Pain on the side of your hip, right over the bony point you can feel when you press the outside of your upper thigh, is one of the most common musculoskeletal complaints. The usual culprit is a condition called greater trochanteric pain syndrome, which is an umbrella term for irritation of the tendons, muscles, or fluid-filled sacs around that bony prominence. But several other conditions can produce pain in the same spot, and telling them apart matters because the fix is different for each one.
Greater Trochanteric Pain Syndrome
The greater trochanter is the wide, knobby part of your thighbone that sits just beneath the skin on the outside of your hip. Several muscles attach here, and a small cushioning sac (a bursa) sits between the bone and the thick band of tissue that runs down your outer thigh. When any of these structures get irritated, you feel a deep ache or sharp tenderness right on the side of the hip that can radiate down the outer thigh.
Common triggers include overuse from exercise or prolonged standing, a sudden jump in activity level, carrying extra body weight, a direct fall onto the hip, or recovering from surgery on the hip or leg. Having one leg slightly longer than the other can also shift stress onto this area over time. The pain typically flares when you lie on the affected side at night, climb stairs, or get up from a chair after sitting for a while.
For years, doctors called this “hip bursitis,” assuming inflammation of the bursa was the main problem. Imaging studies have since shown that the gluteal tendons (the ones connecting your buttock muscles to the bone) are damaged or degenerating in most cases, with the bursa playing a smaller role. That distinction is important because it means strengthening those muscles is more effective than simply reducing inflammation.
IT Band Friction at the Hip
The iliotibial band is a long strip of connective tissue that runs from your pelvis down the outside of your thigh to just below the knee. Most people associate IT band problems with knee pain in runners, but the band also crosses over the greater trochanter at the hip. Repeated rubbing of a tight IT band over that bony point creates friction, inflammation, and pain that feels almost identical to trochanteric pain syndrome. Runners, cyclists, and anyone who rapidly increases training volume are most prone to this. The key clue is that pain worsens specifically with repetitive bending and straightening of the hip, and foam rolling the outer thigh often reproduces or temporarily relieves the discomfort.
Hip Osteoarthritis
Many people assume arthritis in the hip means groin pain, but that’s only part of the picture. A study of primary care patients with confirmed hip osteoarthritis found that 77% reported pain over the greater trochanter, making it the single most common pain location. Only 53% reported groin pain. So lateral hip pain can absolutely be arthritis, especially if you’re over 50, feel stiffness first thing in the morning that loosens up within 30 minutes, and notice the pain gradually worsening over months or years.
What makes arthritis-related side hip pain tricky is that it often coexists with tendon problems. The weakened joint changes how you walk and load the surrounding muscles, which can irritate the tendons at the trochanter at the same time. If you have both, addressing just one won’t fully resolve the pain.
Nerve Compression on the Outer Thigh
If the pain on the side of your hip comes with tingling, burning, numbness, or skin that feels unusually sensitive to light touch, the problem may be a compressed nerve rather than a muscle or joint issue. A sensory nerve runs from your lower spine over the front of your pelvis and into the outer thigh. When it gets pinched, typically by tight clothing, a seatbelt, weight gain, or prolonged standing, it produces a distinctive burning or buzzing sensation on the outer thigh that worsens with walking or standing. The area over the hip bone itself usually isn’t tender to press, which helps distinguish it from tendon or bursa problems.
How Doctors Figure Out Which One It Is
A physical exam is the most useful first step. Pressing directly over the greater trochanter and reproducing your pain points strongly toward trochanteric pain syndrome. A test where you stand on the affected leg while lifting the other knee can reveal weakness in the gluteal muscles, which is common in both tendon problems and arthritis. Specific movements that rotate the hip inward while flexing it can flag problems inside the joint itself, like a labral tear or impingement.
Imaging is not always necessary. X-rays can confirm or rule out arthritis. MRI is more accurate for detecting tears in the gluteal tendons, though ultrasound is sometimes used as a quicker, cheaper alternative. For gluteal tendon abnormalities specifically, ultrasound picks up roughly 57 to 63% of problems that MRI would catch, so a normal ultrasound doesn’t completely rule out a tendon issue.
What Actually Helps
For most causes of lateral hip pain, exercise-based treatment is the strongest first option. A structured program of strengthening, flexibility work, and gradual loading of the hip muscles has consistent evidence behind it. A large analysis of 18 clinical trials found that exercise therapy produces meaningful improvements in both pain and physical function, and those benefits persist for at least six to nine months. Programs typically run 30 to 120 minutes per session, one to five times per week, over a period of five to sixteen weeks.
The specific exercises matter. Strengthening the gluteal muscles (the ones on the side and back of your hip) is the priority for trochanteric pain syndrome and IT band problems. For arthritis, the program broadens to include range-of-motion work, aquatic exercise, and balance training. Hands-on therapy such as joint mobilization can also improve range of motion and reduce pain, particularly for mild to moderate arthritis, with sessions typically scheduled one to three times per week for up to 12 weeks.
Weight management plays a measurable role if you’re carrying extra weight. Clinical guidelines recommend a target of 5 to 7.5% body weight loss for people with a BMI above 25 who have hip osteoarthritis. That’s roughly 10 to 15 pounds for someone who weighs 200 pounds, a realistic and meaningful goal.
Temporary relief while you build strength can come from avoiding lying on the painful side at night (a pillow between your knees helps), reducing repetitive activities that provoke the pain, and applying ice after activity. Corticosteroid injections into the bursa can provide short-term relief for trochanteric pain syndrome, but the effect typically fades within a few months and doesn’t address the underlying tendon weakness.
When the Pain Needs Urgent Attention
Most lateral hip pain develops gradually and responds to conservative treatment. But certain patterns warrant prompt evaluation: pain that followed a fall or car accident, inability to move your hip or bear weight, pain that wakes you from sleep every night and is getting progressively worse, or hip pain accompanied by fever or unexplained weight loss. If at-home measures haven’t improved your symptoms after a few weeks, or the pain is intense enough to keep you from activities you normally enjoy, that’s a reasonable point to get a professional assessment.