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What tissues are on the side of the hip?
The greater trochanter is a bony protrusion on the side of the femur. Several tendons are attached to it, notably those of the gluteus medius and minimus muscles. These muscles help control the pelvis when you walk or support yourself on one leg. A bursa is a small fluid-filled sac that helps tissues slide located between tissues.
The term greater trochanteric pain syndrome includes pain in this region. Tendinopathy refers to a painful tendon whose ability to support certain loads is disrupted. A bursa may be associated with the problem, but tendinopathy and bursitis are not exactly equivalent words. This nuance explains why treating only supposed inflammation does not always solve the problem.
Chapter sources [1]
Understand the picture
On the side of the hip
Gluteal muscles
They participate in the control of the pelvis when bearing weight on the leg.
Tendons
They connect these muscles to the femur and transmit their force.
Bursa and trochanter
A surface that helps tissues slide is found near this bony protrusion.
Chapter sources [1]
What sensations are common?
The pain is often tender to the touch on the side of the hip and may go down the side of the thigh. It can appear when you lie on this hip, go up an incline, take the stairs or stand for a long time. Standing on one leg to put on trousers may be enough to trigger it.
The opposite side is not always comfortable either: the leg on top can fall inwards and change the pressure on the sensitive region. These descriptions guide the assessment, but they do not prove a diagnosis. Joint, back or nerve pain may coexist. Especially report groin pain, tingling, or unusual weakness.
Why is the region becoming sensitive?
An increase in walking, repeated stairs or a return to sport can temporarily exceed the capacity of the tissues. Conversely, a long period of inactivity can reduce this capacity. Changes related to age, general health and certain hormonal periods can contribute to the context, without explaining each case on their own.
The problem is not necessarily a tear or the consequence of a single bad movement. A position that brings the thigh closer to the other leg for a long time can be irritating for some people. This observation is used to adapt a task, not to impose a perfect posture all day long. The assessment looks for a combination of modifiable factors rather than a single culprit.
How does the professional distinguish the causes?
The assessment links the description of your symptoms to walking, palpation and movement and strength tests. The professional can examine the back, hip and balance. He seeks to know which loads reproduce pain and which activities remain possible. An isolated test found on the internet does not replace this approach.
An ultrasound or an MRI can be useful when the diagnosis remains uncertain, a significant lesion is suspected or the evolution leads to considering another treatment. They are not systematically necessary. A visible tendon change does not automatically mean that it explains all the pain. Ask how the result fits with your exam and what it will change about the program.
When should you consult quickly?
After a fall, intense pain or the inability to bear weight on the leg requires urgent evaluation. A very painful area with fever, heat or an unusual general condition should also be evaluated quickly. A new difficulty in lifting the foot or a progressive loss of strength should not be classified under the sole word bursitis.
Without these signs, make an appointment if the pain regularly prevents sleep, significantly limits walking or persists despite reasonable adaptations. A lasting worsening deserves a new assessment. We should neither trivialize any change, nor assume that a painful night necessarily means a serious illness. Note what changes and consult the warning signs guide if in doubt.
Chapter sources [2]
What do we know about treatments?
Active management usually combines an explanation of irritating loads and appropriate muscular work. The LEAP trial studied a supervised program in adults with persistent gluteal tendinopathy. Education combined with exercise gave better overall results than a corticosteroid injection in the short term and at one year; at one year, the difference in pain between these two groups was not clear.
This result does not promise the same answer to each person and does not compare all possible treatments. An injection can be discussed in certain situations, with its limits and risks. Decisions on medications, injections or possible intervention belong to the medical assessment. Temporary relief must be integrated into the return to function, without forcing a sudden increase in activity.
In everyday life
Adapt the stairs without stopping moving
Spot
Note if the repetition of stairs then disrupts the night.
Lighten
Group some tasks together and use the handrail if it helps.
Rebuild
Gradually add trips up and down the stairs when the reaction remains acceptable.
How can the physiotherapist guide progression?
The starting point depends on what you can tolerate: sometimes a contraction or movement with little load, sometimes a more demanding exercise. The program can then progress to single-leg control and walking or sports tasks. The exercise load needs to be useful without maintaining a strong reaction after each session.
Ask what signs to watch for: pain during exercise, ease of walking afterward, sleep and state the next day. If you have more pain during the night following a session, this information may justify reducing the dose or changing the movement. Progression is not just about doing more repetitions. Spreading weight more evenly, a different range of movement or more recovery may be more appropriate.
How to make sleeping and doing tasks easier?
Try to reduce direct pressure on the painful side. On the other side, a cushion between the knees can support the upper leg; on your back, find a position that allows you to relax. These trials are comfort options, not a requirement to sleep still. Choose the solution that really improves your night.
To dress, sit down if standing on one leg causes pain. When standing, avoid resting on the sensitive hip for a long time if this bothers you. On stairs, a handrail or temporary reduction in walking back and forth can help. Modify a few specific situations rather than anxiously monitoring each position. The goal is to keep an active day at a manageable dose.
Chapter sources [1]
Should you stretch, massage or continue running?
The feeling of tension sometimes makes you want to stretch the side of the hip very hard. However, some stretches compress the already sensitive area. The massage roller or a ball pressed on the painful point can also irritate. Intense feeling during a technique is not a sign that it is necessary or effective.
For running, first look at the response to walking and ordinary activities. A temporary break from hills or running may be helpful, while still maintaining another tolerated activity. Recovery is prepared with gradual efforts and recovery times. The general movements in the Exercises section alone do not constitute a complete gluteal tendon program.
How can you recognise progress?
The first progress may be modest: a less interrupted night, an easier staircase or a better tolerated walk. The capacity of a tendon to withstand repeated efforts is gradually rebuilt; several weeks or months may be necessary. A fixed date cannot predict your outcome.
Compare one or two stable activities rather than testing the pain point several times a day. If walking progresses but a long outing awakens the pain, the dosage can still be adjusted. If nothing improves, if the discomfort changes in nature or if the strength decreases, have the diagnosis and program reviewed. Continuing exactly the same treatment without assessment is not a strategy for progression.
Your questions
Are bursitis and tendinopathy the same thing?
No. The bursa and tendon are different structures, although their problems can be found in the same region. The term lateral hip pain describes a situation that needs to be investigated. The program depends more on the difficulties and the results than on the single word used on a prescription.
Chapter sources [1]
Can I sleep on the painful side?
You can choose the position that suits you, but avoid staying in it if the pressure causes pain. An alternate position or support between the knees may help. If no position is bearable or if sleep deteriorates lastingly, ask for a reassessment.
Chapter sources [1]
Does an injection replace exercises?
It can be discussed for some people, but does not alone rebuild the ability to walk, climb stairs or run. The effects and risks must be explained. An education and exercise program remains an important option, supported by a clinical trial.
Chapter sources [3]
Should I stop all my activities?
Stopping everything is not necessary in every situation. Prioritize reducing activities that trigger a marked increase in symptoms and keep those that you tolerate. If pain occurs after a fall or if you can no longer bear weight on the leg, consult before resuming exercises.
Sources and references
- [1] Cambridge University Hospitals — Gluteal tendinopathy
- [2] NHS — Hip pain in adults
- [3] Mellor et al. — Education plus exercise for gluteal tendinopathy
Text updated on
Medical review: awaiting Hasib Selimovic.