What gluteal tendinopathy is
Greater trochanteric pain syndrome describes pain over the bony prominence at the side of the hip. The dominant source is tendinopathy of the gluteus medius and minimus tendons where they attach to that bone.
The name bursitis stuck for decades, and imaging and surgical series have since shown that isolated bursal inflammation is uncommon, with tendon change present in the large majority of cases. That matters, because a tendon needs load and a bursa gets injected.
The pattern is distinctive: pain lying on the affected side at night, pain on single-leg loading such as stairs and hills, and pain on standing with the weight shifted onto one hip.
What causes it
The mechanism is compression combined with tensile load. When the hip adducts, meaning the thigh crosses toward the midline, the iliotibial band compresses the gluteal tendons against the bone underneath. Repeat that often enough and the tendon becomes painful.
This explains why the aggravating positions are so consistent: sitting with legs crossed, standing hanging on one hip, sleeping on the side with the top knee dropped forward, and running with a narrow stride.
What provokes it
- Sitting with the legs crossed for long periods
- Standing with weight shifted onto one hip
- Sleeping on the painful side, or on the other side with the top knee dropped across
- Weakness in the hip abductors, particularly through the outer range
- A rapid increase in running or hill walking volume
- Post-menopausal hormonal change, which is associated with the marked female predominance
The single most effective early intervention is often positional rather than exercise-based. A pillow between the knees at night, stopping the habit of crossing the legs, and standing evenly on both feet remove the compression that keeps the tendon irritable. Many people get a noticeable improvement in the first week from those three changes alone, which then gives the loading programme room to work.
What the evidence says
A well-designed randomised trial compared education plus exercise, corticosteroid injection, and a wait-and-see approach. Education plus exercise was clearly superior at eight weeks and remained superior at 52 weeks, while injection performed well early and faded.
Progressive hip abductor strengthening is the core of treatment, performed in positions that avoid hip adduction so the tendon is loaded without being compressed.
Load management education has a large effect here relative to other tendinopathies, because the compressive positions are so common in daily life and so easily changed.
Shockwave therapy has some supporting evidence for recalcitrant cases that have not responded to a proper loading programme.
Surgery is rarely indicated and is reserved for the small number of cases with a confirmed full-thickness gluteal tendon tear that has failed conservative management.
Recovery timeline
Most people notice an improvement in night pain within two to four weeks of changing the aggravating positions. Meaningful improvement in loading tolerance takes three to six months, since tendon adaptation is slow.
It is a condition where the early wins come from what you stop doing and the lasting change comes from what you build.
| Stage | ✓ Do this | ✗ Avoid this |
|---|---|---|
| Weeks 1–2 | Pillow between the knees at night. Stop crossing legs. Stand evenly. Isometric abductor holds. | ITB foam rolling directly over the painful point, which adds compression |
| Weeks 2–8 | Progressive abduction strengthening in neutral, avoiding positions that cross the midline. | Clamshells with the top knee dropping across, or deep adduction stretches |
| Weeks 8–16 | Add single-leg loading: step-ups, split squats, graded return to hills and running. | Returning to hill running before single-leg strength is symmetrical |
| Ongoing | Two abductor sessions a week, and keep the positional habits. | Reverting to crossed legs once the pain settles |
How we treat it at Kingsway
Treating a painful hip
Assessment confirms the tendon as the source, screens the lumbar spine since referred pain mimics this well, and identifies which daily positions are keeping it going.
- Palpation and single-leg loading tests to confirm the source
- Lumbar spine screen, since referred pain from the back can present identically
- Hip abductor strength testing in neutral and outer range
- Soft tissue release through the glutes and tensor fascia lata, avoiding compression over the tendon itself
- Radial shockwave therapy for cases past three months of loading
- A positional advice sheet plus a progressive abductor programme
Four to six sessions over three months is typical, with the first two close together to get the positional changes and early loading right, then spacing out as the programme progresses.
When to get it checked
Book an assessment if hip pain is disturbing your sleep, if it has lasted more than a month, or if it is limiting stairs and walking. Getting the positional advice early makes a substantial difference to how quickly it settles.
See a doctor or go to A&E if
- Hip pain following a fall, particularly in anyone with osteoporosis, which needs a fracture excluded
- Inability to weight-bear on the leg
- Groin pain with restricted rotation, which points to the hip joint rather than the tendon
- Fever, redness or heat over the hip
- Unexplained weight loss or a history of cancer alongside new hip pain
Common questions
Is it bursitis?
Usually not in isolation. Imaging and surgical studies find tendon change in the large majority of cases of pain at the side of the hip, with bursal inflammation as a secondary finding when it is present at all.
The distinction matters because a tendon improves with graded loading, while treating it as a bursitis tends to lead to repeated injections that work briefly.
Should I foam roll my IT band?
Rolling directly over the painful point at the side of the hip adds compression to an already compressed tendon and commonly makes it worse.
Soft tissue work higher up the thigh and through the glutes is better tolerated, and the abductor strengthening is what changes the problem.
Why does it hurt so much at night?
Side-lying compresses the tendon directly against the bone. Lying on the other side with the top knee dropped forward does the same thing by pulling the hip across the midline.
A pillow between the knees, thick enough to keep the thighs roughly parallel, resolves a large share of night pain within a week or two.
Should I have an injection?
Injection gives useful short-term relief, and the trial evidence shows education plus exercise doing better at both eight weeks and twelve months.
If night pain is severe enough to prevent any sleep, an injection can be a reasonable way to get started with the loading work, discussed with your GP.