If you’ve been dealing with persistent pain on the outside of your hip—especially with stairs, walking, or lying on that side—you’ve probably been told it’s bursitis.  That explanation is common, but often incomplete.

In many cases, the real issue is gluteal tendinopathy, a condition involving the tendons of the glute muscles where they attach to the outer hip. This is a very common condition, affecting around 1 in 4 middle-aged women, and is one of the leading causes of persistent lateral hip pain. The reason it lingers is simple: it’s usually treated like an inflammatory problem when it’s actually a mechanical one.

We recently broke this down step-by-step in our YouTube video, including visual demos of the key positions and exercises—but here’s what you need to understand first.

 

Where It Hurts (and Why It Spreads)

The pain on the outside of the hip (gluteal tendinopathy) typically sits over the bony point (greater trochaner) of the hip but can also spread into the outer thigh, buttock, or down the side of the leg (usually not past the knee). This pattern is common in people with lateral hip pain, and it is often mistaken for bursitis.

What makes it more noticeable is how it behaves. It often worsens with stairs, prolonged walking, sitting for too long, or standing on one leg. Pain on the outside of the hip when lying on that side is one of the most common and aggravating symptoms.

The Real Cause: Compression, Not Inflammation

The key to understanding this condition is recognizing that it’s not primarily about inflammation—it’s about how the tendon is being loaded.

The gluteal tendons become irritated when they are repeatedly compressed against the hip bone while also being placed under tension. This happens when the hip drops, the leg crosses inward, or the pelvis isn’t well controlled during movement.

There is often a nearby bursa that becomes irritated, which is why “bursitis” gets blamed. But that irritation is usually a side effect, not the root problem. If you only treat inflammation, you’re not addressing why the tissue is being overloaded in the first place.  Grimaldi et al. – Mechanisms, Assessment & Management (2015)

Why Stretching Often Makes It Worse

One of the most common mistakes in people with gluteal tendinopathy (pain on the outside of the hip) is trying to stretch the hip to relieve symptoms.

It seems logical, but hip stretching for outer hip pain often increases both compression and tension on the already sensitive gluteal tendon. Positions where the leg crosses the body or the hip is taken into a deep stretch can actually increase lateral hip pain and keep the irritation cycle going.

If you’ve been stretching consistently for pain on the outside of the hip without improvement—or even feeling worse—this is likely why.

Postures/Activity Modifications

Certain everyday positions can either calm or continue to irritate the tendon depending on how much compression they create at the outside of the hip. Below are some simple “good vs bad” movement and sleep positions to help guide what to avoid and what to do instead.

🟢 Good (reduces tendon compression)

• Standing with weight evenly distributed through both legs
• Walking with a hip-width stance (feet not crossing midline)
• Sleeping with a pillow between the knees or on your back

🔴 Bad (increases tendon compression)

• Sitting with legs crossed
• Leaning into one hip while standing
• Walking with feet crossing toward the midline
• Lying directly on the painful side
• Letting the top leg drop inward during sleep

The Real Fix: Progressive Strengthening

Unlike muscles, tendons don’t respond well to rest alone. They need gradual, controlled loading to adapt and recover.

A key first step is setting the correct dosage and a simple baseline test—such as how long you can walk, stand on one leg, or perform a basic bridge without pain increasing beyond mild levels. This helps guide safe progression.

Early on, isometric exercises (where the muscle contracts without movement) can reduce pain while activating the glutes. From there, rehab progresses into slow, controlled strengthening like bridges, squats, and step-ups.

The goal isn’t just strength but improving how the hip manages load. 

There’s a lot of outdated advice around lateral hip pain, and some common recommendations—like stretching or relying on injections—can actually make things worse. Much of this comes from treating it like bursitis instead of a load-related tendon issue. We break down the biggest myths and what to do instead in the video below.

3 Main Goals for Gluteal Tendinopathy Treatment

1. Reduce compression
Temporarily modify or avoid positions that irritate the tendon—like crossing your legs, leaning into one hip, or lying on the painful side—to help calm symptoms.

2. Improve biomechanics
Develop better control of the pelvis and hip during movement. Keeping the pelvis stable reduces unnecessary stress on the tendon with activities like walking and stairs.

3. Build strength and capacity
Gradually strengthen the glute muscles and tendon through progressive loading so they can tolerate daily and higher-level activities without pain. Mellor et al 2018

How to Gauge Pain Without Making It Worse (Stoplight Rule)

• Some mild discomfort is normal during rehab and expected as the tendon adapts (keep pain around ≤ 4/10).
• Pain should settle quickly—it should calm down within a few hours after exercise or stopping and should not be worse the next morning.
• Use the traffic light rule:
• 🟢 Green: Some mild discomfort is normal (up to ~4/10 pain) and acceptable during rehab
• 🟡 Yellow: Any pain increase should settle within a few hours after exercise or stopping activity
• 🔴 Red: Pain should not be worse the next morning—if it is, reduce load or stop and adjust your rehab plan

Key Diagnostic Tests for Gluteal Tendinopathy

Curious if you may have gluteal tendinopathy (often called hip bursitis)? Here are 4 simple clinical tests commonly used to assess outer hip pain and irritation of the gluteal tendons.

1. Single Leg Stance Test

• Stand on one leg for up to 30 seconds to load the gluteal tendons.
• Pain over the outer hip is considered a positive test.

2. Resisted Hip Abduction Test

• The patient pushes the leg outward against resistance.
• Pain or weakness may indicate gluteal tendon involvement.

3. FADER-R Test

• The hip is placed into flexion, adduction, and external rotation with resistance applied.
• Reproduction of lateral hip pain suggests gluteal tendon irritation.

4. FABER Test

• The leg is positioned in a figure-four shape to assess hip movement and symptoms.
• Pain around the outer hip may indicate gluteal tendinopathy.

Why Gluteal Tendinopathy Is More Common in Post-Menopausal Women

Gluteal tendinopathy is more common in post-menopausal women in part due to changes in estrogen levels. Estrogen supports collagen production and tendon repair, so when levels decline, tendons may become less strong and less able to tolerate load.

Lower estrogen may also reduce tendon stiffness and increase pain sensitivity, making the tissue more reactive. Combined with age-related muscle loss and changes in fat distribution around the hip, this can increase stress on the gluteal tendons during daily activities.

In some cases, doctors may assess hormone levels (such as estradiol and FSH) to confirm estrogen deficiency and discuss whether hormone replacement therapy is appropriate.

Why Injections Don’t Solve the Problem

Corticosteroid injections can reduce pain in the short term, but they don’t address the underlying mechanics. Without changing how the tendon is being loaded, symptoms often return.

In many cases, long-term outcomes are better with education and structured rehabilitation than with passive treatments alone.

The Bottom Line

Gluteal tendinopathy persists when it’s treated as an inflammatory issue instead of a loading problem. A landmark clinical study by Rompe et al. (2009) followed 229 patients and compared treatment outcomes—and the results are a wake-up call for anyone considering a steroid injection, especially for persistent cases seen in Redmond, Washington.

When you reduce compressive positions, improve pelvic control, and progressively strengthen the tendon, the condition becomes much more manageable—and often fully reversible.

Temporary relief comes from calming symptoms. Lasting relief comes from changing how your hip handles load.

If you want a done-for-you plan, we’ve put together a step-by-step rehab program that walks you through exactly how to progress exercises, manage pain, and build strength safely over time.

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Performance Sport & Spine l Chiropractic & Sports Rehab in Redmond WA | Vagaro

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.