If you have pain on the outside of your hip that's worse at night, gets aggravated by climbing stairs, and feels tender when you press on the bony point on the side, you're probably dealing with what's commonly called hip bursitis or, more accurately, greater trochanteric pain syndrome (GTPS). It's one of the most common hip conditions we treat, and it responds well to the right approach — but unfortunately, it's also one of the most commonly misunderstood.
Why "hip bursitis" is a slight misnomer
The term "bursitis" suggests inflammation of a bursa — the fluid-filled cushion between the hip bone (greater trochanter) and overlying tissues. While the bursa can become inflamed, current research consistently shows that the primary problem in most cases isn't actually the bursa. It's the tendons of the gluteus medius and minimus where they attach to the side of the hip. These tendons get overloaded, develop microtears, and progress to tendinopathy.
This matters because the treatment for tendinopathy is fundamentally different from the treatment for true bursitis. Tendons need progressive loading to heal — they don't respond well to extended rest or anti-inflammatory medications alone.
What's driving it
The gluteus medius and minimus are the primary stabilizers of your hip during standing, walking, and any single-leg activity. They have a tough job — they have to fire every time your weight shifts onto one leg, hundreds of times a day. When the demand exceeds their capacity, the tendons start to fail.
Common contributing factors:
- Weak gluteus medius/minimus — by far the most common driver. The tendon overloads because the muscle can't share the work.
- Gait abnormalities — overstriding, hip drop during single-leg stance, asymmetric pelvic mechanics
- Leg length discrepancy — chronic asymmetric loading wears the dominant-side tendon
- Sudden activity changes — starting a new walking routine, taking up running, ramping up hiking
- Side sleeping on the affected hip — direct compression on the tendons aggravates symptoms
- Sitting with crossed legs — chronically lengthens and stresses the lateral hip tissues
How it shows up
Classic presentation includes:
- Sharp or aching pain on the outside of the hip, sometimes radiating down the outer thigh
- Pain that's worse with prolonged standing, walking, or climbing stairs
- Tenderness when you press on the bony point on the side of the hip
- Night pain when lying on the affected side (often the most distressing symptom)
- Stiffness after sitting for a while, easing somewhat with movement
How we treat it
The successful treatment plan addresses both the symptom and the underlying overload pattern.
Loading the tendon progressively. This is the cornerstone of recovery. The gluteus medius and minimus tendons need to be loaded in a controlled, progressive way to remodel and strengthen. Specific exercises like side-lying hip abduction, single-leg bridges, lateral step-downs, and (eventually) loaded carries form the backbone of rehabilitation. Done correctly, they're far more effective than rest.
Soft tissue work. Graston Technique, ART, and dry needling on the gluteal tendons and surrounding tissues (TFL, ITB origin, deep external rotators) address the local restriction and break the pain-tension cycle.
Shockwave therapy has strong evidence for lateral hip tendinopathy and can be especially useful for cases that haven't responded to exercise alone.
Joint mobilization of the hip, SI joint, and lumbar spine often releases protective patterns that prolong symptoms.
Acupuncture can reduce the pain sensitivity that builds up around chronic tendinopathies and improves sleep, which matters because night pain is often what brings patients in.
Gait analysis and biomechanical correction. If your walking or running pattern is overloading the lateral hip, no amount of treatment will hold without addressing it.
What you can do today
- Stop sleeping on the painful side. If you have to, put a pillow between your knees and another supporting your top knee so the leg doesn't drop and stretch the lateral hip.
- Avoid crossing your legs when sitting and try not to "hang" on one hip when standing.
- Start gentle glute strengthening — clamshells, side-lying leg lifts, and bridges. 2-3 sets of 12, daily.
- Use ice for acute flares, heat for chronic stiffness — both have their place at different stages.
- Don't push through running or heavy stair-climbing if it's clearly aggravating. Temporary load reduction speeds recovery.
The recovery timeline
Most cases of lateral hip tendinopathy resolve within 8 to 16 weeks with consistent treatment and home exercises. Cases that have been brewing for a year or more typically take longer, but they still respond — they just need more patience with the loading progression. The biggest predictor of fast recovery is doing the exercises consistently between visits.
If your hip has been bothering you for more than a few weeks, especially if you're losing sleep over it, get assessed. It's a fixable problem.