Lateral hip pain, the aching or sharp discomfort felt on the outer side of your hip, is most often caused by a condition called greater trochanteric pain syndrome (GTPS). This umbrella term covers irritation of the tendons and surrounding tissues where they attach to the bony bump on the outside of your upper thigh bone. GTPS accounts for 10 to 20% of all hip pain cases seen in primary care, and it’s most common in women between the ages of 40 and 60.
Greater Trochanteric Pain Syndrome: The Primary Cause
For years, lateral hip pain was blamed almost entirely on bursitis, inflammation of the small fluid-filled sacs that cushion the hip joint. That diagnosis is now considered incomplete. The main driver of the pain, in most cases, is tendinopathy of the gluteus medius and gluteus minimus tendons. These two muscles sit deep in your buttock and attach to the greater trochanter, the bony prominence you can feel on the outside of your hip. When those tendons become damaged or degenerative, the result is persistent outer hip pain that can linger for months or years if not addressed.
Tendinopathy develops when tendons are subjected to a combination of compressive and tensile loading they can’t recover from. In practical terms, this means the tendon is being squeezed against bone while simultaneously being pulled under tension. Over time, the tendon’s internal structure breaks down. It’s not an acute injury like a tear from a single event. It’s a gradual process driven by repeated mechanical stress.
Why Hip Position Matters
The position of your hip joint plays a central role in whether these tendons get overloaded. Excessive hip adduction, where the thigh crosses toward or past the midline of your body, compresses the gluteal tendons against the greater trochanter. This happens in many everyday situations: standing with your weight shifted onto one hip, crossing your legs while seated, sleeping on your side without support between your knees, or even walking with a wide pelvis and narrow stance.
When you stand on one leg (climbing stairs, walking, running), the gluteus medius and minimus work hard to keep your pelvis level. If those muscles are weak or fatigued, the pelvis drops on the opposite side, increasing the adduction angle and compressive load on the standing leg’s tendons. This is why runners, people who walk long distances, and those who spend long periods standing on one leg or leaning to one side are particularly vulnerable.
Other Conditions That Cause Outer Hip Pain
Not all lateral hip pain comes from the tendons themselves. Several other conditions can produce similar symptoms, and it’s worth understanding how they differ.
Referred Pain From the Lower Back
Problems in the lumbar spine, particularly around the L4-L5 vertebrae, can send pain radiating into the lateral hip. The key distinguishing features are the presence of lower back pain, stiffness or reduced movement in the spine, and tenderness when someone presses along your back. If your pain started in or around the spine and travels down to the hip area, the source may be a nerve issue in your back rather than a local hip problem.
Hip Osteoarthritis
Osteoarthritis of the hip can sometimes be confused with GTPS, but the two feel quite different. Arthritis typically causes groin pain more than outer hip pain, comes with morning stiffness that gradually worsens, and makes it progressively harder to do things like put on shoes and socks. People with GTPS generally don’t have difficulty with that task, which serves as a useful way to tell the two apart.
IT Band Tightness
The iliotibial band, a thick strip of connective tissue running along the outside of your thigh, passes directly over the greater trochanter. When this band is excessively tight or the biomechanics of the hip are altered, it can contribute to compression and friction at the lateral hip. IT band issues often coexist with greater trochanteric pain syndrome rather than occurring in isolation.
How Lateral Hip Pain Typically Feels
The hallmark of GTPS is pain on the outside of the hip that worsens with activity and, notably, when lying on the affected side at night. Many people first notice it because it disrupts their sleep. The pain tends to flare during single-leg activities like walking upstairs, standing on one foot, or getting out of a car. You may also notice weakness when trying to push your leg out to the side or extend it behind you.
A simple self-check: stand on the affected leg for 30 seconds. If pain develops on the outer hip during that time, it strongly suggests GTPS. In clinical studies, this single-leg stance test showed 100% sensitivity for detecting the condition on MRI. Pressing directly on the bony point of the outer hip is another reliable indicator. If that spot is very tender, there’s roughly an 83% chance of a positive finding on imaging.
Who Gets It Most Often
Women are disproportionately affected, particularly between ages 40 and 60. Several factors contribute to this. Women generally have a wider pelvis relative to their femur length, which increases the angle at which the gluteal tendons attach to the bone and amplifies compressive forces. Hormonal changes around menopause also affect tendon health, reducing the tendons’ ability to tolerate and recover from load. Sedentary habits, sudden increases in walking or exercise, and weight gain can all tip the balance toward tendon overload.
That said, lateral hip pain is not exclusive to middle-aged women. Runners, athletes, and anyone who rapidly increases their activity level can develop it. People recovering from hip or knee surgery sometimes develop lateral hip pain on the opposite side because they’ve been favoring one leg.
What Helps: Exercise vs. Injections
The most effective long-term treatment for gluteal tendinopathy is a structured exercise program focused on gradually reloading the tendons. A landmark clinical trial compared three approaches over 52 weeks: education plus exercise, corticosteroid injections, and a wait-and-see approach. At one year, 78% of participants in the exercise group reported global improvement, compared to 57% in the injection group and 52% in the wait-and-see group.
Interestingly, pain intensity at one year was similar between the exercise and injection groups, with both outperforming the wait-and-see approach. But the exercise group had significantly better overall outcomes. Injections can provide short-term relief, which is useful when pain is severe, but they don’t address the underlying tendon weakness that drives the condition. Exercise does.
The loading program typically starts with simple, low-load exercises like isometric holds (pressing your leg against a wall without movement) and progresses toward functional strength work: squats, step-ups, and eventually single-leg activities. The goal is to rebuild the tendon’s capacity to handle the loads of daily life. This process takes months, not weeks.
Daily Habits That Reduce Pain
Small changes in how you position your body throughout the day can make a significant difference by reducing compression on the affected tendons.
- Sleeping: Avoid lying on the painful side. Sleep on your back with a pillow under your knees, or on your good side with a pillow between your legs to keep your thighs parallel.
- Sitting: Don’t cross your legs. Keep your knees in line with or slightly wider than your hips.
- Standing: Avoid hanging on one hip with your weight shifted to one side. Distribute your weight evenly between both legs.
- Walking and stairs: Take shorter steps and avoid letting your knee drift inward. Use a handrail on stairs if needed to reduce load on the affected side.
These modifications won’t fix the underlying problem on their own, but they reduce the daily irritation that keeps the tendons sensitized and painful. Combined with a progressive strengthening program, most people with lateral hip pain see substantial improvement within three to six months.