If you have pain on the outside of your hip, there’s a good chance you’ve been told it’s bursitis.
There’s also a good chance that’s not what it is.
When researchers have looked at what’s actually going on in lateral hip pain — through imaging and through surgery — the most common finding isn’t an inflamed bursa. It’s tendinopathy of the gluteal tendons, the gluteus medius and minimus, where they attach to the bony prominence on the outside of your hip. Studies examining greater trochanteric pain syndrome have specifically noted how rarely primary bursitis turns out to be the culprit.
That distinction matters enormously, because it changes what you should be doing. And in this particular condition, a great deal of the improvement comes from something most people are never told about: the positions you spend your day in.
The Mechanism, in One Paragraph
Your gluteal tendons wrap around the bony point on the outside of your hip — the greater trochanter. Running over the top of them is the iliotibial band, a thick sheet of connective tissue down the outside of your thigh.
When your hip moves into adduction — when your thigh crosses towards or past the midline of your body — the ITB tightens over the trochanter and compresses the tendons underneath against the bone.
That compression is the problem. It’s thought to be the mechanism by which gluteal tendinopathy develops and persists. And it means that any position placing your hip in adduction is, for hours at a time, squeezing an already irritated tendon.
Once you understand that, the whole management approach becomes obvious.
The Positions to Audit
Crossing your legs. The single most common one, and completely automatic for most people. Sitting with one leg crossed over the other places the upper hip in significant adduction. If you do this for hours a day at a desk, in meetings, or on the sofa, that’s hours of compression.
What to do instead: Sit with knees roughly hip-width apart, feet flat. If crossing feels necessary for comfort, cross at the ankles rather than the knees.
Standing hanging on one hip. The classic posture when you’re waiting, queuing, or holding a child — weight shifted onto one leg, that hip pushed out sideways. It puts the standing hip into adduction and it’s a position people hold for long periods without noticing.
What to do instead: Stand with weight distributed evenly between both feet. It feels less relaxed at first, which tells you how habitual the other pattern has become.
Sleeping on your side. This one causes a lot of the sleepless nights that make this condition so miserable. Lying on the painful side compresses the tendons directly. Lying on the unaffected side is often no better, because the top leg drops across the body into adduction.
What to do instead: Lie on the less painful side with a pillow — a firm one, and a substantial one — between your knees and ankles, thick enough to keep the top leg roughly parallel with the mattress rather than dropping forwards and across. Some people do better on their back with a pillow under the knees.
Low, soft seating. Deep sofas and low chairs push the hips into more flexion and often more adduction, and they’re harder to rise from, which loads the tendons on the way up.
What to do instead: Higher, firmer seating where you can. A cushion to raise the seat height helps.
Sitting with knees together and feet apart. Common, particularly in skirts or in cramped seating. It’s adduction by another route.
Sleeping or resting with the top leg hitched forwards. Even with a pillow, if the top leg slides forward across the body overnight, the compression returns. A longer pillow, or a body pillow, holds the position better.
The Things You’ve Been Told to Do That Make It Worse
This is where a lot of people go wrong, usually with the best intentions.
Stretching the outside of your hip. The classic figure-four stretch, or pulling the knee across the body, or the standing IT band stretch where you cross one leg behind the other and lean. Every one of those positions is hip adduction — which is to say, every one of them compresses the tendon you’re trying to help.
Stretches that increase compression have been specifically identified as a problem in the management of this condition. If you’ve been diligently stretching your “tight” hip and it’s not improving, this may well be why.
Foam rolling the IT band. Rolling directly over the outside of the hip presses the ITB into the very tendons that are already being compressed. It often feels productive and frequently isn’t.
Waiting for it to settle. Which brings us to the evidence.
What the Research Actually Found
A randomised trial published in the BMJ in 2018 — the LEAP trial — compared three approaches in 204 people with gluteal tendinopathy: education on load management plus exercise, a single corticosteroid injection, and a wait-and-see approach.
The education and exercise group did better than both the injection group and the wait-and-see group, on global improvement and on pain. Not only in the short term — those improvements were maintained at 52 weeks.
Two things are worth pulling out of that.
First, the injection underperformed education and exercise, both at eight weeks and at a year. Corticosteroid injection has long been the default offering for lateral hip pain, and this trial is a significant part of why that’s being reconsidered.
Second, education was half the intervention. Not education as a pleasant add-on to the real treatment — education about load management, meaning precisely the positional advice above, delivered as a core component alongside the exercise programme.
If nobody has talked to you about how you sit, stand and sleep, you’ve had half the treatment.
The Loading Half
Positional change reduces the compression. It doesn’t build the tendon’s capacity, and both are needed.
Loading programmes for this condition typically progress through stages — beginning with gentle isometric work to settle symptoms, moving into controlled strengthening of the hip abductors while keeping the hip out of adduction, and progressing to more demanding functional loading over time.
The important principles: it’s progressive, it avoids compressive positions particularly early on, and it takes months rather than weeks. Tendon tissue adapts slowly. Expecting resolution in a fortnight is the most common reason people abandon a programme that was working.
Who Tends to Get This
Lateral hip pain of this kind is particularly common in women aged roughly 40 to 60. It’s frequently persistent, it disturbs sleep, and research has documented its effect on work, physical activity and quality of life.
It’s also commonly mislabelled, undertreated, and dismissed as something to live with — which, given what the trial evidence shows, it isn’t.
When to Get It Checked Rather Than Self-Managed
Lateral hip pain has other causes. Seek assessment for pain in the groin rather than the outside of the hip, which more often points towards the joint itself; pain following a fall or significant trauma; an inability to weight-bear; night pain that’s severe and unrelenting regardless of position; hip pain with fever, unexplained weight loss or feeling generally unwell; any history of cancer with new hip pain; or pain with numbness, tingling or weakness down the leg.
Also worth assessing: lateral hip pain that has persisted for months despite the changes described here. Getting the diagnosis confirmed is worth more than another few months of guessing.
Get the Other Half of the Treatment
Positional advice and a properly progressed loading programme are what the evidence supports. Most people arrive having had neither.
Chadwick’s Physiotherapy offers a free discovery visit at no cost and no obligation. You’ll get a proper assessment to confirm what’s actually causing your lateral hip pain, a review of the positions and habits contributing to it, and a loading programme progressed appropriately for your stage.
If your presentation suggests something other than gluteal tendinopathy, we’ll tell you plainly and help you get to the right place.