Hip pain and gluteal tendinopathy: what actually helps

Pain on the outer side of the hip, often worst when lying on that side, climbing stairs or after sitting, is frequently gluteal tendinopathy, and the best-evidenced treatment is education plus a progressive exercise programme, which outperforms corticosteroid injections over time. This is one of the most common causes of lateral hip pain, particularly in women around and after menopause and in runners. It is often mislabelled as "bursitis" and treated with repeated injections, when the evidence actually points to load management and strengthening as the more effective route.

What it is

Gluteal tendinopathy is overload and irritation of the tendons of the gluteal (buttock) muscles where they attach on the outer hip. Because a bursa sits nearby, it is often loosely called "hip bursitis," but the tendon is usually the main problem, which matters because it changes the treatment. Like other tendinopathies, it reflects a mismatch between load and the tendon's capacity, and certain positions, crossing the legs, standing with the hip dropped, lying on the side, tend to compress and aggravate the tendon.

Why exercise beats injections

This is where good evidence should change practice. A landmark randomised trial (the LEAP trial) compared education plus exercise, a corticosteroid injection, and a wait-and-see approach for gluteal tendinopathy. Education and exercise came out clearly on top, with more people substantially improved at eight weeks than with injection, and better longer-term outcomes. Injections may calm pain briefly but tend not to fix the underlying tendon problem, and repeated injections can be counterproductive. Learning which positions and loads to modify, then progressively strengthening the tendon, addresses the cause. It requires patience, but it works better.

Where shockwave fits

For cases that remain stubborn despite good load management and strengthening, shockwave therapy is a reasonable adjunct, used alongside the exercise programme. As with other tendinopathies, it is a stimulus to add to loading rather than a replacement for it. Getting the diagnosis right first, distinguishing tendinopathy from hip joint problems or referred pain from the back, ensures the right treatment is applied.

Why Hanbury Health is different

Lateral hip pain is a condition where the evidence and typical practice often diverge, and we deliberately follow the evidence. At Hanbury, gluteal tendinopathy is treated with the education and progressive loading the research supports, rather than a cycle of injections, with diagnostic ultrasound to confirm the diagnosis and both radial and focused shockwave available for persistent cases. Because rehabilitation is overseen with surgical-level knowledge and consultant links, hip joint problems that are not tendinopathy are identified and directed appropriately. It is lateral hip pain treated the way the best evidence says it should be. See how our physiotherapy service works, or read our companion pieces on what shockwave therapy actually is and when to see a physiotherapist .