Pain on the side of your butt most commonly comes from irritation of the tendons, muscles, or bursae around your hip joint, particularly near the bony prominence on the outside of your upper thigh called the greater trochanter. This area is a hub where several muscles attach, and problems here are grouped under the umbrella term greater trochanteric pain syndrome, or GTPS. Less commonly, the pain originates from a nerve being compressed deep in the buttock. The good news: most causes respond well to targeted exercises and activity changes.
The Most Likely Cause: Gluteal Tendon Problems
For years, doctors attributed lateral buttock and hip pain to an inflamed bursa (a fluid-filled cushion near the bone). But surgical, imaging, and tissue studies have overturned that idea. The primary source of pain in most cases is tendinopathy of the gluteus medius or gluteus minimus tendons, the muscles responsible for stabilizing your pelvis when you walk, climb stairs, or stand on one leg. The bursae may be irritated too, but the tendon damage is usually the main driver.
This type of pain tends to build gradually over weeks or months rather than appearing overnight. It typically worsens with weight-bearing activities like walking, climbing stairs, or running, and it can radiate down the outer thigh as far as the knee. One of the hallmark complaints is difficulty sleeping on the affected side, because lying on it compresses the already irritated tendons against the bone. Prolonged sitting and crossing your legs can also flare it up.
The underlying problem is a combination of excessive compression and high tensile load on the tendons. Positions that pull the hip into adduction (your knee drifting inward past your midline) are particularly damaging because they squeeze the tendon against the bone while simultaneously stretching it. This is why people who habitually stand with their weight shifted to one hip or who have weak lateral hip muscles are especially vulnerable.
Piriformis Syndrome and Deep Gluteal Pain
If your pain sits deeper in the buttock, closer to the center or slightly behind the hip, a nerve issue may be involved. The piriformis is a small muscle that runs across the back of the hip, and in some people, it can compress or irritate the sciatic nerve. The resulting pain often feels like a deep ache in the buttock with tingling or numbness running down the leg. A distinguishing feature: people with piriformis syndrome often can’t tolerate sitting for more than 20 to 30 minutes before the pain ramps up, and the discomfort tends to worsen with hip rotation.
A related condition, ischiofemoral impingement, produces a similar deep gluteal ache that can show up lateral to the sit bone, in the groin, or right in the center of the buttock. It comes from the space between two bones in the hip narrowing and pinching soft tissue. Taking a long stride on your unaffected leg can reproduce this pain because the movement narrows that space on the painful side.
Snapping Hip Syndrome
Some people notice an audible or visible snapping sensation on the outside of their hip along with the pain. This is called external coxa saltans, or snapping hip. It happens when the iliotibial band or a tendon slides over the greater trochanter during hip movement. You can sometimes see or feel a band rolling over the bone if you place your hand on the outer hip while flexing and extending your leg. In mild cases the snap is painless, but when the surrounding tissues become inflamed, it adds to the lateral buttock pain.
Who Gets This and Why
GTPS is significantly more common in women, particularly between the ages of 40 and 60, partly because of wider pelvic anatomy that increases the angle of pull on the gluteal tendons. Runners and people who suddenly increase their activity level are also at higher risk. Falls, even minor ones, can trigger an episode. Other risk factors include obesity, leg-length differences, and weakness in the core and hip stabilizer muscles. If you’ve recently started a new exercise program or ramped up your walking or running volume, that’s a common trigger.
How Doctors Figure Out the Cause
A physical exam can often distinguish between tendon problems, nerve compression, and joint issues without imaging. One of the most telling tests is the single-leg stand: you stand on the affected leg for 30 seconds, and if your opposite hip drops, it signals weakness in the gluteal muscles. This test is up to 96% specific for gluteal tendinopathy, meaning a positive result strongly points to that diagnosis.
Another highly accurate test involves lying on your back while the examiner rotates your hip outward, then asks you to push against resistance to rotate it back inward. If this reproduces pain on the outer hip, it has 88% sensitivity and 97% specificity for gluteal tendinopathy. For piriformis syndrome, a seated stretch test where the examiner rotates your hip inward while extending your knee reproduces the deep buttock pain with about 91% accuracy.
Imaging like MRI or ultrasound is generally reserved for cases that don’t improve with initial treatment or when a tendon tear is suspected. X-rays can rule out arthritis or stress fractures but won’t show tendon damage.
What Actually Works for Treatment
Exercise-based rehabilitation is the most effective long-term treatment. A structured program typically starts with gentle isometric holds (contracting the muscle without moving the joint) to reduce pain and begin loading the tendon safely. A common starting exercise is lying on your side and holding your top leg in a slightly raised position for 30 seconds at a time, repeated six times. As pain allows, you progress to slow, controlled movements like side-lying hip raises and standing hip slides, performing sets of 10 repetitions with a deliberate three-second lift and three-second lower.
The goal is to gradually rebuild the tendon’s tolerance to load. Most programs run 8 to 12 weeks, with exercises performed once or twice daily. Strengthening the entire chain matters too: your quadriceps, calves, and core all contribute to how much stress lands on your lateral hip during walking and running.
Corticosteroid injections can provide short-term relief, and many people feel noticeably better within days. However, when researchers compared injections to exercise programs, exercise produced better long-term outcomes. Patients who did structured rehabilitation were more likely to experience meaningful, lasting improvement than those who received injections alone. Injections can still be useful as a bridge, reducing pain enough to let you participate in rehab, but they aren’t a standalone fix.
What to Avoid While You Recover
Certain habits compress or overload the irritated tendons and slow healing. Sleeping on the painful side is one of the biggest aggravators. If you’re a side sleeper, placing a pillow between your knees keeps your hip in a more neutral position and reduces compression. Avoid crossing your legs, standing with your hip hitched to one side, or stretching the outer hip aggressively. Deep stretches that pull the knee across the body feel like they should help, but they actually compress the tendon against the bone and can make things worse.
Sitting for long periods, especially in low chairs, can also flare symptoms. If your job keeps you seated, standing up and walking briefly every 30 to 45 minutes helps. For runners, reducing mileage temporarily and avoiding banked surfaces or tight track curves limits the repetitive loading pattern that irritates the lateral hip.