Lateral Hip Pain And Gluteal Tendinopathy

Pain over the outside of the hip that flares when you lie on that side at night and when you take the stairs is, in most cases, gluteal tendinopathy rather than bursitis. The single most useful thing to know about it is that the treatment with the best evidence behind it is not an injection. In a randomised trial, education plus exercise clearly beat corticosteroid injection at 8 weeks and again at 52 weeks, and we will say so before we offer you anything else.

Key points

  • Lateral hip pain turns up most often in women between 40 and 60, and imaging and surgical studies point to gluteus medius or minimus tendinopathy, not bursitis, as the usual cause.

  • The LEAP randomised trial found a physiotherapy-led education and exercise programme beat both a single corticosteroid injection and a wait-and-see approach at 8 and 52 weeks.

  • At 52 weeks around 80% of the education and exercise group had recovered, compared with roughly 50% in the injection and wait-and-see groups.

  • Corticosteroid injection buys shorter-lived relief and can leave tendons more prone to tearing, which is why it does not belong first in line here.

Outer hip pain keeping you awake? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.

What it actually is

Not bursitis

The label trochanteric bursitis was used for decades and has stuck. Imaging and surgical work has since shown the usual underlying pathology to be degenerative change in the gluteus medius and minimus tendons at their attachment to the greater trochanter, the bony prominence on the outer hip.

The distinction is not pedantry, because it dictates the treatment. Bursitis suggests inflammation and steers you towards an anti-inflammatory injection. Tendinopathy is a failed healing response inside the tendon, and what shifts it is progressive load rather than the suppression of inflammation.

Why it develops

The mechanism is compression. When the hip moves into adduction, meaning the thigh travels towards the midline, the iliotibial band presses the gluteal tendons against the greater trochanter. Weak hip abductors raise that compression further, because the pelvis drops or shifts when you stand on one leg.

That accounts for the familiar aggravating positions. Sitting with the legs crossed. Standing with your weight slung onto one hip. Sleeping on the sore side, or on the other side with the upper leg falling across. Walking uphill or climbing stairs.

Who gets it

Mostly women aged 40 to 60, an age range that maps closely onto the menopausal transition. Tendon contains oestrogen receptors, and declining oestrogen is linked to the connective tissue changes that make tendinopathy likelier, which is why the same woman often collects a frozen shoulder, a tennis elbow or plantar fasciitis within a few years of this.

Not sure this is what you have? Ask our doctors on WhatsApp.

What the evidence says

The LEAP trial

This is the trial that ought to shape how lateral hip pain is managed, and it is the reason we do not lead with injections in this condition.

LEAP, published in the BMJ in 2018, randomised a little over 200 people aged 35 to 70 who had lateral hip pain of more than 3 months with gluteal tendinopathy confirmed clinically and on MRI. There were three arms. A physiotherapy-led education and exercise programme, 14 sessions across 8 weeks. A single ultrasound-guided corticosteroid injection. Or wait and see.

Education plus exercise delivered greater improvement in global rating of change and in pain at 8 weeks and, crucially, still held that advantage at 52 weeks. At the 52-week mark about 80% of the exercise and education group reported a successful recovery, against roughly 50% in both the corticosteroid and the wait-and-see arms.

The education side concentrated on staying out of the positions that compress the tendon. The exercise side moved through familiarisation, then early loading, then graduated loading.

What this means for injections

The corticosteroid injection gave short-term relief that did not last, and steroid placed around tendons can leave them more vulnerable to tearing. Its place is where pain is bad enough to stop you beginning an exercise programme at all, as a way of opening a window rather than as the treatment in itself.

PRP is a sensible second-line option once a properly delivered exercise programme has failed, because it works on the failed healing rather than damping inflammation, and it carries no tendon-weakening concern. It is not a replacement for the loading work, and anybody presenting it as one is disregarding the strongest evidence in this condition.

What to do, in order

First, the positions

Free, immediate and constantly overlooked. Stop crossing your legs when you sit and stop parking your weight on one hip when you stand. Sleep on the good side with a pillow between the knees so the upper leg cannot drop across the midline. If you currently sleep on the painful side, change that before anything else. Steer clear of deep stretches that draw the knee across the body, since they compress the very tendon you are trying to calm.

Second, the exercise programme

Progressive hip abductor strengthening, supervised and built up over months rather than handed over on a sheet. This is the treatment, not the extra. Without a structured programme you have not yet tested the best-evidenced option, and that is where your money and effort belong first.

Third, imaging and assessment where it is not settling

Ultrasound or MRI confirms the diagnosis and rules out the alternatives, which matter here. Hip osteoarthritis, pain referred from the lower back, a frank tear rather than tendinopathy, and inflammatory conditions can all look similar and all need something different.

Fourth, injection if it is still not settling

Where a genuine loading programme has been seen through without enough improvement, an image-guided injection becomes a fair conversation. Guidance counts, because the target is precise and the structures sit deep enough that a blind injection can miss.

What treatment costs in London

Image-guided joint and tendon PRP at specialist clinics in central London usually starts around £780 to £900 or more per injection with assessment included, and a course often runs past £2,000. Outside central London the figure is roughly £250 to £500, where injections are frequently given without image guidance.

The NHS does not routinely commission PRP for tendon conditions and private insurance rarely pays for it, so this is self-pay. Physiotherapy and corticosteroid injection are both available on the NHS, and on the trial evidence an NHS physiotherapy programme is the first avenue to chase rather than the last.

Our care is doctor-led and priced beneath flagship central London rates, with the figure confirmed after your free suitability review. We would far rather send you off to do the exercise programme than take a booking for an injection you do not need yet.

Ask whether you have exhausted the first-line options. Message us on WhatsApp.

The suitability review

Nothing here begins with a booking. Every enquiry begins with a free doctor-led suitability review. A GMC-registered doctor takes the history, examines the hip, scans it with ultrasound, and returns one of two answers.

Approved, with the diagnosis confirmed, the evidence set out, the loading work that runs alongside it explained and the cost given before you commit.

Or not approved, which with lateral hip pain is the likelier outcome. Most people who contact us about this have never been through a structured hip abductor programme, and the honest recommendation is to do that first, because the trial evidence says it outperforms what we would be charging them for.

We decline a meaningful share of these enquiries. It costs us the booking and it is the correct clinical advice.

Why people choose The London PRP Clinic by The Wellness

The London PRP Clinic by The Wellness is a doctor-led clinic working from 10 Portman Square in Marylebone and the Light Centre in Belgravia. GMC-registered doctors carry out every treatment using image guidance, and no clinician treats a patient here before completing 100 supervised treatments.

We teach ultrasound-guided joint PRP to doctors through our Academy, and we follow the evidence where it goes even when it points away from treatment we sell. Across our work we report more than 187 five-star reviews.

Book your free suitability review. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.

Frequently asked questions about lateral hip pain

Is my hip pain bursitis?

Usually not. Imaging and surgical studies identify gluteus medius or minimus tendinopathy, rather than bursitis, as the commonest cause of lateral hip pain, and that changes the treatment.

What is the best treatment for gluteal tendinopathy?

Education about load plus a progressive hip abductor exercise programme. In the LEAP randomised trial that combination beat corticosteroid injection and wait-and-see at 8 and 52 weeks, with about 80% recovered at 52 weeks against roughly 50%.

Should I have a steroid injection?

It offers short-term relief that does not last, and steroid around tendons can make them more prone to tearing. Its role is opening a window to begin exercise, not serving as the treatment.

Where does PRP fit?

As a second-line option where a properly delivered exercise programme has not worked. It addresses failed healing rather than suppressing inflammation and carries no tendon-weakening concern, but it does not replace the loading work.

Why does it hurt most at night?

Lying on the affected side presses the tendon against the greater trochanter, and lying on the other side with the upper leg falling across the midline does the same thing. A pillow between the knees usually helps.

Is it connected to menopause?

It appears most often in women aged 40 to 60. Tendon contains oestrogen receptors and falling oestrogen is linked to connective tissue changes, which is why it frequently arrives alongside frozen shoulder or tennis elbow.

This article is for information and does not replace personal medical advice. Evidence for PRP differs by condition and preparation is not standardised. Loading rehabilitation remains the first-line treatment for gluteal tendinopathy. All treatments at The London PRP Clinic by The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The London PRP Clinic by The Wellness. Last updated September 2026.

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