By Dr. Zach Greenwade, DC, MS | Published: August 26th, 2026

If you’re dealing with pain on the outside or lateral aspect of your hip, there is a high probability you’ve been diagnosed with hip bursitis (inflammation of the trochanteric bursa).

Clinical and imaging research suggests that isolated trochanteric bursitis is uncommon; lateral hip pain is more often associated with gluteal tendon pathology and other structures around the greater trochanter.

While cortisone injections, rest, and ice might offer short-term relief, they fail to deliver lasting results because they target inflammation rather than the underlying structural driver. Understanding the key differences in a trochanteric bursitis vs. gluteal tendinopathy breakdown is essential for choosing the right recovery strategy. In most cases, building long-term durability requires a targeted progressive exercise protocol, detailed in our comprehensive gluteal tendinopathy management guide.

If you prefer to watch a visual walkthrough of the anatomy, daily position fixes, and exercise demonstrations, check out our full video breakdown on YouTube below.

Trochanteric Bursitis vs. Gluteal Tendinopathy

To understand why traditional treatments fail, we have to look at hip anatomy:

• The Bone: The greater trochanter is the broad bony prominence on the outside of your hip.

• The Bursa: A fluid-filled cushion designed to reduce friction between soft tissues and bone.

• The Tendon: The gluteus medius and minimus tendons, which anchor the lateral hip muscles directly onto the greater trochanter.

In one MRI study of patients with greater trochanteric pain syndrome, only 2 of 24 patients (8.3%) demonstrated trochanteric bursal distension—and importantly, neither had isolated bursal pathology; both had gluteus medius pathology.  Bird PA, Oakley SP, Shnier R, Kirkham BW. (2001) Gluteal tendon pathology appears to be a more common finding than isolated trochanteric bursitis in patients with lateral hip pain-degeneration, micro-tears, or compression overload of the gluteal tendons.  For example, ultrasound found some form of trochanteric bursitis in 20.2% of 877 patients, but only 8.1% had bursitis without accompanying gluteal tendinopathy.  Long et al (2013)

Why Cortisone and Aggressive Stretching May Not Solve the Problem

Compression of the gluteal tendons against the greater trochanter—particularly in hip adduction—is thought to contribute to symptoms and may reduce the tendon’s ability to tolerate load.

When your hip moves into adduction (crossing midline), the gluteal tendon compresses directly against the greater trochanter. Aggressive stretching or foam rolling can increase compression around the greater trochanter and may aggravate symptoms in an irritable tendon.

4 Cardinal Symptoms of Gluteal Tendinopathy

• Nighttime Pain: Difficulty sleeping on the affected hip, or sleeping on the unaffected side without support (causing the top leg to drop across midline).

• Weight-Bearing Pain: Sharp or dull aching during walking, running, or single-leg stance.

• Stair Aggravation: Increased pain climbing stairs, particularly when the pelvis drops or tilts side-to-side.

• Start-Up Stiffness: Stiffness when standing up after prolonged sitting that gradually eases after a few steps.

Daily Modifications: 6 Tips to Decrease Hip Pain

Reducing excessive or provocative compressive loading throughout the day is an important early step in recovery. Check out our guide to optimal posture and daily activity modifications to learn how to adjust your sitting, standing, and sleeping habits to protect your hip.  Mellor R, Bennell K, Grimaldi A, et al. (2018), Grimaldi & Fearon, (2015)

Posture & Position Adjustments

1. Sitting Position: Keep feet wider than hip-width apart. Never cross your legs or sit with your knees touching.

1. Standing Stance: Distribute weight evenly across both feet. Avoid sinking into or leaning onto one hip (“hip hanging”).

1. Sleeping Posture: Sleep on your back with a pillow under your knees. If side-sleeping, place a thick pillow between your knees and ankles to keep the top leg level.

Walking & Stair Modifications

4. Soft Heel Strike: Reduce stride length and land softly on the heel to minimize ground reaction forces.

5. “Think Tall”: Engage your core and keep the pelvis level during every step to prevent hip drop (Trendelenburg gait).

6. Stair Assist: Use the handrail on the opposite side to support pelvic alignment when going upstairs.

Progressive Exercise Protocol for Lateral Hip Pain

Rehabilitation requires building load tolerance in the gluteal tendons through controlled isometric, isotonic, and functional movements. However, popular movements like the clamshell exercise can irritate the gluteal tendon by increasing compression against the bone. Also, these stretches cause gluteal tendon compression and should be strictly avoided during the early to middle stages of rehab.  Access our main gluteal tendinopathy exercise guide to explore the full progressive loading protocol, or start with these gentle outer hip exercises for seniors if you need a low-impact option.  Mellor R, Bennell K, Grimaldi A, et al. (2018), Patricio Cordeiro TT, Rocha EAB, Silva RS. (2024)

Tier 1: Isometric & Glute Activation

• Supine Banded Isometric Hold: Lay back with knees bent and a loop band above the knees. Press outward into the band and hold for 30–45 seconds.

• Standing Isometric Floor Tear: Stand with feet wide, turn feet slightly outward, and push outward against the floor without moving your feet.

• Slow-Tempo Glute Bridge: 3-second concentric lift, 1-second pause at the top, and 3-second lowering.

Tier 2: Functional Weight-Bearing

• Staggered & Single-Leg Bridges: Increase loading unilaterally while keeping the pelvis level.

• Tempo Bodyweight Squats: Maintain a wide stance and lower over 3 seconds to keep tension in the glutes rather than the knees.

• Assisted Single-Leg Stance & Step-Ups: Practice standing tall through the stance hip without lateral pelvic tilting.

Tier 3: Lateral Stability & Dynamic Loading

• Side-Steps & Banded Lateral Walks: Maintain wide feet and a slight knee bend while stepping laterally.

• Single-Leg Deadlifts (RDL): Pivot strictly at the hip while keeping the back straight and pelvis square.

• Side-Lying Leg Elevates: Perform with a pillow between the legs to avoid starting in a compressed/adducted position.

Diagnostic Imaging: Do You Need an MRI?

Recommended Internal Linking Structure

To improve internal site architecture, link this article to key service pages and related clinical protocols:

1. Understanding Gluteal Tendinopathy

2. Bursitis vs. Tendinopathy Breakdown

3. Best Exercises Rehab Program for Outer Hip Pain

4. Postures to Avoid for Hip Pain

5. 4 Best Tips to Decrease Hip Pain

6. Walking Modifications for Hip Pain

7. 5 Exercises that Likely with Aggravate your Hip Pain
8. 4 Best Test for Determining Gluteal Tendinopathy

Frequently Asked Questions About Lateral Hip Pain

Is gluteal tendinopathy the same as hip bursitis?

No. While both cause pain on the outside of the hip, trochanteric bursitis is inflammation of the fluid-filled bursa sac, whereas gluteal tendinopathy is an overuse injury or degeneration of the gluteus medius or minimus tendons. Clinical imaging shows that over 90% of outer hip pain cases are caused by gluteal tendinopathy rather than isolated bursitis.

Should I stretch my hip if I have gluteal tendinopathy or bursitis?

No, you should avoid stretching your lateral hip. Traditional hip stretches (like bringing your knee across your body or pulling your ankle to your opposite shoulder) pull the gluteal tendon tightly across the greater trochanter bone. This creates high compressive force on the tendon, worsening irritation and delaying recovery.

Why does my hip hurt more at night when I’m sleeping?

Nighttime hip pain occurs because sleeping on your side causes your top leg to fall forward into adduction (crossing your midline), compressing the upper gluteal tendon. If you sleep on the painful side, direct pressure from the mattress compresses the lower tendon against the bone.

How long does it take for gluteal tendinopathy to heal?

With proper load management, posture modifications, and targeted progressive exercise, notable symptom relief usually occurs within 4 to 6 weeks. However, full tendon remodeling and strength restoration typically take 3 to 6 months of consistent rehabilitation.

Are cortisone injections effective for outer hip pain?

Cortisone injections can offer short-term pain relief (typically lasting 2 to 6 weeks) by temporarily dampening localized inflammation. However, because gluteal tendinopathy is primarily a tendon load and structural issue rather than an inflammatory disease, injections do not repair the tendon and often lead to recurrence if underlying gait and postural habits aren’t corrected.

Do I need an MRI to diagnose lateral hip pain?

Not always. A qualified physical therapist or sports chiropractor can accurately diagnose gluteal tendinopathy through physical examination and clinical strength/provocation tests. An MRI is generally reserved for severe cases, suspected full-thickness tendon tears, or cases that fail to respond to conservative care after 8 to 12 weeks.