Outer Hip Pain
Pain on the outside of the hip, worse lying on that side, on stairs or rising from a chair. Usually cranky buttock (gluteal) tendons rather than “bursitis”. Slow to settle, but very fixable.
The outer hip pain ladder
Start at the bottom, climb only if you need to. Tendons are slow: give exercise at least 12 weeks before you judge it.
- Step 1 · Self-careTake the squash off the tendonNo leg crossing, no low chairs, no hanging on one hip. Sleep with a pillow between your knees, and break up long walks.
- Works
- Not tested alone, but key to the education in LEAP’s winning program; makes every other step work better
- Cost
- Free (maybe a decent pillow)
- How long
- Start now; most improve over 2–3 months
- Watch for
- Stretches that pull the leg across your body squash the tendon and usually make it worse.
Standing with all your weight on one hip is a pose, not a posture.
- Step 2 · PharmacyAnti-inflammatory gel or a short course of tabletsDiclofenac or ibuprofen gel, or ibuprofen or naproxen tablets, for bad patches or poor sleep.
- Works
- Small benefit: in arthritis trials about 1 extra person in 10 gets good relief; doesn’t fix the tendon
- Cost
- Gel about $15–30; tablets about $5–15
- How long
- A week or two around bad patches
- Watch for
- Tablets: stomach upset, kidney and heart risks. Not for everyone: check with your pharmacist.
A painkiller is a bridge, not a destination.
- Step 3 · Allied healthEducation and exercise with a physioA program that gradually strengthens the hip muscles and teaches you to stop squashing the tendon.
- Works
- About 3 in 4 improved in the Australian LEAP trial at 8 weeks (vs 3 in 10 waiting) and at 1 year: better than an injection
- Cost
- About $90–130 a session; Medicare rebates with a GP care plan
- How long
- At least 12 weeks, mostly done at home
- Watch for
- Mild soreness is fine if it settles by the next morning.
The boring answer that actually wins. Annoying, we know.
- Step 4 · Allied healthShockwave therapyPulses of sound energy to the tendon, usually from a physio, for pain that hangs on.
- Works
- In one trial, about 7 in 10 improved at 4 months (vs 4 in 10 with home exercise); evidence is limited
- Cost
- About $60–120 a session, usually 3–5 sessions
- How long
- Weekly for 3–5 weeks
- Watch for
- Sore during and after. An add-on to exercise, not a replacement.
Loud, a bit zappy, and still needs you to do your exercises.
- Step 5 · ProcedureSteroid (cortisone) injectionAn injection near the tendon, often with ultrasound guidance.
- Works
- About 6 in 10 improved in LEAP: good short-term relief, but at 1 year no better than waiting it out
- Cost
- About $0–250 depending on the clinic; sometimes bulk-billed
- How long
- Relief for weeks to a few months
- Watch for
- Pain flare for a day or two, skin thinning or lightening, a temporary rise in blood sugar if you have diabetes. Repeated injections may weaken the tendon.
Great at buying time. Spend the time on exercises.
- Step 6 · SpecialistSurgeryFor a torn tendon, or long-lasting pain despite good rehab. Rarely needed.
- Works
- No good trials; case series suggest it helps selected people
- Cost
- Free in the public system (expect a wait); private out-of-pocket costs often run to thousands
- How long
- Months of rehab afterwards
- Watch for
- Usual surgical risks. Needs an orthopaedic assessment and usually an MRI first.
The last rung, not a shortcut past the physio.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Stretching the ITB and foam rollingThese squash the sore tendons against the bone, which can make outer hip pain worse. Stretch something else.
- Scans ‘just to see’Tendon changes are common in people with no pain, and a scan rarely changes the first steps. Exercise first; scan if you’re not improving.
- Platelet-rich plasma (PRP) injectionsSmall trials with mixed results, often hundreds of dollars a shot, and not proven better than a good exercise program.
- Waiting it outIn the LEAP trial, wait-and-see did worst. Tendons respond to the right load, not to being ignored.
What you can do
- Uncross your legs. Yes, you just did it again.
- Sleep on your back, or on the good side with a pillow between your knees.
- Swap hills and stairs for swimming or cycling for now.
- If you are above a healthy weight, losing some takes load off the tendons.
- Do the exercises: our hip pain exercise handout has sets and progressions on one page.
See your GP if
- No better after 6 to 8 weeks of exercise
- Groin pain, a limp or a stiff hip (could be the hip joint itself)
- Pain spreading down the leg with numbness or tingling
See a doctor the same day for a hot, swollen, very painful hip with fever, or if you can’t put weight on your leg after a fall.
Common questions
Is outer hip pain bursitis?
Usually it’s irritated buttock (gluteal) tendons rather than bursitis, though both affect the same area. It’s most common in women over 40 and often takes a few months to settle.
What is the best treatment for outer hip pain?
A physio-guided education and exercise program. In the Australian LEAP trial, about 3 in 4 people improved at 8 weeks and at 1 year, more than with a steroid injection. Allow at least 12 weeks.
Should I have a cortisone injection for hip bursitis?
It eases pain in the short term, but at 1 year it was no better than waiting it out in the LEAP trial. Repeated injections may weaken the tendon. Use the relief to get going with exercise.
How should I sleep with outer hip pain?
Sleep on your back, or on the good side with a pillow between your knees. Avoid crossing your legs and sitting in low chairs.
What causes outer hip pain?
Most often gluteal tendinopathy: the tendons of the buttock muscles become sensitive where they attach to the side of the hip. It’s linked to compression (crossing legs, hanging on one hip), sudden increases in activity, menopause and extra body weight.
How long does outer hip pain last?
Without treatment it often lingers for many months and can last a year or more. With a good exercise and education program, most people improve within about 8 weeks and keep improving over the following months.
Is walking good for hip bursitis?
Usually, yes, at a comfortable pace and distance. Hills, stairs and long walks can flare it early on, so build up gradually. Avoid standing with your weight on one hip and crossing your legs.
Helpful resources
- Hip pain exercise handoutPrintable, one page, with sets and progressions. Free, from us.
- RNOH: Patient’s guide to gluteal tendinopathySitting, sleeping and activity tips that take pressure off the tendon, from a specialist NHS orthopaedic hospital. Free.
Evidence and more information
- Healthdirect: Greater trochanteric pain syndrome
- LEAP trial (BMJ 2018): Exercise vs injection vs wait and see
- Cambridge University Hospitals: Gluteal tendinopathy
- Running Physio: LEAP trial results summary
- Am J Sports Med (2009): Shockwave vs injection vs home exercise
- Cochrane: Anti-inflammatory gels for chronic pain
maladywise.com/hip-pain/