Outer hip pain can be miserable.
It can start as a small niggle when walking, then gradually become the thing that stops you lying on your side, climbing stairs comfortably, getting out of the car, or enjoying a normal walk without thinking about every step.
A lot of patients come into clinic having been told they have “hip bursitis” or “trochanteric bursitis”. That may be true, but it is often only part of the story.
The bursa can become irritated, but in many stubborn cases the bigger issue is what is happening around it: the gluteal tendons, the way the hip is being loaded, the way the person walks, and sometimes even what is happening lower down at the foot and ankle.
That is why some people rest, take painkillers, try anti-inflammatories, have a steroid injection, or do a few exercises, only for the pain to settle for a while and then return.
In clinic, this is one of the most common patterns I see with outer hip pain. The pain gets labelled as bursitis, but the reason it keeps coming back has not always been properly addressed.
It often starts with sleep, stairs or walking
Most people do not come into clinic talking about “greater trochanteric pain syndrome” or “gluteal tendinopathy”.
They usually say things like:
“I can’t lie on that side at night.”
“It aches down the outside of my thigh.”
“It catches when I go upstairs.”
“I thought it would settle, but it keeps coming back.”
“I had an injection and it helped for a while, but now it’s painful again.”
“It feels worse after walking, especially hills.”
“I feel fine for a bit, then it flares up again.”
This type of pain is usually felt around the outside of the hip, near the bony area at the top of the thigh. It may stay local to that area, or it may travel down the outside of the thigh.
It can be sharp, aching, burning or tender to touch. For some people, the worst part is the night pain. They cannot lie on the painful side, and even lying on the opposite side can sometimes pull the top leg across the body and irritate the hip.
Over time, this can affect sleep, mood, walking, exercise and confidence.
Why the word “bursitis” can be misleading
The greater trochanter is the bony prominence on the outside of the hip. Around this area are the gluteal tendons and a small fluid-filled structure called a bursa.
The bursa helps reduce friction between the bone and soft tissues. When it becomes irritated, it can become painful. This is where the term “trochanteric bursitis” comes from.
However, outer hip pain is not always just an inflamed bursa.
Many cases are now described more broadly as Greater Trochanteric Pain Syndrome. This term is useful because it recognises that pain around the outside of the hip can involve the bursa, the gluteal tendons, the surrounding soft tissues, or a combination of these structures.
In many longer-lasting cases, the gluteus medius and gluteus minimus tendons are involved. These tendons are important because they help stabilise the pelvis when you walk, climb stairs, stand on one leg, run, or move from side to side.
If these tendons are overloaded, compressed, weakened or irritated, the area can become painful. The bursa may then become sensitive as part of the wider problem.
That is why treating it as “just inflammation” can be too simplistic. The reason it settles… then flares agai. When outer hip pain keeps returning, there is usually a reason.
It may be that the hip is being asked to tolerate more load than it can currently cope with. That does not mean you have done anything wrong. It may simply mean the tissues around the hip have become sensitive, weaker, overloaded, or poorly conditioned for what you are asking them to do.
Common contributing factors include:
- A sudden increase in walking distance
- More hills or uneven ground than usual
- A new exercise routine
- Returning to activity after time off
- Gluteal weakness
- Poor pelvic control when walking or climbing stairs
- Previous foot, ankle, knee, hip or back injury
- Altered walking pattern
- Foot posture or lower limb mechanics increasing load through the hip
- Unsuitable or worn footwear
- Regularly sleeping on the painful side
- Sitting with the legs crossed
- Standing with the hip pushed out to one side
- Weight gain or increased load through the lower limbs
- Poor sleep, high stress or reduced recovery
- Hormonal changes, particularly around the peri-menopausal and post-menopausal years
This is one reason outer hip pain is particularly common in women over 40. Tendon health, muscle strength, hormones, recovery and body composition can all influence how well the hip tolerates load.
The good news is that this does not mean the problem is permanent. It does mean the treatment needs to be more thoughtful than simply resting and hoping it settles.
Rest can calm it down, but it rarely rebuilds the hip. Rest can help calm symptoms, especially when the hip is very painful. The problem is that rest does not necessarily improve the strength or load tolerance of the hip.
This is the cycle many patients get stuck in:
- The hip becomes painful
- They rest
- The pain improves
- They walk more again
- The pain returns
The reason this happens is that the hip may not have become more capable. It has just had a quieter period.
For longer-term improvement, the aim is usually not complete rest. The aim is to find the right level of movement, strengthening and recovery so the hip can gradually tolerate more again.
This is where a proper plan matters.
Where injections can help, and where they can fall short. Steroid injections can be helpful for some patients, especially if pain is very irritable and inflammation is playing a significant role.
However, an injection does not automatically improve hip strength, tendon capacity, walking mechanics, footwear, foot posture or activity load.
So, while an injection may reduce pain in the short term, it may not address why the area became overloaded in the first place.
This is not about being anti-injection. There are times when injections may be appropriate. But if the pain keeps coming back, it is worth asking whether the underlying drivers have been properly assessed.
In clinic, I often see patients who have already tried rest, medication, physiotherapy exercises or injections. Some have improved for a while, but then the pain has returned as soon as they have gone back to walking, hills, stairs, gym work or normal life.
That is when we need to look deeper. This is where a proper assessment changes the plan. At RS Podiatry Clinic, we do not only look at the painful area.
The hip is important, of course, but the hip does not work in isolation. The foot, ankle, knee, hip and pelvis all influence how load is absorbed when you walk, stand, climb stairs or exercise.
For outer hip pain, assessment may include looking at:
- Where your pain is and what brings it on
- How long the problem has been present
- Whether you can lie on the painful side
- Your walking tolerance
- Stairs, hills and sitting tolerance
- Previous scans, injections or treatment
- Hip strength and control
- Gluteal loading tolerance
- Foot posture
- Walking pattern
- Lower limb alignment
- Footwear
- Work demands
- Exercise habits
- Previous injuries
- Your goals and what you want to get back to
Gait assessments for hip pain
This helps us understand whether the pain is mainly being driven by local tissue irritation, tendon overload, gait mechanics, weakness, footwear, training load, or a combination of factors.
Two people can both be told they have hip bursitis, but the reason behind their pain may be very different. That means the treatment plan should not be identical.
The treatment depends on what is driving the pain. The right treatment depends on how irritable the pain is, how long it has been present, what has already been tried, and what the assessment shows.
For some patients, the first step is calming the area down. For others, the main priority is strengthening. Some need footwear changes. Some need orthotics. Some may benefit from MLS Laser Therapy. Others need a clearer walking or exercise plan. Most people need a combination.
First, we stop feeding the irritation. In the early stages, we often need to reduce the things that are repeatedly irritating the hip.
This may include advice around:
- Sleeping position
- Reducing direct pressure on the painful side
- Using a pillow between the knees
- Avoiding crossed-leg sitting
- Reducing hills temporarily
- Modifying walking distance
- Avoiding repeated stair aggravation where possible
- Adjusting gym exercises
- Reviewing footwear
- Avoiding aggressive stretching into painful positions
These small changes can make a big difference, especially when the hip is sensitive. It is not about stopping everything. It is about reducing the things that are keeping the area irritated while we start rebuilding capacity.
Where MLS Laser Therapy can fit in
MLS Laser Therapy is one of the treatment options we use regularly for painful outer hip conditions, including trochanteric bursitis, gluteal tendinopathy and Greater Trochanteric Pain Syndrome.
In clinic, this is an area where I have seen some excellent results.
Outer hip pain can be difficult to settle because the painful tissues are often irritated every time the patient walks, climbs stairs, lies on their side or increases activity. When the hip is too painful to rehabilitate properly, the patient can get stuck: they need strengthening, but the pain stops them doing enough to make progress.
This is where MLS Laser Therapy can be particularly useful.
It is non-invasive, does not involve needles or medication, and is designed to help reduce pain, calm irritated soft tissues and support the body’s natural healing response.
In my experience, when laser therapy is used appropriately, it can be a very effective way of reducing pain enough for the patient to start moving better, sleeping better and progressing with rehabilitation.
That point is important. I do not see laser therapy as a stand-alone “quick fix” where we simply treat the painful area and ignore everything else. The best results are usually seen when it forms part of a more complete plan: reducing the aggravating factors, improving footwear where needed, addressing gait or lower limb mechanics, and gradually rebuilding strength around the hip.
For some patients, MLS Laser Therapy is the treatment that helps break the cycle. Pain reduces, walking becomes easier, sleep improves, and the patient is then able to engage more confidently with the strengthening work needed for longer-term improvement.
As with any treatment, results can vary depending on the diagnosis, severity, duration of symptoms and the individual patient. But for persistent outer hip pain, this is one of the treatment options I value highly in clinic.
Rehabilitation
Then we rebuild what the hip needs to tolerate. The gluteal muscles play a major role in controlling the pelvis and hip.
If the gluteal muscles are weak or not tolerating load well, the outside of the hip can become overloaded during walking, stairs, hills and single-leg activities. Rehab needs to be progressive and appropriately dosed.
One of the biggest mistakes is giving exercises that are either too easy to make a difference, or too hard for the current stage of pain. Another common mistake is stopping as soon as the pain starts to improve.
With persistent outer hip pain, strengthening often needs to build over weeks to months. This does not mean every patient needs to join a gym or do complicated exercises. It means the hip needs the right level of challenge at the right time.
The plan may start very gently and then gradually progress into more functional strength work, depending on the patient. Sometimes the hip is reacting to how you move Footwear can influence how load travels through the lower limb.
If a shoe is unstable, worn out, too flexible, poorly cushioned, or simply wrong for the person’s walking pattern, it may contribute to symptoms. Sometimes a more stable shoe helps. Sometimes more cushioning helps. Sometimes the issue is that the shoe is just past its best. Sometimes the footwear is fine, and the bigger issue is strength or activity load.
This is why assessment matters. The aim is not to tell everyone with hip pain to buy the same shoe. The aim is to understand what that individual needs.
When orthotics are worth considering
Orthotics may help in selected cases where foot posture or lower limb mechanics are contributing to the way the hip is being loaded.
This does not mean every patient with hip pain needs orthotics.
However, in some patients, the way the foot functions can influence rotation through the lower limb, knee position, hip control and pelvic mechanics. If this is contributing to the overload pattern, orthotics can be a useful part of the plan.
They may be especially relevant when outer hip pain is linked with:
- Foot posture issues
- Overpronation
- Recurrent lower limb injuries
- Knee pain
- Leg length difference
- Poor walking tolerance
- Symptoms that are worse in certain shoes
- A clear biomechanical pattern contributing to hip overload
The key is that orthotics should be prescribed for a reason, not simply because the patient has hip pain.
Getting you back to walking, stairs and normal life
For many patients, the goal is not just to have less pain during the appointment. The goal is to get back to normal life.
That might mean walking the dog, sleeping on the side, going upstairs, returning to hiking, going to the gym, playing golf, running, gardening, or simply getting through a working day without the hip constantly aching.
A proper plan may include guidance on:
- How far to walk
- Whether to avoid hills temporarily
- How quickly to increase activity
- Which exercises to avoid for now
- Which exercises to start with
- How to judge acceptable pain
- How to respond to flare-ups
- When to progress strengthening
- When to return to more demanding activity
This part is often missed, but it is one of the most important parts of treatment. Patients need to know what to do when the pain improves, not just what to do when it hurts.
When it is worth getting it looked at:
- The pain has lasted more than a few weeks
- You cannot lie comfortably on that side
- Walking distance is reducing
- Stairs are painful
- The pain keeps returning when you increase activity
- You have tried rest and it has not solved the problem
- You have had treatment but symptoms keep coming back
- You have had an injection but the pain has returned
- You are limping
- You are unsure whether the pain is coming from your hip, back or thigh
- You are avoiding normal activities because of pain
The earlier the cause is understood, the easier it is to put the right plan in place.
A quick note on symptoms not to ignore
Most outer hip pain is not dangerous, but some symptoms should be checked medically. You should seek medical advice if you have severe unexplained pain, recent significant trauma, fever, unexplained weight loss, a history of cancer, constant night pain that is not linked to position, significant weakness, numbness, or changes in bladder or bowel control.
If we assess you and feel that imaging, GP review, orthopaedic opinion or another pathway is needed, we will advise you appropriately.
The aim is not just pain relief, it is confidence again. Outer hip pain can be stubborn, but that does not mean you have to put up with it forever.
If your pain keeps coming back, the important question is not just: “How do we calm the bursa down?”
The better question is: “Why is this area being irritated in the first place?”
Patient review
“I had severe hip pain from March 2025 and eventually sought medical advice and was diagnosed with Bursitis in July 2025. I knew nothing about this condition and I was put on a course painkillers which helped ease the pain but then my view was that I could not continue with painkillers as this was not a sustainable answer to this condition. This affected me day to day with severe pain when walking, going up stairs, sitting for too long and was excruciating when in bed at night.
My sister-in-law told me about Rick at RS Podiatry so my husband made me an appointment to go and have a consultation. Rick was great and talked me through Bursitis and what could be done to hopefully alleviate the pain. Rick suggested a course of laser treatment which scared me a bit but I needed to try and get some relief from this condition and I booked in for 6 sessions.
The laser treatment is not at all painful and lasts about half an hour. After the first session, I noticed some relief and then after each session it got better and I was able to get a good night’s sleep without any pain. I could also get out of the chair and walk without it hurting which was amazing.
I would definitely recommend this treatment to anyone who is suffering with this very painful condition”. Linette
At RS Podiatry Clinic, we look at the bigger picture. We assess the hip, but we also consider the foot, ankle, knee, gait, footwear, strength, activity levels and the way your body is loading day to day.
Treatment may include MLS Laser Therapy, which we have found particularly useful for many patients with persistent outer hip pain, alongside footwear advice, custom orthotics where appropriate, progressive strengthening and a realistic plan to help you return to normal activity.
If you are struggling with hip bursitis, outer hip pain, gluteal tendinopathy or Greater Trochanteric Pain Syndrome, we would be happy to help.
RS Podiatry Clinic sees patients from Coventry, Solihull, Warwickshire and the surrounding areas.
To book an appointment, call 07516 425 748 or book online.
Early, well-planned treatment can make a real difference.
Questions patients often ask
It can be either, or both.
The bursa can become irritated, but many longer-lasting cases of outer hip pain also involve the gluteal tendons. This is why the term Greater Trochanteric Pain Syndrome is often more accurate than simply calling it bursitis.
Lying directly on the painful side can compress the sensitive tissues around the outside of the hip.
Even lying on the opposite side can sometimes aggravate it if the top leg drops across the body and places the hip in a compressed position. Some patients find that a pillow between the knees helps reduce this irritation.
It depends how much walking you are doing and how the hip responds.
Walking is not automatically bad, but too much walking, especially hills, uneven ground or longer distances, can keep the area irritated. The aim is usually to find a level of walking that keeps you active without repeatedly flaring the pain.
The foot and ankle influence how the lower limb moves when you walk.
In some people, foot posture, footwear or walking mechanics can affect rotation through the leg, knee position and hip loading. This does not mean every hip problem comes from the foot, but it can be part of the picture.
MLS Laser Therapy can be a very useful treatment option for painful outer hip conditions, and it is something we have had excellent results with in clinic.
It is non-invasive, does not involve injections or medication, and is used to help reduce pain, calm irritated soft tissues and support tissue recovery.
At RS Podiatry Clinic, we usually use MLS Laser Therapy as part of a wider plan, rather than in isolation. The aim is to reduce pain enough to help you walk, sleep and move more comfortably, while also addressing the underlying reasons the hip became overloaded in the first place.
Why stretching sometimes makes it angrier
Some hip stretches place the leg across the body, which can compress the irritated gluteal tendons around the outside of the hip.
If the area is already sensitive, repeatedly stretching into that position may make symptoms worse. In many cases, carefully progressed strengthening and load management are more useful than aggressive stretching.
This varies.
Some patients improve within a few weeks, especially if the problem is caught early and the aggravating factors are addressed. Longer-standing cases can take several months of well-planned treatment and rehabilitation.
The aim is not just to settle the pain, but to improve the hip’s ability to tolerate normal life again.