Pain on the outside of the hip is common, but it is often misunderstood. Many people are told they have “hip bursitis,” receive an injection, feel better for a while, and then wonder why the pain returns.
The bursa can certainly become irritated, but persistent lateral hip pain often involves the gluteus medius and gluteus minimus tendons, the strong tendons that attach the hip abductor muscles to the greater trochanter on the outside of the femur.
Problems along this spectrum are often grouped under the term greater trochanteric pain syndrome. They can range from tendon irritation and degeneration, called gluteal tendinopathy, to partial- or full-thickness tendon tears.
The important point is that these conditions are not all treated the same way. A person with early tendinopathy and good strength may need a very different plan from someone with a chronic full-thickness tear, weakness, and a Trendelenburg gait.
Where does lateral hip pain usually come from?
The gluteus medius and minimus muscles help stabilize the pelvis when you stand or walk on one leg. Their tendons attach near the greater trochanter, the bony prominence you can feel on the outside of the hip.
Several structures in this area can become painful:
- Gluteus medius or minimus tendons
- Trochanteric bursae
- Iliotibial band and surrounding soft tissues
- Nearby muscles and fascia
Pain can also be referred to the side of the hip from the lumbar spine, sacroiliac region, or the hip joint itself. That is one reason a careful examination matters before assuming every case is “bursitis.”
What does gluteal tendinopathy feel like?
Typical symptoms include aching or sharp pain directly over the outside of the hip. Many patients notice pain when:
- Lying on the affected side
- Walking uphill or climbing stairs
- Standing on one leg
- Getting out of a chair
- Walking longer distances
- Crossing the legs
- Sitting with the knees pressed together
- Returning to running or higher-impact exercise
Night pain can be especially frustrating because direct pressure on the painful side may compress the irritated tendon against the greater trochanter.
Some patients have pain without major weakness. Others develop a limp or have difficulty keeping the pelvis level during single-leg stance.
Is this the same thing as hip bursitis?
Not exactly.
The traditional label “trochanteric bursitis” suggests that inflammation of the bursa is the main problem. In many patients with persistent lateral hip pain, however, imaging and clinical studies show that the gluteal tendons are an important part of the condition.
That does not mean the bursa is irrelevant. Tendon and bursal irritation can occur together. But if the tendon is the main source of symptoms, repeatedly treating only the bursa may not address the underlying load problem.
For patients, the practical lesson is simple: persistent pain on the outside of the hip deserves a tendon-focused evaluation rather than assuming every case is isolated bursitis.
What is a gluteus medius tendon tear?
A tear occurs when part or all of the tendon fibers detach from their attachment on the greater trochanter.
Tears can be:
- Partial thickness
- Full thickness
- Acute after an injury
- Chronic and degenerative
- Associated with tendon retraction, muscle atrophy, or fatty degeneration
A small partial tear can sometimes behave more like severe tendinopathy. A chronic full-thickness tear with weakness may behave more like a rotator cuff tear of the shoulder, except it affects the hip abductors.
The severity of the MRI finding matters, but treatment is not based on the scan alone. Symptoms, strength, gait, duration, activity goals, response to rehabilitation, tendon quality, and overall health all influence the plan.
How can you tell if the tendon is torn?
There is no single home test that reliably diagnoses a gluteal tendon tear.
During an orthopedic examination, we may assess:
- Tenderness over the greater trochanter
- Pain with resisted hip abduction
- Pain with specific tendon-loading positions
- Hip abductor strength
- Single-leg balance
- Trendelenburg sign or gait
- Hip range of motion
- Lumbar spine and neurologic findings
- Whether symptoms appear to come from the hip joint itself
A pronounced limp or clear abductor weakness raises concern for a more substantial tendon problem, but imaging may be needed to define the anatomy.
Do you need an MRI?
Not every patient with lateral hip pain needs an MRI immediately.
If the history and examination fit uncomplicated gluteal tendinopathy and there is no major weakness, a structured rehabilitation program can often begin before advanced imaging.
MRI becomes more useful when:
- There is meaningful hip abductor weakness
- A Trendelenburg gait is present
- Symptoms persist despite appropriate rehabilitation
- A significant tendon tear is suspected
- Surgery is being considered
- The diagnosis remains uncertain
- Another hip or bone problem needs to be excluded
MRI can show tendon thickness, partial or full tearing, retraction, muscle quality, fatty infiltration, and other abnormalities around the hip.
Musculoskeletal ultrasound can also evaluate the gluteal tendons and bursa and can be useful dynamically or when guiding an injection. MRI generally provides a more comprehensive view when tear extent and muscle quality are important to treatment planning.
What is the first-line treatment for gluteal tendinopathy?
For most patients without a major acute tear or severe weakness, treatment starts nonsurgically.
One of the strongest randomized trials in this area compared education plus targeted exercise, corticosteroid injection, and a wait-and-see approach for MRI-confirmed gluteal tendinopathy. The education-and-exercise group had better global improvement than the injection group at both eight weeks and 52 weeks. The program emphasized tendon load management and progressive hip abductor strengthening.[1]
That matters because gluteal tendinopathy is not simply a problem of “inflammation.” Tendons respond to how they are loaded.
A good rehabilitation plan may include:
- Education about positions that compress the tendon
- Gradual hip abductor strengthening
- Pelvic and trunk control work
- Progressive single-leg loading
- Gait and movement assessment
- A staged return to walking, hiking, running, or sport
The goal is not to avoid using the hip. It is to reduce provocative compression while progressively rebuilding the tendon’s capacity to tolerate load.
Which positions commonly aggravate the tendon?
Some patients repeatedly compress the irritated tendon without realizing it.
Examples include:
- Sleeping directly on the painful side
- Letting the painful leg fall inward while standing
- Crossing the legs for long periods
- Sitting with the knees tightly together
- Hanging the pelvis to one side while standing
Reducing these positions does not mean becoming rigid or fearful of movement. It simply gives the tendon a better environment while strength and tolerance are rebuilt.
When symptoms permit, progressive loading is usually more useful than prolonged rest.
Do steroid injections help?
A corticosteroid injection can reduce pain for some patients, particularly in the short term. It may be reasonable when pain is limiting sleep, walking, or participation in rehabilitation.
But short-term pain relief should not be confused with rebuilding tendon capacity.
In the BMJ randomized trial, both corticosteroid injection and education plus exercise outperformed waiting at eight weeks, but education plus exercise produced better global improvement than injection. At 52 weeks, the education-and-exercise group still reported better global improvement than the injection group.[1]
This is one reason injections should usually be considered as one component of a treatment strategy, not an automatic substitute for rehabilitation.
Injection choice also depends on the diagnosis. An injection into a symptomatic bursa is different from injecting directly into a tendon substance, which is generally avoided because of concern for tendon weakening.
What about PRP or other biologic injections?
PRP is sometimes considered for chronic gluteal tendinopathy, especially when symptoms persist despite rehabilitation. The evidence remains evolving, and results vary across studies and protocols.
For actual gluteus medius tendon repair, biologic augmentation strategies such as PRP, platelet-derived products, collagen patches, grafts, and bone marrow-related products have also been studied. A 2025 systematic review concluded that comparative evidence is still insufficient to show a consistent advantage of biologic augmentation over standard repair.[2]
That means biologics should not be presented as a guaranteed way to heal a tendon tear. The specific diagnosis, tear pattern, tissue quality, prior treatment, and evidence for the proposed intervention all matter.
When might surgery be considered?
Most lateral hip pain does not require surgery.
Surgical repair becomes a more relevant discussion when there is a symptomatic partial- or full-thickness gluteal tendon tear and the patient has one or more of the following:
- Persistent pain despite a well-executed nonsurgical program
- Meaningful abductor weakness
- A persistent Trendelenburg gait or limp
- Functional limitation that interferes with walking or desired activities
- A tear pattern that is technically repairable
A 2024 review described both open and endoscopic repair as established surgical options for selected gluteus medius and minimus tears.[3] A 2026 systematic review found that published surgical studies generally reported improvements in pain and quality of life, but the certainty of evidence was very low and the literature was dominated by case series rather than randomized trials.[4]
That limitation is important. Surgery can help appropriately selected patients, but the current evidence does not support treating every MRI tear operatively.
Does waiting make a tear harder to repair?
Sometimes.
Chronic tendon tears can retract, and the associated muscle can develop atrophy or fatty degeneration. Those changes can make repair more difficult and may influence prognosis.
That does not mean every painful hip needs an urgent MRI or surgery. It means that persistent weakness, a progressive limp, or failure to improve deserves reassessment rather than months or years of repeated injections without revisiting the diagnosis.
What if the tear cannot be repaired directly?
Some chronic tears have substantial retraction, poor tendon quality, or advanced muscle degeneration. In those cases, surgeons may consider augmentation, reconstruction, or tendon-transfer strategies rather than a simple repair.
These procedures are more complex and are not needed for the majority of patients with lateral hip pain. A recent systematic review of irreparable abductor tears found multiple reconstructive strategies in the literature, but the evidence remains heterogeneous and largely based on lower-level studies.[5]
The key is identifying the problem before assuming that every lateral hip pain syndrome belongs on the same pathway.
Can lateral hip pain come from arthritis instead?
Yes.
Hip osteoarthritis more commonly causes groin or deep anterior hip pain, stiffness, and loss of motion, but pain patterns overlap. Some patients with arthritis feel pain laterally. Others have both arthritis and gluteal tendon disease.
The lumbar spine can also refer pain toward the hip, and nerve problems may produce weakness or altered gait.
A careful examination, and sometimes X-rays or advanced imaging, helps separate these possibilities.
What should active patients do?
If your goal is to return to hiking, running, cycling, strength training, martial arts, or other demanding activities, treatment should be based on function rather than pain alone.
A useful return-to-activity plan considers:
- Hip abductor strength
- Single-leg control
- Walking tolerance
- Ability to climb stairs or hills
- Balance and pelvic stability
- Pain response during and after activity
- Sport-specific loading demands
For athletes and active adults, our sports medicine care in Hawaiʻi focuses on matching the diagnosis and rehabilitation plan to the activity you actually want to return to.
When should you seek prompt evaluation?
Schedule an orthopedic evaluation if lateral hip pain is persistent, recurrent, or progressively limiting activity, particularly if you also have weakness or a limp.
Seek more urgent evaluation after a significant injury if you cannot bear weight, have severe new weakness, develop marked swelling or bruising, or have symptoms suggesting a fracture or other acute problem.
You should also seek prompt medical attention for fever with a hot or swollen hip, progressive neurologic weakness, unexplained severe night pain, or other systemic symptoms.
The bottom line
Pain on the outside of the hip is often more than simple “bursitis.” Gluteal tendinopathy and tears of the gluteus medius or minimus tendons are important causes of persistent lateral hip pain.
For many patients, the best first step is education about tendon loading plus progressive, targeted rehabilitation. Injections can sometimes help control symptoms, but they should not automatically replace a tendon-focused strengthening plan.
MRI is most useful when the diagnosis is uncertain, meaningful weakness is present, symptoms fail to improve, or a tendon tear needs to be defined for treatment planning. Surgery is generally reserved for selected patients with symptomatic tears, weakness, functional limitation, and failure of appropriate nonsurgical care.
If pain on the outside of your hip is limiting walking, sleep, exercise, or sport, or you have developed weakness or a limp, schedule an orthopedic evaluation with Pacific Bone & Joint to determine whether the problem is tendinopathy, bursitis, a tendon tear, arthritis, or another source of hip pain.
Sources and Further Reading
- Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. https://doi.org/10.1136/bmj.k1662
- Liu Y, Allen M, Kumar R, Bini S. Comparative Efficacy of Biologic Augmentations in Gluteus Medius Tendon Repair is Lacking: A Systematic Review. Orthopedic Reviews. 2025;17:143293. https://doi.org/10.52965/001c.143293
- Morgan A, et al. Surgical Treatment and Outcomes for Gluteal Tendon Tears. Current Reviews in Musculoskeletal Medicine. 2024. PMID: 38619805.
- Fearon A, et al. Low quality evidence supports surgery for gluteal tendon tears, no non-surgical evidence was identified: a systematic review. BMC Musculoskeletal Disorders. 2026. https://doi.org/10.1186/s12891-026-09519-0
- Treatment Options for Irreparable Hip Abductor Tears: A Systematic Review and Meta-Analysis. Journal of Hip Preservation Surgery. 2025.
