Outer hip pain

What it is

Greater trochanteric pain syndrome is a compressive tendinopathy of the gluteus medius and minimus tendons where they attach to the bony point of the hip. It was called bursitis for decades; imaging studies showed the tendons are the main problem and the bursa is often normal, which changed the treatment substantially.

The key mechanism is compression. Any position that brings the thigh across the midline - crossing the legs, standing with the weight hung on one hip, sitting with knees together, lying on that side - presses the iliotibial band onto the tendon and squeezes it against the bone. Removing those positions is half the treatment.

What it feels like

• Pain on the bony point of the outer hip, sometimes spreading down the outer thigh
• Worst lying on that side at night, and often the reason for waking
• Painful on stairs, on getting up from sitting, and on standing on that leg
• Tender to press directly on the bone
• Does not usually go below the knee, which distinguishes it from nerve pain

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Compressive tendinopathy at the greater trochanter

The gluteal tendons are compressed against the bone by the overlying iliotibial band whenever the hip adducts. Repeated compression on top of tensile load produces tendon degeneration.

Hip adduction positions

Crossing the legs, standing on one hip, sitting with the knees together and side-lying all bring the thigh across the midline and compress the tendon. These are the aggravating factors and they run all day.

Gluteal tendon weakness

The gluteus medius and minimus are what control the pelvis on a single leg. Weak tendons are less able to tolerate the load, and weak muscles allow the pelvis to drop, which increases the compression further.

A dropping pelvis on walking

When the pelvis drops on the swing side, the stance-side hip adducts and the tendon is compressed on every step. It is one of the most repeated aggravating events available.

Menopause

The condition is far more common in women after fifty, and tendon changes with falling oestrogen are a plausible driver. This is one of the most sex-skewed conditions on the site.

A sudden increase in walking or running

As with any tendinopathy, load exceeding capacity is the precipitant. Long walks, hill work and new running programmes are common triggers.

Side sleeping

Lying on the affected side compresses the tendon under body weight for hours. It is often both the main symptom and a major perpetuating factor.

Wider pelvis geometry

A wider pelvis increases the adduction angle at the hip during single-leg stance, which is part of why this condition is so much more common in women.

Low back or knee problems

Altered gait from pain elsewhere changes hip loading and frequently precipitates it on one side.

Who tends to get it

• Women over fifty, in whom it is much more common
• Anyone who has recently increased walking, hill work or running
• Habitual side sleepers
• People who habitually stand hanging on one hip or sit with legs crossed
• Anyone with weak glutes, a dropping pelvis on walking, or existing back or knee problems

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineHip Relief & Rotation

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Night pain that prevents lying on either side and does not settle needs imaging

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Load management plus progressive gluteal strengthening produces good results over three to six months, and trials show exercise plus education outperforming both corticosteroid injection and waiting at twelve months. Removing the compressive positions often produces noticeable relief within a fortnight, well before the strength work has done anything - which makes it worth doing first. Pain that travels below the knee, or comes with numbness, is more likely nerve-related and needs a different look.

Prevalence basis: Primary-care incidence data

Others the same routine covers

These share the Hip Relief & Rotation routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.