Hip & pelvis
Greater Trochanteric Pain Syndrome (Outer Hip Pain)
Greater trochanteric pain syndrome (gluteal tendinopathy) is pain on the outer hip, worse lying on that side, climbing stairs and standing on one leg. Most common in women over 40.
Common symptoms
- Pain on the outside of the hip, tender to press over the bony point
- Pain lying on the affected side at night, often disturbing sleep
- Pain climbing stairs, walking uphill or standing on one leg
- Ache after sitting with legs crossed or getting up from a low chair
- Pain spreading down the outside of the thigh, but not usually below the knee
- Worse after long walks or runs
Overview
The greater trochanter is the bony bump you can feel on the outside of your hip. The gluteal tendons attach here, and a fluid-filled bursa cushions them. For many years outer hip pain was labelled "trochanteric bursitis", but we now know the main problem is usually the gluteal tendons themselves becoming irritated and less able to handle load — a gluteal tendinopathy. The umbrella term is greater trochanteric pain syndrome (GTPS).
GTPS is most common in women between 40 and 60, although it affects runners and people of any age who have suddenly increased their walking, hill work or stair climbing. The classic complaint is pain lying on the affected side at night, so sleep is disturbed. Pain is also felt when climbing stairs, getting up after sitting, standing on one leg or walking longer distances, and the side of the hip is tender to press.
It can be stubborn because the tendon continues to be compressed by daily postures — crossing the legs, sitting with knees together, standing with weight on one hip. Recovery depends on reducing those compressive loads while gradually strengthening the gluteal muscles so the tendon becomes more robust.
Causes and risk factors
- A sudden increase in walking, running, hill work or stairs
- Habitual postures that compress the tendon: crossing legs, standing on one hip, side-lying
- Weak gluteal muscles, particularly gluteus medius
- Being female and over 40; hormonal changes around the menopause affect tendon health
- Wider pelvis or leg-length difference changing the angle of pull on the tendon
- Lower back pain or hip OA altering walking pattern
- Being overweight
How we may be able to help
Our assessment confirms the diagnosis with specific tendon-loading and compression tests, checks your gluteal strength and single-leg control, examines the lumbar spine and hip joint to rule out referred pain, and reviews the daily habits that compress the tendon.
Treatment is led by our physiotherapists. The foundation is education on reducing compression — how to sit, stand and sleep — combined with a progressive gluteal strengthening programme, which has the strongest evidence for lasting improvement. Manual therapy to the surrounding tight muscles and the lumbar spine can help, and dry needling may be used for trigger points in the gluteal and tensor fasciae latae muscles.
For tendinopathy that has persisted despite loading exercises, focused shockwave therapy is a recognised option. It delivers acoustic pulses to the tendon attachment to stimulate the body's repair response and reduce pain, usually over a course of several sessions, and is combined with ongoing exercise rather than used alone. Interferential therapy may be used for short-term pain relief, and a 3D posture scan can reveal pelvic drop or asymmetry that keeps overloading one side.
What you can do at home
- Sleep on the other side with a pillow between your knees, or on your back
- Avoid crossing your legs and standing with your weight on one hip
- Sit with knees slightly apart and hips higher than knees where possible
- Reduce hill walking, long stairs and long walks temporarily, then build back gradually
- Avoid stretching the outer hip (e.g. pulling the knee across the body) — it compresses the tendon
- Practise the gluteal strengthening exercises your therapist gives you, even on good days
When to seek urgent help
If you have any of the following, call us straight away for an urgent same-day appointment — we can examine you and arrange fast-track X-ray or MRI through our imaging partner. If you cannot reach us, go to A&E. For loss of bladder or bowel control, numbness around the groin, chest pain, a sudden severe headache or rapidly worsening weakness, call 999 or go to A&E immediately:
- Sudden severe hip pain after a fall with inability to bear weight — possible fracture, go to A&E
- Hot, red, swollen outer hip with fever or feeling unwell
- Hip pain with unexplained weight loss, night sweats or a history of cancer
- Numbness, tingling or weakness spreading below the knee, which suggests a nerve or spinal cause
Frequently asked questions
Is it bursitis or tendinopathy?
Usually tendinopathy, sometimes with some bursal irritation alongside. The distinction matters less than the approach: both improve when you reduce compression of the area and progressively strengthen the gluteal muscles.
Should I stretch my outer hip or IT band?
Generally no. Stretches that pull the knee across the body compress the gluteal tendon against the bone and can make GTPS worse. Strengthening and positional changes are more helpful.
When is shockwave appropriate?
Focused shockwave is considered when the tendon pain has persisted despite a proper strengthening programme. It is delivered after assessment as part of a plan that keeps the exercises going, and usually involves several sessions about a week apart. Some insurers do not cover shockwave, so please check first.
Can I keep running?
Often at a reduced volume, avoiding hills and keeping to flat, even surfaces while the tendon settles. We will adjust your running load as the gluteal strength improves.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.
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