Why Your “Hip Bursitis” May Not Actually Be Bursitis
If you’ve been told you have hip bursitis, “glute tendonitis,” or “trochanteric bursitis,” but rest, stretching, or anti-inflammatory treatments haven’t helped, there’s a good chance the real issue is being missed.
Do you have:
- Pain on the outside of your hip when walking
- Hip pain when lying on your side
- Pain going upstairs or standing on one leg
You are not alone.
Gluteal tendinopathy is one of the most common causes of outer hip pain, especially in adults over 40, and is frequently mistaken for “hip bursitis.”
Modern research shows that in most persistent cases, the gluteal tendons—not the bursa—are the main source of symptoms.
The good news is that once you understand why tendon compression and load tolerance matter, recovery becomes much more predictable.
This article is informed by current evidence in hip pain rehabilitation, including the work of Dr. Alison Grimaldi (BPhty, MPhty (Sports), PhD, FACP), whose research has helped reshape modern understanding of this condition.
A key source informing this perspective is the 2025 open-access review, “Gluteal tendinopathy masterclass: Refuting the myths and engaging with the evidence” published in Musculoskeletal Science and Practice (ScienceDirect), which highlights that gluteal tendinopathy is the primary driver of lateral hip pain in most cases, rather than isolated bursal inflammation.
🎥 Watch This Video First
Before diving into the myths below, watch this video explaining:
- Why “hip bursitis” is often misdiagnosed
- Why stretching may actually worsen symptoms
- The biggest rehab mistakes people make
- And how tendon compression affects recovery
This will make the rest of the article much easier to understand.
What Is Gluteal Tendinopathy?
gluteal tendinopathy involves irritation and degeneration of the gluteus medius and gluteus minimus tendons, which attach to the outside of the hip near the greater trochanter.
These tendons help stabilize the pelvis during:
- Walking
- Running
- Climbing stairs
- Standing on one leg
When overloaded or repeatedly compressed, they can become painful and sensitive.
Common symptoms include:
- Pain on the outside of the hip
- Hip pain lying on your side
- Pain walking longer distances
- Pain climbing stairs
- Tenderness over the outside hip bone
- Pain standing on one leg
-
New to Gluteal Tendinopathy?
If you are new to gluteal tendinopathy and want to learn more about the causes, symptoms, diagnosis, and treatment options for outer hip pain, check out our complete guide below:
Myth #1: Outer Hip Pain Is Always “Hip Bursitis”
One of the biggest misconceptions is that pain on the outside of the hip is mainly caused by inflammation of the bursa.
While the bursa can become irritated, imaging studies consistently show that the gluteal tendons are usually the primary source of pain, not the bursa itself. Bursitis in
Research commonly finds:
- Tendon thickening
- Tendon degeneration
- Tendon compression changes
Meanwhile, isolated bursitis without tendon involvement appears to be relatively uncommon.
Clinical Pearl
Persistent outer hip pain is more commonly a tendon compression and load intolerance problem than a pure inflammatory bursitis issue.
Myth #2: This Only Happens in Older Women
Although gluteal tendinopathy is more common in postmenopausal women, it can affect:
- Men
- Runners
- Active adults
- Postpartum mothers
- People with hip or knee arthritis
Hormonal changes, altered walking mechanics, surgery history, and sudden increases in activity can all contribute.
At clinics around Redmond, we frequently see recreational athletes and active adults struggling with this condition—not just older populations.
Clinical Pearl
The issue is usually not age itself—it is the tendon’s ability to tolerate load and compression.
Myth #3: Pressing on the Hip Alone Diagnoses the Problem
Tenderness over the outside of the hip is common, but this alone does not confirm gluteal tendinopathy.
A stronger diagnosis combines:
- Tenderness over the greater trochanter
- Pain or weakness with resisted hip abduction
- Pain standing on one leg for 30 seconds
- Provocative hip tests such as FADER testing
The more positive findings present, the more likely the diagnosis.
Clinical Pearl
Pain during single-leg loading is one of the most useful signs of gluteal tendinopathy.
Myth #4: MRI Alone Can Diagnose the Problem
Many people are surprised to learn that MRI findings do not always match symptoms.
Research shows many adults without hip pain still demonstrate:
- Tendon degeneration
- Tendon thickening
- Partial tears
This means imaging findings must always be interpreted alongside a clinical examination.
Clinical Pearl
Treat the person—not just the MRI.
Myth #5: Does Rest Help Gluteal Tendinopathy?
Complete rest is rarely the best solution.
Many people initially improve with rest, only for symptoms to return when activity resumes.
The tendon usually needs:
- Progressive strengthening
- Better load management
- Reduced compression
- Gradual return to activity
Clinical Pearl
Tendons generally respond better to gradual loading than prolonged rest.
🚨 Why Most People Fail Rehab
One of the biggest reasons people continue to struggle with gluteal tendinopathy is that they are:
- Stretching irritated tendons
- Avoiding all activity
- Progressing exercises too quickly
- Or not strengthening the hip enough
Many rehab plans fail because they do not properly address:
- Tendon compression
- Load progression
- Pain-guided exercise progression
Ready to Start Rehab the Right Way?
If you want a structured, step-by-step rehab plan designed specifically for gluteal tendinopathy and outer hip pain, check out our guided rehab program below.
The program includes:
- Progressive strengthening phases
- Exercise demonstration videos
- Pain-guided progression rules
- Load management education
- Flare-up guidance
- Return-to-walking and activity recommendations
Myth #6: Stretching the Hip Helps
This is one of the most common mistakes.
Many traditional hip stretches place the irritated tendon under:
- Compression
- Tension
- Friction against the bone
This often increases symptoms.
Positions that aggressively stretch the outside hip or pull the leg inward can significantly aggravate pain.
Clinical Pearl
For many people, reducing compression is more helpful than increasing flexibility.
Myth #7: Cortisone Injections Are the Best First Treatment
Corticosteroid injections can temporarily reduce pain, but they may not address the underlying tendon problem.
Repeated injections may:
- Weaken tendon tissue
- Reduce long-term tendon health
- Delay proper rehabilitation
Education and strengthening generally provide more sustainable long-term improvement.
Clinical Pearl
Short-term pain relief does not always equal long-term recovery.
Myth #8: Clamshells Are the Best Exercise
Clamshells are commonly prescribed but are often overused and poorly progressed.
In some people, clamshells may:
- Increase tendon compression
- Irritate symptoms
- Provide insufficient loading for meaningful tendon adaptation
More functional weight-bearing exercises are often more effective.
Clinical Pearl
The best exercise is not the most popular one—it is the one your tendon tolerates and adapts to.
Myth #9: Every Glute Tendon Tear Needs Surgery
Hearing the word “tear” on an MRI can sound alarming, but not all tears require surgery.
Many partial tendon tears improve significantly with:
- Proper strengthening
- Activity modification
- Progressive loading
Surgery is usually considered only when:
- Symptoms persist for months
- Significant weakness exists
- Function remains severely limited
Clinical Pearl
Imaging findings do not automatically predict pain or disability.
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Frequently Asked Questions About Gluteal Tendinopathy
Is walking good for gluteal tendinopathy?
Walking is often beneficial when symptoms are managed appropriately. However, walking volume may need temporary modification during flare-ups.
Why is hip pain worse at night?
Lying on the affected side increases compression of the irritated gluteal tendons, which can significantly worsen symptoms at night.
How long does gluteal tendinopathy take to heal?
Mild cases may improve within 6–12 weeks, while more persistent cases can take several months depending on tendon irritability and load tolerance.
Should I stretch gluteal tendinopathy?
Aggressive stretching of the outer hip often worsens symptoms because it increases tendon compression.
Can gluteal tendinopathy heal without surgery?
Yes. Most cases improve significantly with proper strengthening, load management, and activity modification.
Final Thoughts
Gluteal tendinopathy is one of the most misunderstood causes of outer hip pain. Many people are incorrectly told they simply have “hip bursitis” and are advised to rest or stretch—often making symptoms worse.
The good news is that with proper education, progressive strengthening, and load management, most people can improve significantly and return to normal activities.
If you are struggling with persistent hip pain near Redmond or the greater Seattle area, understanding the difference between inflammation and tendon overload may be the first step toward meaningful recovery.
Medical Disclaimer
This article is intended for educational and informational purposes only and should not be considered medical advice or a substitute for individualized evaluation or treatment.
While we aim to provide evidence-informed rehabilitation guidance, every individual and injury is different. Always consult a qualified healthcare professional regarding your specific condition, symptoms, or treatment plan.
Participation in any exercise program is done at your own risk.
