TL;DR: Pain on the bony point of the outer hip — worst lying on that side, climbing stairs, or standing on one leg — is commonly labelled “hip bursitis.” The current understanding is that the primary problem is usually gluteal tendinopathy, irritation of the gluteus medius and minimus tendons where they attach, with bursal inflammation secondary or absent. That distinction is not semantic. In a randomised trial, an eight-week programme of load-management education plus exercise produced greater improvement in pain and global rating of change than a corticosteroid injection or a wait-and-see approach — at 8 weeks and at 52 weeks.
Recognising It
The pattern is specific enough to be worth listing:
- Pain over the greater trochanter — the bony prominence on the outside of the hip — sometimes referring down the outer thigh, but not usually past the knee.
- Lying on that side hurts. This is the symptom people describe first, and it is often what finally sends them to a clinic, because it wrecks sleep.
- Lying on the other side can hurt too, because the top leg drops across the body and compresses the tendons on the painful side.
- Stairs, hills, and standing on one leg provoke it.
- Prolonged sitting with crossed legs is a common aggravator, for the same compression reason.
Note what is not on that list: deep groin pain, which points more toward the hip joint itself, and pain travelling below the knee with numbness or tingling, which points toward a nerve source. Both are covered on our hip pain page and in our guide to leg pain of spinal origin.
Why “Bursitis” Is the Wrong Mental Model
“Trochanteric bursitis” suggests an inflamed fluid sac, and it suggests an obvious remedy: rest it and take the inflammation down. Both of those inferences send people in an unhelpful direction.
The broader term now used is greater trochanteric pain syndrome, and the dominant pathology within it is tendinopathy of the gluteal tendons. Tendinopathy is a degenerative and load-related condition, not primarily an inflammatory one. What it responds to is graded loading and reduced compression — not rest, and not an anti-inflammatory strategy on its own.
The compression part is the piece nobody explains, and it is the most immediately actionable thing in this article. The gluteal tendons get compressed against the greater trochanter whenever the thigh crosses the midline of the body. Which means several habits that feel like sensible rest are actively provoking:
- Sitting with legs crossed.
- Standing with your weight slumped onto one hip.
- Sleeping on your side without a pillow between your knees.
- Stretching the outer hip by pulling the knee across the body — a very common “self-treatment” that increases exactly the compression driving the symptoms.
People often arrive having diligently stretched their painful hip for months and made it worse. That is not a failure of effort; it follows logically from the wrong diagnosis.
What the Evidence Supports
The LEAP trial randomised 201 people with gluteal tendinopathy to one of three arms: a corticosteroid injection, a physiotherapist-delivered load-management and exercise programme, or wait-and-see. Fourteen sessions of education on load management plus exercise, delivered over eight weeks, produced greater improvement in global rating of change and pain than either the injection or wait-and-see — and the advantage was still there at 52 weeks.
That is a useful result for two reasons. It tells you the condition responds well to the right programme, which is genuinely good news. And it tells you that the quick option is not the better option here, which is worth knowing before you are offered one.
What the Programme Looks Like
Remove the compression first. A pillow between the knees at night, no crossed legs, no hanging on one hip when standing, no cross-body stretching. Some people improve meaningfully on this alone, within a couple of weeks.
Then load the tendon progressively. Isometric holds early when things are irritable, moving toward abduction strengthening and eventually single-leg work. The progression is the treatment; the specific exercises matter less than whether the load is being advanced at the right rate for the tissue.
Address what is above and below. Weak hip abductors are the usual finding, and the reason the tendon was overloaded in the first place. So are gait patterns that drop the pelvis on each step.
Give it time. The trial protocol ran eight weeks of supervised work, and the benefit was measured at a year. Tendons remodel on a slow timeline.
When It Is Something Else
A careful evaluation is worth having, because several things present around the outer hip. Hip joint osteoarthritis typically gives groin pain and restricted rotation. Lumbar referral gives pain that travels further and may bring neurological symptoms. Less commonly there are stress-related bone problems, particularly in runners or in people with osteoporosis risk, and those need imaging rather than loading.
At Innovare Tx we evaluate the hip and then treat what the examination actually shows. Rowena Calleja, PT runs the loading programme; Charles Ortega, PA-C handles the medical evaluation and coordinates imaging or a surgical referral where the picture calls for it. We also offer autologous orthobiologic procedures — PRP and BMAC — and whether one is an appropriate option for you is a decision made after a clinical evaluation, not a default step.
PRP, PPP, BMAC, and A2M are autologous procedures prepared from your own blood or bone marrow. They are considered investigational and are not FDA-approved for the treatment of any specific orthopedic condition, including osteoarthritis. Individual results are not guaranteed. Any decision to pursue an orthobiologic procedure should be made with your provider after a clinical evaluation.
Call (214) 233-3094 or request an appointment at our Addison clinic.
Is hip bursitis real, or is it tendinopathy?
Bursae around the greater trochanter can be involved, but current understanding is that the primary pathology in most outer-hip pain is gluteal tendinopathy — irritation of the gluteus medius and minimus tendons — with bursal changes secondary or absent. The umbrella term used now is greater trochanteric pain syndrome. The distinction matters because tendinopathy responds to graded loading and reduced compression rather than to rest and anti-inflammatory strategies alone.
Why does my hip hurt when I lie on my side?
Side-lying compresses the gluteal tendons against the greater trochanter. Lying on the painful side compresses them directly; lying on the other side lets the top leg fall across the body, which compresses them too. A pillow between the knees to keep the top thigh from crossing the midline is one of the most effective single changes you can make.
Should I stretch my outer hip?
Generally no — not the cross-body stretch most people reach for. Pulling the knee across the body increases the compression on the gluteal tendons that is driving the symptoms. Many people arrive having stretched conscientiously for months and become steadily worse. Loading the tendon progressively, while removing compression, is the approach with evidence behind it.
Is a cortisone injection the best treatment for gluteal tendinopathy?
The randomised evidence does not support it as the first choice. In the LEAP trial, an eight-week education and exercise programme outperformed a corticosteroid injection on pain and global rating of change at both 8 and 52 weeks. Injections have a role in some circumstances, which is a conversation to have with your provider after an evaluation.
