Pain on the outside of the hip is common, and it is easy to put down to getting older or simply doing too much. When it starts to interfere with sleep, walking or activity, it is worth understanding what is driving it and what actually helps.

A common cause is Greater Trochanteric Pain Syndrome (GTPS), a broad term for pain and tenderness around the tissues on the outside of the hip, over the bony point called the greater trochanter. It is a problem with the soft tissues around the hip rather than the hip joint itself.¹

This article explains what GTPS is, why it happens, how it is assessed, and how it is treated, along with when it is worth being seen in person. The reassuring part is that many people manage it well with education, load management and progressive strengthening, without needing surgery or injections.

The Short Version

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of pain and tenderness on the outside of the hip. Overload or sensitivity of the gluteal tendons is often an important part of it, and the nearby bursa and other soft tissues can also be involved. Symptoms are often worse when the hip tissues are compressed, such as lying on the painful side, crossing the legs, or standing with your weight hanging on one hip. Many people improve with education, load management and progressive strengthening, together with temporary changes to the positions that aggravate the hip. Injections or surgery may be considered in selected situations, but they are not the starting point for most people. Seek urgent care if you cannot put weight on the leg after an injury, or if the hip is hot and swollen with a fever.

Dealing with outer-hip pain that will not settle? A proper assessment can work out what is driving it and the best way forward.

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What Is Greater Trochanteric Pain Syndrome?

Greater Trochanteric Pain Syndrome is a broad term used to describe pain and tenderness around the outside of the hip. In many people, overload or sensitivity of the gluteus medius and minimus tendons is an important contributor. The nearby bursa and other soft tissues can also become irritated.^1,²

It is not a problem with the hip joint itself. The gluteal muscles attach to the greater trochanter through tendons, and these tissues can become sensitive when they are loaded or compressed more than they currently tolerate. Despite the older name “trochanteric bursitis,” primary bursitis is actually uncommon when the area is imaged, which is one reason the broader term GTPS is now used.⁵

How Common Is It?

GTPS is a common cause of pain on the outside of the hip. It is seen particularly often in women during midlife, although it can affect adults of different ages and activity levels.¹

Common Signs and Symptoms

You may notice some or all of these:

Pain on the outside of the hip, often worse with walking, stairs, standing or activity.
Pain when lying on the painful side, which can disturb sleep.
Tenderness when you press on the bony point on the side of the hip.
Discomfort with prolonged sitting, or stiffness for the first few steps after sitting.
Pain when crossing the legs or with movements that bring the leg across the body.
A sense of weakness or a limp when walking, often related to the pain.

Why Does It Happen?

GTPS often develops when the tissues around the outside of the hip are exposed to more load or compression than they currently tolerate. This can follow a sudden increase in running or walking, repeated hill or stair work, changes in training, prolonged side-lying, or a period of reduced strength and activity. General health, previous injuries and other hip or lower-back problems can also influence symptoms. It is not always possible to identify one single cause.

The Gluteal Tendons and Bursa

The gluteus medius and minimus tendons attach to the greater trochanter and help control the hip when you walk, stand and climb stairs. These tendons, and the tissues around them, can become sensitive when they are overloaded or repeatedly compressed against the bone. The nearby bursa can be involved too, but isolated primary bursitis is uncommon, so it is usually more accurate to think of this as a problem of the tendons and surrounding tissues rather than a “bursitis” alone.^3,⁵

Positions That Can Aggravate the Hip

The tissues around the outside of the hip can become more sensitive when they are repeatedly compressed. This can happen when you lie directly on the painful side, cross your legs, stand with your weight hanging on one hip, or let the top leg drop across your body while sleeping. Adjusting these positions may reduce irritation and make symptoms easier to manage while you gradually rebuild the hip’s strength and tolerance.³

These are temporary, symptom-guided adjustments, not postures that must be avoided forever. The aim is to settle the irritation enough to build the hip’s capacity back up.

What Other Conditions Could It Be?

Hip Osteoarthritis

Osteoarthritis involves changes inside the hip joint, whereas GTPS affects the soft tissues on the outside. Osteoarthritis pain is more often felt in the groin and comes with stiffness, and the two can overlap, which is one reason the whole picture matters rather than a single finding.

Sciatica and Referred Back Pain

Nerve-related pain from the lower back can travel down the leg, sometimes with tingling or numbness, which is not typical of GTPS. Back and hip problems can also occur together, so both are checked during an assessment.

Iliotibial Band Syndrome

This tends to cause pain further down the outer thigh or towards the outer knee, often with running or cycling, whereas GTPS pain stays mainly around the outside of the hip.

Bursitis

Irritation of a bursa can be part of the picture in GTPS, but isolated primary bursitis is uncommon. That is why current understanding treats the tendons and surrounding tissues, rather than the bursa alone, as the usual source of symptoms.⁵

Femoral Stress Injury

A bone stress injury of the thigh bone can cause deeper groin or thigh pain that worsens with weight-bearing and does not settle with rest. This is a different problem from GTPS and is worth distinguishing during assessment (see the safety section below).

Common Mistakes When Managing GTPS

Pushing Straight Through an Irritable Hip

Training hard through a hip that is sore and irritable tends to keep it flared up. Temporarily adjusting the aggravating load and positions can help settle symptoms while you keep moving within comfortable limits and begin rebuilding capacity.

Resting Completely and Avoiding All Movement

Long periods of complete rest can leave the hip stiff and the surrounding muscles weaker, which does not help recovery. Gentle movement and graded exercise are usually better than doing nothing.

Relying Only on Painkillers or Injections

Medication or an injection may ease symptoms for a while, but on their own they do not build the hip’s capacity. They work best, when used at all, as part of a plan that centres on education, load management and progressive strengthening.

Expecting a Scan to Give All the Answers

A scan is one piece of information, not the whole story. Tendon and bursal changes show up on imaging in people without much pain, so the findings have to fit your symptoms and examination to be useful.^5,⁶

What Happens If GTPS Is Not Treated?

GTPS does not automatically worsen if treatment does not begin immediately. Some cases settle with sensible activity changes, while others remain troublesome and interfere with walking, sleeping or exercise. An assessment can help when symptoms are severe, keep returning, are limiting normal activity, or are not improving with reasonable changes to load and position.

Recovery varies. Many people improve with education, progressive strengthening and changes to the activities or positions that repeatedly aggravate the hip. Some cases take longer, especially when symptoms have been present for several months or other hip and back problems are also involved.

When to Have Your Hip Assessed in Person

Most outer-hip pain can be managed well, but a few situations are worth checking in person.

Seek urgent medical assessment if:

you cannot walk or put weight on the leg after a significant fall or injury
the hip is hot or visibly swollen and you have a fever or feel generally unwell

Seek prompt in-person assessment if:

you develop deep groin or upper-thigh pain that is worsening with ordinary walking, a marked limp, difficulty putting weight on the leg, or pain at rest that is not simply from lying on the painful hip

Arrange an assessment if:

typical outer-hip pain is progressively limiting your walking, sleep or exercise
the diagnosis is unclear, or symptoms are not improving with sensible activity changes

Pain when lying directly on the outside of the hip is common in GTPS and is not, by itself, a sign of a stress fracture.

When Are Scans Needed?

GTPS is usually diagnosed from your symptoms and a physical examination. A scan is not routinely needed when the presentation is typical. Imaging may be considered when the diagnosis is uncertain, symptoms are not improving as expected, a significant tendon tear is suspected, or another cause such as hip osteoarthritis or a bone stress injury needs to be ruled out.¹

X-rays can help assess the bones and hip joint. Ultrasound can assess the gluteal tendons, bursa and other superficial soft tissues. MRI provides a more detailed view when a tendon tear, bone injury or another deeper problem is suspected.

Scan findings need to be interpreted alongside the symptoms and examination. Tendon or bursal changes on a scan do not always explain how much pain a person has, and many people assessed for GTPS do not have bursitis on imaging at all.^5,⁶

Is Surgery Needed?

Most people with GTPS do not need surgery. Education, load management and progressive exercise are the first-line approach, and for many people this improves symptoms without an injection or an operation.^2,⁴

Surgery is considered in specific situations, mainly a significant tear of the gluteal tendons that is not responding to a proper rehabilitation programme. Where a gluteal tendon tear is repaired, rehabilitation afterwards is what rebuilds strength and guides a graded return to activity.⁸ Whether imaging or a specialist opinion is needed is guided by your assessment.²

Treatment Options

Treatment is individualised and guided by your assessment. Education, load management and progressive strengthening form the core, and the options below are used alongside them to keep you comfortable and moving.^2,^4,⁷

Exercise Therapy and Load Management

This is the cornerstone. The programme is progressed according to your symptoms, goals and current capacity, and it may include hip strengthening, balance work and a gradual return to walking, stairs, running or other activities. Education plus exercise is well supported as a first-line approach for the outer-hip pain of gluteal tendinopathy.⁴

Corticosteroid Injections

A corticosteroid injection may provide short-term relief for some people, but the benefit may reduce over time. It should not replace education, load management and progressive exercise. The risks and benefits of an injection should be discussed with the treating doctor, particularly if repeated injections are being considered.^4,⁹

Myofascial Release

Myofascial release can help ease discomfort in tight or sensitive muscles around the hip and make movement or rehabilitation exercises feel more comfortable. It is used to support the active rehabilitation plan rather than to remove pressure from the tendon.

Orthopaedic Manual Therapy

Hands-on techniques may provide short-term relief of stiffness or discomfort in the hip, lower back or nearby joints, making movement and exercise easier. They are used alongside rehabilitation rather than as a structural correction.

Laser Therapy

I may use laser therapy as a modest adjunct for comfort during rehabilitation. It is not a stand-alone treatment and does not replace progressive exercise and load management.

Dry Needling

Dry needling may help ease muscle-related discomfort around the hip for some people and make movement more comfortable. It is used as an adjunct to exercise and rehabilitation.

Taping and Strapping

Taping can provide temporary sensory or movement support and may make daily activity more comfortable for some people while the hip’s capacity is rebuilt.

Frequently Asked Questions

Should I stop sleeping on that hip?

Not permanently. Lying directly on the painful hip compresses the sensitive tissues, so it often helps to sleep on the other side for a while, with a pillow between your knees to stop the top leg dropping across your body. This is a temporary, symptom-guided adjustment while you rebuild the hip’s tolerance, not a rule to follow forever.

Do stretches help or make it worse?

Strong stretches that pull the leg across your body can compress the outer-hip tissues and aggravate symptoms, so aggressive stretching is usually not the priority. Progressive strengthening and load management tend to be more useful. Gentle movement is fine; if a particular stretch reliably flares the hip, it is reasonable to ease off it for now.

Do I need a scan or an injection?

Usually not straight away. GTPS is generally diagnosed from your symptoms and a physical examination, and a scan is mainly useful when the diagnosis is unclear, things are not improving, or another cause needs to be ruled out. An injection may give some people short-term relief, but it does not replace education, load management and exercise, and it is a decision to discuss with the treating doctor.

How long does it take to settle?

It varies. Recovery depends on how irritable the hip is, how long symptoms have been present, the activities you need to tolerate and whether other hip or back problems are involved. Progress is judged by improvements in walking, sleep, strength and activity rather than one fixed timeline.

Can I keep walking or running?

Often, within comfortable limits. The aim is usually to adjust how much and how hard you load the hip rather than to stop completely, and to build back up as it tolerates more. Sudden increases in distance, hills or stair volume can aggravate symptoms for some people, so a gradual, monitored return is usually more manageable.

Conclusion

Greater Trochanteric Pain Syndrome can be persistent, but for most people it is manageable. Education, load management and progressive strengthening are the core of treatment, along with adjusting the positions that repeatedly compress the outside of the hip. Recovery takes time and consistency, and it varies from person to person, but steady progress is a realistic goal with an appropriate plan. If outer-hip pain is limiting your walking, sleep or activity, an assessment can work out what is driving it and set a clear plan.

Ready to take the next step? Book a session at Daniel da Cruz Physiotherapy in Sandton.