Medically reviewed by Dr Santiago Echeverri, FMH Orthopaedic Surgery
You have pain on the outside of your hip, right on the bone that sticks out. You can’t sleep on that side any more. Stairs make it hurt, standing for a while makes it hurt, and getting up out of a low armchair makes it hurt.
You’ve probably been told “bursitis”. And you’ve probably been offered an injection.
In the large majority of cases, that diagnosis isn’t right. And because it isn’t right, the treatment heads off in the wrong direction.
What’s actually going on
“Bursitis” means inflammation of a small fluid-filled sac that acts as a cushion between bone and tendon. It’s a logical explanation. The trouble is that when you look closely — on scans, or during surgery — that’s almost never what you find.
What you usually find is a gluteal tendon that is struggling to cope with the load placed on it. Your buttock muscles attach to that bony point on the side of your hip by tendons, and it’s the tendons that are struggling. And when that tissue is examined under a microscope, the inflammation you’d expect simply isn’t there.
This isn’t hair-splitting. Inflammation gets calmed down with an anti-inflammatory. A tendon that is struggling needs to be gradually strengthened and loaded again. Those are two completely different treatments — and one of them works far better over time.
Is it common?
Much more than people realise. This pain affects roughly one woman in four over 50.
And it weighs more heavily than its reputation suggests. In studies, the effect on quality of life is comparable to severe hip arthritis. Sleep is a big part of that: you can’t lie on the painful side, and often not on the other side either, because the top leg drops across and presses on the hip underneath.
Plenty of people live with this for years assuming it’s “just age”. It isn’t, and it’s treatable.
What an Australian study compared
Researchers brought together 204 people aged 35 to 70 (mostly women, average age 55) who’d had this pain for more than three months. Three groups, chosen at random:
- an explanation of how to take pressure off the tendon, plus targeted exercises: 14 sessions over eight weeks;
- a cortisone injection;
- nothing in particular: some basic advice, then wait and see.
After two months the results were already clear: about 3 people in 4 were better in the explanation-plus-exercise group. A little under 6 in 10 in the injection group. Fewer than 3 in 10 in the wait-and-see group.
But it’s at one year that it gets interesting. The explanation-plus-exercise group was still at roughly 8 people in 10 doing well. The injection group had dropped to just under 6 in 10 — which is essentially the same result as the group that did nothing at all.
Why the effects of the injection don’t last
There are two reasons, and both make sense.
The first is biological. Cortisone relieves pain, Cortisone relieves pain, but it also can have negative effects on tendon tissue, including slowing repair and reducing its mechanical strength. You calm the symptom while potentially weakening the affected tissue.
The second is very human. When pain disappears within days, you naturally ease off. You cross your legs again, you forget the exercises, you slip back into the habits that were putting excessive pressure on the tendon. And when the effect fades after a few weeks, the instinct is to ask for another injection rather than get back to the work.
That doesn’t make injections useless. When pain is so bad you can’t start anything at all, one can help create a window in which rehabilitation becomes possible. But if nothing follows, a year later the outcome may be no better than with no active treatment.
Taking pressure off the tendon doesn’t mean resting
This is the first common misunderstanding. Your tendon isn’t suffering from doing too much. It’s mostly suffering from being squashed against the hip bone in certain positions. Identifying and avoiding these positions can sometimes make a difference within days.
The main culprits:
- Crossing your legs, sitting or lying down.
- Standing with your weight on one hip — the posture you fall into waiting somewhere, carrying a heavy bag, or balancing a child on your hip.
- Sleeping on the painful side — or on the other side without a pillow between your knees, because the top leg then falls across compresses the tendon against the hip bone.
- Low, deep seats, soft sofas included.
And one trap worth flagging, because it’s extremely common: stretching. Pulling hard on your buttock or the outside of your thigh is exactly the movement that compresses the tendon against the bone. Plenty of people stretch diligently every morning believing they’re helping — and end up perpetuating the problem.
Once those positions are removed, the other half of the work begins: gradually rebuilding the glutes, the muscles on the side of the hip that take the leg outwards. Not stretching them. Strengthening them.
How long does it take?
In the study, the programme ran eight weeks — and the benefit was still there, if anything better, a year later.
That’s the realistic scale: a few weeks to feel a real change, a few months to make it stick. Tendons respond poorly to both prolonged inactivity and sudden increases in load. Consistency matters more than intensity.
A close relative worth knowing about
If the pain isn’t on the side but under your buttock, on the bone you sit on, and it’s worse after sitting a long time or walking uphill, a different tendon may be involved — the hamstring tendon, at the back of the thigh. It’s less well known, often misidentified, and it responds to the same principles: reduce compression, then rebuild strength gradually.
Getting assessed at Dr.E in Pully
Our centre is medically supervised by Dr Santiago Echeverri, FMH orthopaedic surgeon. This diagnosis is mainly made by examination — scans are more useful for ruling out other conditions than for confirming it.
The assessment starts by measuring the strength of your glutes. That number becomes both the target and the reference point: it’s what tells you whether things are improving, independently of good days and bad days. Strengthening then happens on controlled-load machines that let you work without compressing the tendon, with the load increased gradually. Then we measure again.
Treatment is covered by health insurance with a physiotherapy prescription from your family doctor or specialist. Get in touch for an assessment.
Frequently asked questions
How do I know if it’s the tendon or hip arthritis?
The location differs. Hip arthritis typically hurts in the groin, sometimes down the front of the thigh. A glute tendon hurts on the outside, over the bone that sticks out, with pain when you press on it and especially when you lie on that side. Only an examination can tell.
Do I need an MRI?
Not routinely. The diagnosis is usually made by talking it through and testing a few movements. Imaging becomes useful if there’s doubt, or if things aren’t progressing as expected.
Should I stop walking or exercising?
Rarely. The aim is to remove the positions that compress the tendon and adjust the amount of activity if necessary, not to stop everything — inactivity weakens the muscles and can make things worse in the long run.
Do stretches help?
No, and they often do the opposite. Pulling hard on your buttock or the outside of your thigh compresses the tendon against the bone. It’s one of the most common mistakes with this particular pain.
Why mainly women over 50?
This pain affects roughly one woman in four over 50. Pelvic shape plays a part, as do changes in muscle over the years.Which is exactly why keeping the glutes strong is particularly beneficial at this age.
This article gives general information and does not replace your doctor’s advice.
Sources: LEAP trial (education and exercise versus cortisone injection versus wait and see), BMJ, 2018 · systematic review of gluteal tendinopathy treatments, 2025 · review of hip tendinopathies, Rheumatology Advances in Practice, 2024.
