10.1016/j.physio.2024.01.001

Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H., & Vicenzino, B. (2018). Education 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, 361, k1662. https://doi.org/10.1136/bmj.k1662

Millar, N. L., Silbernagel, K. G., Thorborg, K., Kirwan, P. D., Galatz, L. M., Abrams, G. D., Murrell, G. A. C., McInnes, I. B., & Rodeo, S. A. (2021). Tendinopathy. Nature Reviews Disease Primers, 7(1), Article 1. https://doi.org/10.1038/s41572-020-00234-1

Pianka, M. A., Serino, J., DeFroda, S. F., & Bodendorfer, B. M. (2021). Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology. SAGE Open Medicine, 9, 20503121211022582. https://doi.org/10.1177/20503121211022582

Medical disclaimer

This blog is general educational information only and is not a substitute for individual medical advice, diagnosis, or treatment. If you have persistent, worsening, traumatic, severe, or unexplained hip pain, or symptoms such as fever, night sweats, unexplained weight loss, significant weakness, numbness, or difficulty weight-bearing, please seek assessment from a qualified health professional.