Pain over the bony point on the outside of the hip, worst when lying on that side at night, is one of the most recognisable presentations in musculoskeletal practice. It is also one of the most commonly mislabelled.
For years this was called trochanteric bursitis, implying an inflamed fluid sac. Imaging studies have since shown that the bursa is often unremarkable and the real problem is usually the gluteal tendons where they attach to the outside of the hip. Hence the current term: gluteal tendinopathy, or greater trochanteric pain syndrome.
That relabelling is not academic. It changes the treatment entirely.
So is it hip bursitis or not?
Both names describe the same presentation, and you will hear either used. "Hip bursitis" and "trochanteric bursitis" are the older labels, still in wide use. "Gluteal tendinopathy" and "greater trochanteric pain syndrome" are the current ones.
The reason the newer names took over is practical rather than pedantic. If you believe the problem is an inflamed fluid sac, the logical treatments are rest and anti inflammatories. If you understand it as a tendon under compression, the treatments become unloading the tendon and then progressively loading it, which is what actually works.
Does this sound like you?
- Pain over the bony prominence on the side of your hip
- Can't lie on that side, which is often what finally prompts people to seek help
- Sore lying on the other side too, with the painful hip dropping across
- Worse after prolonged standing, especially with weight shifted onto one leg
- Painful climbing stairs or hills
- Often begins after a change in walking volume
It is most common in women over 40, and frequently arrives after an increase in walking.
Compression is the enemy
Here is the mechanism that explains almost everything about this condition.
Tendons tolerate load well but tolerate compression poorly. Whenever your knee crosses the midline of your body, the gluteal tendons get squeezed against the bone underneath them. Every position that provokes this condition involves exactly that:
| Position | What it does |
|---|---|
| Lying on the painful side | Direct compression against the mattress |
| Lying on the good side, top leg flopping forward | Stretches the painful tendon across the bone |
| Standing with weight on one hip ("hip hanging") | Sustained compression |
| Sitting cross-legged | Sustained compression |
| Aggressive ITB stretching | Compression, which is why it makes things worse |
This is why the classic advice to "stretch your IT band" so often backfires. Stretching a compressed tendon compresses it further.
Start with these three changes
Position changes alone often reduce night pain within a week or two, before any exercise begins to work.
- Pillow between the knees when lying on your side, thick enough that your top knee stays level with your hip, not dropping across
- Stop standing on one hip. Consciously keep weight even through both feet when queuing, cooking, or waiting
- Uncross your legs when sitting
Then load the tendon
The evidence here is unusually clear. A well-conducted trial comparing education plus exercise against corticosteroid injection and against a wait-and-see approach found the education and exercise group did best, both at eight weeks and still at a year. Injection gave short-term relief that did not last.
The exercise progression is deliberately unglamorous:
- Isometric holds first, static abduction against a wall, which often eases pain immediately
- Slow, controlled abduction work in a neutral position, avoiding any crossing of the midline
- Progressive weight-bearing loading: bridges, step-ups, single-leg control
- Return to full walking volume, built up gradually
Give it three months of consistency. Tendons remodel slowly, and this one is often provoked all day by ordinary positions, which makes patience harder and more necessary.
What about an injection?
Corticosteroid injection can help when pain is severe enough to prevent any meaningful exercise. But given the trial evidence, it is best used as a way to enable rehabilitation rather than as a treatment in itself, and repeated injections into tendon tissue are generally avoided.
When to get it assessed
See someone if the pain is not improving after a few weeks of the position changes above, if it radiates down the leg, which suggests nerve involvement and is covered in our sciatica guide, if you have deep groin pain rather than outer-hip pain, or if there is any night pain accompanied by fever or unexplained weight loss.
Groin-dominant pain in particular points to the hip joint itself rather than the tendons, and is assessed quite differently.