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Greater Trochanteric Pain Syndrome (Lateral Hip Pain)

Pain on the outer hip, worse lying on that side - it is a gluteal tendon problem, not "bursitis", and exercise beats injection long-term.

Overview

Greater trochanteric pain syndrome (GTPS) is pain over the bony point on the outer hip, classically worse when lying on that side at night and aggravated by stairs, walking and standing on one leg. It is one of the most common causes of hip pain, especially in women between 40 and 60 – and it is widely mislabelled.

For years this was called “trochanteric bursitis,” implying an inflamed bursa to be injected. Modern imaging and research have overturned that: the primary problem is gluteal tendinopathy – overload of the tendons of the gluteus medius and minimus where they attach to the outer hip – with the bursa only sometimes involved. This matters enormously, because it changes the treatment from anti-inflammatory injections to tendon loading and posture change. The landmark LEAP trial showed that education plus exercise beat corticosteroid injection both at 8 weeks and a full year later. ACTYMED treats GTPS for what it actually is.

Signs & Symptoms

Pain over the bony point on the outer hip (the greater trochanter)
Worse lying on that side at night - a very characteristic feature
Aggravated by climbing stairs, walking uphill and standing on one leg
Pain sometimes spreading down the outer thigh
Tender to press directly on the outer hip point
Pain crossing the legs or standing with the hip hitched

Causes

Overload of the gluteal tendons (gluteus medius and minimus) where they attach to the outer hip - the true source, formerly mislabelled bursitis
Compression of the tendons against the bone by adducted-hip postures (standing hip-hitched, crossing legs, side-lying)
Sudden increases in walking or running load
Weak hip abductor muscles allowing the pelvis to drop
Hormonal changes around menopause affecting tendons
Sometimes coexisting low back or hip osteoarthritis

Risk Factors

Women aged 40-60, especially peri- and post-menopausal - the classic group
Runners and walkers who increase load quickly
Weak hip abductors and poor pelvic control
Higher BMI
Postures that compress the tendons - crossing legs, hanging on one hip, side-sleeping
Coexisting hip osteoarthritis or low back pain

Understanding the Anatomy

The gluteus medius and minimus muscles attach by tendons to the greater trochanter - the bony bump on the outer hip - and act as the hip's crucial stabilisers, stopping the pelvis dropping when you stand on one leg.

For decades this was called trochanteric bursitis, but imaging and surgical studies show the primary problem is tendinopathy of these gluteal tendons, often with only secondary bursal involvement - a shift that completely changes treatment away from anti-inflammatory injections toward tendon loading.

The tendons are compressed against the bone whenever the hip is drawn across the midline (adduction) - which is exactly why side-lying, leg-crossing and hip-hitched standing provoke it, and why avoiding those compressive positions is central to recovery.

Types & Classification

Gluteal tendinopathy - the core problem, with a spectrum from reactive to degenerative
Trochanteric bursitis - present in some, usually secondary to the tendinopathy
Gluteal tendon tears - partial or full-thickness, in more advanced or older cases
External snapping hip (a band snapping over the trochanter) - a related but distinct cause of lateral hip symptoms
Distinguish from: hip joint osteoarthritis (groin pain), and referred pain from the lumbar spine

How We Diagnose It

Pinpoint tenderness over the greater trochanter plus the classic night pain lying on that side
Pain reproduced by single-leg standing and resisted hip abduction
Screening the hip joint (groin pain, rotation) and lumbar spine to exclude referral
Assessing hip abductor strength and pelvic control
Ultrasound or MRI when a gluteal tendon tear is suspected or the picture is unclear
Diagnosis is usually clinical - imaging is confirmatory, not routine

If Left Untreated

Chronic, sleep-disrupting lateral hip pain when treated as simple bursitis with repeated injections
Progression of gluteal tendon tears in advanced cases
Deconditioning and altered gait from long-standing pain
Repeated short-lived relief from injections without lasting change if loading is never addressed

The ACTYMED Advantage

Correct diagnosis first - we treat it as gluteal tendinopathy, not bursitis, which changes everything
Education plus load-based exercise, the approach the landmark LEAP trial showed beats corticosteroid injection at both 8 weeks and one year
Compression-avoidance coaching - the simple postural changes (stop crossing legs, side-sleeping strategies, avoid hip-hitching) that stop provoking the tendon
Progressive hip abductor strengthening for lasting recovery
Honest injection counselling - useful for short-term relief in some, but not the durable fix
Dry needling, soft-tissue therapy and gait retraining as adjuncts
Recognising and appropriately referring the minority with significant gluteal tendon tears

How We Treat It

🌿 Ayurveda Treatments Exercise Therapy Sports Rehabilitation & Return-to-Play Manual Therapy Dry Needling Myofascial Release Agnikarmam (Therapeutic Thermal Cautery)

💳 Inpatient treatment for this condition may be covered by your health insurance. ACTYMED supports both cashless and reimbursement claims, and our team handles the entire documentation for you. Check your eligibility →

Recovery & Prognosis

Most improve over 3 months with education, compression-avoidance and progressive loading
The LEAP trial showed education-plus-exercise gave the best outcomes at both 8 weeks and 52 weeks - better and more durable than injection
Corticosteroid injection can relieve pain short-term but is outperformed by exercise longer-term
Longstanding or tendon-tear cases are slower and occasionally need surgical opinion
Recurrence falls when abductor strength and postural habits are maintained

Prevention Tips

Keep hip abductor muscles strong - single-leg control work
Avoid habitual leg-crossing and standing hitched on one hip
Increase walking and running loads gradually
Use side-sleeping strategies (pillow between the knees) if prone to it
Maintain a healthy body weight
Address early outer-hip twinges before they become chronic

Home Care & Self-Management

Do's

Do the progressive hip abductor loading programme - the core of recovery
Stop crossing your legs and standing hitched on one hip
Use a pillow between the knees when side-sleeping
Increase walking loads gradually
Be patient - tendons respond over weeks to months, not days

Don'ts

Do not accept "it is just bursitis" and rely on repeated injections - that misses the real problem
Do not sleep directly on the painful hip without a strategy
Do not habitually cross your legs or hang on one hip
Do not do provocative stretches that compress the tendon against the bone (deep hip-adduction stretches)
Do not expect a quick fix - loading takes time

Frequently Asked Questions

I was told I have bursitis – is that wrong?

It is outdated. The label “trochanteric bursitis” assumes an inflamed fluid sac, but studies now show the real problem in the great majority is tendinopathy of the gluteal tendons, with the bursa only secondarily involved if at all. This is not a technicality – it is why treating it as bursitis with repeated anti-inflammatory injections so often disappoints, and why load-based rehabilitation works. We diagnose and treat it accurately.

Why does it hurt so much lying on that side at night?

Because lying on the hip compresses the gluteal tendons directly against the bone, and any position that draws the hip across the midline (crossing your legs, standing hitched on one hip, deep adduction stretches) does the same. That compression provokes an already-overloaded tendon. A big part of recovery is simply learning to avoid these compressive positions – including side-sleeping strategies like a pillow between the knees.

Should I get a steroid injection?

We will be honest: an injection can settle the pain for a few weeks, and occasionally that is useful to get you moving. But the best evidence – the LEAP trial – showed that education plus exercise clearly outperformed injection both at 8 weeks and at one year. Injection is a short-term aid at best, not the durable solution, and repeated injections into a tendon are not advisable. The lasting fix is loading and posture change.

What actually makes it better?

Three things, together: avoiding the compressive positions that provoke it, a progressive hip abductor strengthening programme that rebuilds the tendons” capacity, and patience – tendons respond over weeks to months. Most people improve substantially within about three months. We also use dry needling, soft-tissue therapy and gait work as helpful adjuncts, but the loading is the core.

Could this pain be coming from my hip joint or back instead?

It can, and we check. True hip joint arthritis usually causes groin pain and stiffness, while the lumbar spine can refer pain to the outer hip. GTPS is specifically tenderness right over the outer bony point with that characteristic night pain. Sorting out which of these is driving your pain is exactly why an assessment comes before treatment – each needs a different plan.

When is surgery indicated?

Rarely. Surgery is considered only for the minority with a significant, confirmed full-thickness gluteal tendon tear who have genuinely failed a proper loading programme, or occasionally for a persistent snapping band. The overwhelming majority of GTPS never needs surgery and responds to loading and posture change – so we exhaust honest conservative care first and refer only the genuine tendon-tear cases.

What the Evidence Says

Mellor et al. (LEAP trial, BMJ 2018): education plus exercise significantly outperformed corticosteroid injection and wait-and-see for gluteal tendinopathy at 8 weeks, with benefits sustained at 52 weeks - the key trial guiding our approach
Grimaldi and Fearon (JOSPT 2015): reframing GTPS as gluteal tendinopathy with a compression-avoidance and loading model
Long et al. (AJR 2013): imaging shows tendinopathy, not isolated bursitis, as the dominant pathology
Reid (2016) review: injection gives short-term relief only, exercise superior long-term

Specialists Who Can Help

Dr. Ajeesh T Alex

Ayurvedic Orthopaedics & Sports Medicine

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