If you have pain on the outside of your hip that flares when you lie on that side at night, climb stairs or stand for a while, you're describing one of the most common hip complaints we see. It used to be labelled simply “bursitis,” but our understanding has moved on — and that shift changes the treatment for the better.
What is it?
Greater trochanteric pain syndrome (GTPS) is pain over the bony point on the outside of the hip — the greater trochanter. For a long time it was assumed to be inflammation of the bursa (a small fluid-filled cushion that reduces friction between tissues) in the area, which is why it was often simply called trochanteric bursitis. We now know it's usually primarily a tendon problem: an overload of the gluteal tendons (gluteus medius and minimus) where they attach to that bony point, sometimes with the bursa involved as a secondary feature rather than the main driver (Grimaldi et al., 2015).
That reframing matters a great deal in practice, because a tendon overload is managed very differently from a simple case of inflammation — with progressive loading rather than rest, and rather than relying on repeated corticosteroid injections, which was the older, now largely outdated approach to this condition.
Why this condition became so misunderstood for so long
It's worth understanding a little of the history here, because it explains why so many people have been told conflicting things about this condition over the years. For decades, any pain over the outside of the hip was routinely labelled as bursitis, and treatment focused heavily on calming the bursa itself — typically with rest, anti-inflammatory medication, and corticosteroid injections directly into the area. Imaging studies over the past fifteen to twenty years, however, have consistently shown that in the majority of people with this pain pattern, the gluteal tendons themselves show clear signs of overload and structural change, while the bursa is often either normal or only mildly involved as a secondary feature.
This matters enormously in practice, because treating a tendon overload with rest and repeated injections — the old bursitis-focused approach — tends to provide only short-term relief at best, and can sometimes make things worse over time by allowing the tendon to become further deconditioned. Understanding that this is primarily a tendon-loading problem, much like the other tendinopathies covered elsewhere in this series, is what unlocks a treatment approach that actually addresses the root cause rather than just dampening the symptoms temporarily.
Why does it happen?
The gluteal tendons don't like being compressed against the bony point they attach to, and certain everyday positions do exactly that — sitting with your legs crossed, standing with your weight slung onto one hip (a position many people fall into without realising), or lying directly on the painful side at night. Add in weakness of the hip's stabilising muscles and a recent change in activity level, and the tendon becomes progressively overloaded and painful. It's considerably more common in women and around midlife, particularly the perimenopausal and postmenopausal years, though it can affect anyone of any age or sex. Hormonal changes around menopause are thought to affect tendon health and resilience more broadly, which may partly explain why this particular age group and sex are so disproportionately affected.
As with the other tendinopathies covered in this series, it's fundamentally a story of load and compression outstripping the tendon's current capacity to cope, rather than a single dramatic injury or event. Many people can't identify one specific moment when it started, because it typically builds gradually from an accumulation of everyday compressive positions and postures. Recognising this pattern in your own history — rather than a single memorable moment of injury — is itself a useful clue that points towards a tendinopathy rather than an acute strain or tear.
What does it feel like?
The hallmark symptom is pain over the outside of the hip that's distinctly worse lying on that side — so it frequently and significantly disturbs sleep, sometimes waking people repeatedly through the night — and with stairs, hills, and prolonged standing or walking. The pain can radiate down the outside of the thigh, sometimes as far as the knee, which occasionally leads people to think the problem is more widespread than it actually is. This wider radiation pattern doesn't usually indicate anything more serious — it's simply how pain from this area can sometimes be perceived along the outer thigh. Pressing directly on the bony point on the outside of the hip usually reproduces the familiar tenderness clearly.
Conditions that can look similar
A few other conditions can present with similar lateral hip pain. Hip osteoarthritis causes pain that's more commonly felt in the groin, with stiffness and reduced range of movement in the joint itself, though it can occasionally cause some lateral discomfort too. Referred pain from the lower back, particularly from the lumbar spine, can present as lateral hip pain without a clear tender spot directly over the greater trochanter. Snapping hip syndrome, discussed elsewhere in this series, causes a distinct snapping or clicking sensation that GTPS typically doesn't. And a lumbar nerve root problem can occasionally refer pain to this area, usually alongside other back or leg symptoms. Because the treatment for GTPS centres so specifically on gluteal tendon loading and avoiding compression, confirming the diagnosis accurately makes a real difference to how quickly things improve. Working out which of these it genuinely is early on saves a great deal of frustration and wasted treatment aimed at the wrong target.
How we assess it
We'll press over the greater trochanter to find the tender spot precisely, and use specific tests that load the gluteal tendons — such as standing on one leg for around 30 seconds, or resisting particular hip movements against manual resistance — to reproduce your pain in a controlled way. We'll also assess your overall hip strength and movement control, and carefully check that the pain isn't actually coming from the hip joint itself or being referred from the lower back, both of which can present in a broadly similar way to the untrained eye and need a different treatment approach. A single leg standing test that reproduces your pain within around 30 seconds is a particularly reliable and simple indicator that the gluteal tendons are the source of the problem, and is something we can also use to track your progress objectively over the course of treatment.
How it's treated
The evidence here is genuinely encouraging, and this is one of the better-researched tendinopathies in terms of high-quality clinical trials. A landmark trial found that a structured programme of education and exercise outperformed both a corticosteroid injection and a simple wait-and-see approach for gluteal tendinopathy, with the benefits of the exercise-based approach holding up strongly a full year later — a notably longer follow-up than many studies in this area achieve (Mellor et al., 2018). This was a particularly well-designed trial by the standards of musculoskeletal research, and it has genuinely shifted clinical practice away from the injection-first approach that was common for many years beforehand. So the core of treatment is genuinely twofold: load the tendon progressively through targeted exercise to rebuild its capacity to tolerate everyday activities, and reduce the compressive positions that are actively aggravating it in daily life.
A typical loading programme begins with isometric holds of the gluteal muscles to settle irritability and introduce load safely, before progressing to more dynamic strengthening exercises such as side-lying leg raises, bridges and single-leg work, always avoiding positions of excessive hip adduction (the leg crossing towards or past the midline) that would compress the tendon further. Over several weeks this typically progresses to more functional, weight-bearing strengthening that mirrors the demands of daily activities like stairs and walking.
The education component of treatment is genuinely, almost deceptively powerful — simply learning to avoid the specific positions that compress the tendon, such as crossing the legs, standing with weight hanging on one hip, or lying directly on the sore side without support, often takes a significant amount of heat out of the problem within days, even before any strengthening has had time to take effect. Hands-on treatment can help you feel more comfortable in the short term, but the progressive loading and the load-management advice together are what drive lasting, durable recovery. Corticosteroid injections may have a legitimate short-term role in some particularly painful cases to help someone engage with exercise, but on the current evidence, they don't outperform a well-run exercise programme over a longer time frame, and repeated injections in particular are generally best avoided. This particular study is one that we often refer back to directly with patients, because it gives such clear, high-quality evidence for a treatment approach that many people initially assume sounds too simple to work.
Expect a gradual improvement over a period of a couple of months for most people, with sleep often among the very first things to improve noticeably once the tendon is properly protected from compression at night through simple positional changes. and often before the more visible strength gains from the exercise programme have fully developed.
What you can do yourself
Start with the positional changes, since these often make a surprisingly quick difference: avoid crossing your legs when sitting, try not to stand for long periods with all your weight shifted onto one hip, and put a pillow between your knees at night when lying on your side — or, better still, sleep on the unaffected side with support — to take the direct pressure off the tendon, a modest change that costs nothing and can start helping from the very first night. Then commit consistently to a progressive hip-strengthening programme, since this is what builds the tendon's genuine capacity over time rather than just managing symptoms day to day. Avoid aggressive or deep stretching of the outside of the hip, which feels intuitive when an area is tight and sore but actually tends to compress the tendon further and can make things noticeably worse.
When to seek help
See someone if the pain is disturbing your sleep on a regular basis, is limiting stairs and walking in daily life, or simply isn't settling despite a reasonable trial of these self-care steps. It's also worth getting a proper assessment to make sure the pain isn't actually coming from the hip joint itself or being referred from the back, since both need a meaningfully different treatment approach from straightforward gluteal tendinopathy.
Frequently asked questions
Is an injection ever a good option? It can provide short-term relief in particularly painful cases and may help someone engage more comfortably with an exercise programme, but current evidence doesn't support it as a long-term solution on its own, and repeated injections aren't generally recommended.
Why does it hurt more at night than during the day? Direct compression from lying on the affected side, combined with a period of relative stillness that can allow the area to stiffen slightly, tends to make nighttime symptoms more prominent than daytime ones for many people.
How long before I notice improvement? Many people notice a meaningful reduction in night pain within one to two weeks of making the positional changes alone, while the deeper tendon capacity built through strengthening typically takes six to twelve weeks to show its full effect.
At BPR we'll confirm it's genuinely the gluteal tendons, teach you the position changes that often make an immediate and noticeable difference, and build a loading programme that gets you sleeping and moving comfortably again. You can book an assessment at bpr.rehab.
References
Grimaldi, A., Mellor, R., Hodges, P. et al. (2015) 'Gluteal tendinopathy: a review of mechanisms, assessment and management', Sports Medicine, 45(8), pp. 1107–1119.
Mellor, R., Bennell, K., Grimaldi, A. et al. (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.