Lateral Hip Pain & Gluteal Tendinopathy

Understanding the Problem

Why does the outside of my hip hurt?

This is a very common question in my office. Many patients come in worried that pain around the hip automatically means they have hip arthritis or need a hip replacement. Fortunately, that is often not the case.

One of the most common sources of pain on the outside of the hip is the group of tendons that attach the gluteal muscles to the upper part of the femur.

The two we talk about most are the gluteus medius and gluteus minimus. These muscles help keep your pelvis level when you walk and help move and stabilize your hip.

Their tendons attach near the greater trochanter, which is the bony prominence you can feel on the outside of your hip. When those tendons become irritated, worn, or torn, that area can become painful.

The good news is that most of these problems do not require surgery. The first step is figuring out what is actually hurting.

Location Matters

Is the pain coming from arthritis or from the outside of the hip?

This is one of the first things I try to sort out when I see someone with hip pain.

Hip arthritis usually causes pain in the groin or toward the front of the hip. It can make it difficult to put on shoes and socks, get in and out of a car, or rotate the hip. Sometimes that pain travels down the thigh toward the knee.

Gluteal tendon pain is usually different. Patients often point directly to the bony area on the outside of the hip. It may hurt to sleep on that side, climb stairs, walk for a long time, or stand on one leg.

If you are having more groin pain and stiffness, our Understanding Hip Arthritis guide explains that problem in more detail.

The Terminology

Bursitis, tendinitis, tendinosis, tendinopathy — what does all of this mean?

The terminology can get confusing, and you may hear several different names for what sounds like the same problem.

A bursa is a small fluid-filled sac that helps tissues glide over one another. There are bursae around the greater trochanter, and they can become irritated.

For years, almost any pain over the outside of the hip was commonly called trochanteric bursitis. We now understand that the nearby gluteal tendons are often an important part of the problem.

Tendinitis generally refers to an irritated or inflamed tendon. Tendinosis describes more chronic degenerative changes within the tendon. Tendinopathy is a broader term that includes painful tendon problems across this spectrum.

You may also hear the term greater trochanteric pain syndrome, or GTPS. That is an umbrella term for pain in this area that may involve the gluteal tendons, bursa, and surrounding tissues.

The exact label matters less than understanding which tissues are actually causing your symptoms and how severe the problem is.

Symptoms & Diagnosis

What does gluteal tendinopathy usually feel like?

Everyone describes pain a little differently, but there are some patterns I hear over and over again.

• Pain directly over the outside of the hip
• Tenderness when you press over that area
• Pain when lying on the affected side
• Pain with longer walks or prolonged standing
• Pain going up or down stairs
• Pain when standing on one leg
• Pain when getting up from a chair
• Pain that can travel down the outside of the thigh

Some patients are mostly bothered at night. Others feel fine sitting but develop pain after walking a certain distance. More advanced tendon problems may cause weakness or a limp.

Why It Happens

Why do the gluteal tendons become painful?

Tendons are living tissue. They adapt to the amount of work we ask them to do.

Sometimes pain begins after a sudden increase in activity: more walking, a new exercise program, hills, stairs, travel, or another change in routine. In other people, the tendon changes gradually over time and there is no single injury they can remember.

Compression can also aggravate the tendon. Sleeping directly on the painful side, repeatedly standing with your weight shifted onto one hip, or sitting with the legs crossed may bother some patients.

This does not mean you have damaged your hip every time it hurts. It usually means we need to temporarily change how much stress the tendon is seeing and then gradually build its capacity back up.

Stretching is not always the answer either. Some stretches that pull the leg far across the body can actually increase compression of the irritated tendons against the outside of the hip. If a particular stretch consistently makes the lateral hip pain worse, I generally do not want you forcing through it.

Evaluation

How do I figure out what is actually causing the pain?

I start with the story. Where exactly does it hurt? What activities bring it on? Does it hurt in the groin or directly over the side of the hip? Can you sleep on that side? Have you noticed weakness or a limp?

The examination is just as important. I look at how you walk, your hip motion, strength, tenderness, and whether certain movements reproduce the pain.

What do X-rays show?

X-rays are useful because they show the hip joint itself. They help us look for arthritis, changes in the shape of the hip, prior injuries, and other bone problems.

The gluteal tendons themselves usually cannot be evaluated well on a routine X-ray. A normal X-ray therefore does not mean there is nothing wrong.

Do I need an MRI?

Usually not at the beginning.

If the history and examination fit a typical case of gluteal tendinopathy and your strength is good, we can often begin treatment without advanced imaging.

MRI or ultrasound becomes more helpful when the diagnosis is unclear, there is significant weakness, I am concerned about a larger tendon tear, or you have completed an appropriate treatment program without improving the way we expected.

Even when we obtain an MRI, I still interpret it in the context of the patient in front of me. I do not treat an MRI report in isolation.

Treatment

So how do we treat it?

For most people, we do not start with surgery — and we do not necessarily start by telling you to stop everything you enjoy doing either.

Tendons respond to load. Too much load can keep an irritated tendon painful, but avoiding activity completely does not make the tendon stronger.

The goal is to find the middle ground: calm things down enough to make you more comfortable, then gradually build the strength and capacity of the tendon back up.

Modify what is irritating it

If a particular activity is repeatedly causing a significant flare, we may temporarily reduce the amount or intensity rather than eliminating activity altogether.

If sleeping on that hip is painful, try sleeping on the other side with a pillow between your knees or sleeping on your back. It may also help to avoid prolonged positions where the painful hip is pushed outward and the tendon is compressed.

Physical therapy and strengthening

For most patients, this is the foundation of treatment.

A good therapy program combines education about how you are loading the tendon with gradually progressive strengthening. We usually work on the hip abductors along with the other muscles that control your pelvis and leg when you walk, climb stairs, and stand on one leg.

The key word is gradually. The goal is not to completely rest the tendon, but it is also not to push through significant pain every day. We want to give the tendon enough load to become stronger without repeatedly causing a major flare.

This takes some patience. Tendons generally respond to consistent, progressive loading over time rather than a quick fix.

Medication

Anti-inflammatory medication, acetaminophen, or other pain medication may be reasonable for some patients depending on their health and other medications.

Medication can make the symptoms easier to manage, but it does not replace the strengthening portion of treatment.

Other Treatments

What about injections, shockwave therapy, or PRP?

These treatments come up frequently, especially when symptoms have been present for a while.

Corticosteroid injections

Corticosteroid injections

A cortisone injection around the greater trochanter can provide useful short-term pain relief for some patients. That can be especially helpful when pain is interfering with sleep, normal walking, or the ability to participate in therapy.

The important thing to understand is that an injection does not rebuild or strengthen a degenerative tendon. Studies also suggest that the early benefit of a steroid injection does not necessarily translate into better long-term results than a good education and exercise program.

I therefore think of an injection as one tool that may help us control symptoms while we address the underlying problem rather than as the entire treatment plan.

Shockwave therapy

Shockwave therapy uses externally applied acoustic energy over the painful tendon. It is a nonsurgical option that may be considered for persistent gluteal tendinopathy when a good rehabilitation program has not been enough.

Some studies have shown improvement in pain and function, but the evidence is still developing. It is not something every patient needs.

Platelet-rich plasma (PRP)

PRP uses a concentrated portion of your own blood that is injected around the abnormal tendon.

There is interest in PRP for chronic tendon problems, including gluteal tendinopathy. Some studies are encouraging, but results are not consistent enough for me to tell every patient that PRP is necessary or guaranteed to work.

Both shockwave therapy and PRP have been studied for persistent gluteal tendinopathy, and there are encouraging results for selected patients. The evidence is still evolving, however, and neither is a treatment that every patient with lateral hip pain needs.

If symptoms continue despite an appropriate education and strengthening program, we can discuss whether one of these options makes sense for your particular situation.

Gluteal Tendon Tears

Can the gluteal tendon actually tear?

Yes, but seeing the word tear on an MRI does not automatically mean you need surgery.

I think of these problems as a spectrum. On one end, the tendon may simply be irritated or worn. As the problem becomes more advanced, small partial tears can develop. Some patients eventually develop a larger partial or full-thickness tear of the gluteus medius or minimus.

What matters is how the imaging fits with everything else.

Are you weak? Are you limping? Can you stand on that leg? How much is the pain affecting your life? Have you already given a good nonsurgical treatment program a fair chance?

Those answers are often more important than one sentence in an MRI report.

Surgery

When do we start talking about surgery?

Most patients with lateral hip pain will never need an operation.

Surgery becomes a more serious conversation when we have a meaningful gluteus medius or minimus tear that matches what you are experiencing — particularly if you are weak, walking with a persistent limp, struggling with normal activities, and have not improved despite a good nonsurgical treatment program.

Even then, I do not operate on an MRI. We put the whole picture together.

Weakness matters here. Someone whose main problem is tenderness over the side of the hip but who still has good abductor strength is different from someone who has developed substantial weakness and a persistent limp because the tendon is no longer functioning normally.

A small partial tear in someone with good strength and manageable symptoms is very different from a retracted tear in someone who has substantial weakness and difficulty keeping the pelvis level when standing or walking.

Repair & Reconstruction

What does gluteal tendon repair involve?

When a symptomatic tendon tear is repairable, the goal is to bring the damaged gluteus medius or minimus tendon back to its attachment on the greater trochanter and secure it back to the bone.

This is commonly done with strong sutures and anchors placed into the bone. Depending on the tear, the procedure may be performed through an open incision or with an endoscopic technique.

The exact operation depends on the size and pattern of the tear, how far the tendon has pulled away, the quality of the remaining tissue, and the condition of the muscle.

What if the tear has been there for a long time?

This is where things can become more complicated.

With a chronic tear, the tendon may retract away from the bone. Over time, the muscle can also become smaller and develop fatty changes. That can make a straightforward repair more difficult and sometimes less predictable.

Some tendons can still be mobilized and repaired. Some repairs may need additional support or augmentation.

What if the tendon cannot be repaired?

Fortunately, this is much less common.

In a severe chronic tear, the original tendon may no longer be able to reach its attachment or the muscle may be too damaged for a reliable direct repair. In selected patients, a reconstruction or tendon transfer may then be considered to improve hip abductor function.

These are very different situations from routine gluteal tendinopathy, which is why it is important not to treat every case of lateral hip pain as though it is the same problem.

Recovery After Surgery

What is recovery like after a gluteal tendon repair?

This is an important point: recovery after a gluteal tendon repair is not the same as recovery after a routine hip replacement.

The tendon needs time to heal back to the bone. Because of that, there are usually restrictions during the early part of recovery.

Depending on the tear and repair, patients may have temporary limits on how much weight they put on the leg and restrictions on actively using the hip abductor muscles. A brace may be used in some situations.

Physical therapy is then advanced gradually as healing progresses. The exact protocol depends on the size of the tear, quality of the tissue, and type of repair.

This is a recovery measured in months rather than days. Regaining strength and correcting a longstanding limp can take time even after the tendon has healed.

For that reason, patients who undergo repair receive a specific postoperative plan based on their operation rather than a one-size-fits-all timeline.

How Long Does It Take?

What if I do not need surgery?

Tendons tend to improve more slowly than most of us would like. If the problem has been present for months, it is usually not realistic to expect it to disappear after a week of exercises or a single treatment.

Improvement is often gradual. You may first notice that you can sleep more comfortably, walk farther, or use stairs with less pain before the symptoms disappear completely.

The goal is steady progress: gradually increasing strength and activity while keeping symptoms manageable.

When to Come In

When should lateral hip pain be evaluated?

If the pain is mild and recently started, simple activity changes and strengthening may be reasonable.

I would consider an evaluation when the pain is persistent, interfering with sleep, limiting normal activity, causing a limp, or not improving despite reasonable treatment.

I also want to know about substantial weakness or a sudden change after an injury.

If you have severe pain after a fall or injury and cannot bear weight, that deserves more urgent evaluation because we also need to consider fractures and other causes of acute hip pain.

Common Questions

Frequently asked questions