Lateral hip pain that flares up during a simple activity like walking can be confusing and disruptive, but it is a common complaint. This discomfort is typically felt over the bony prominence on the side of the upper thigh, known as the greater trochanter. The pain is not usually a sign of a problem deep within the hip socket, but rather an issue involving the soft tissues that cover the outside of the hip. When walking or standing on one leg becomes painful, the underlying cause is often irritation and damage to these structures.
Primary Causes of Pain on the Outer Hip
Pain experienced on the outer hip when walking is most frequently attributed to a condition called Greater Trochanteric Pain Syndrome (GTPS). This is an umbrella term encompassing two main soft tissue issues: Gluteal Tendinopathy and Trochanteric Bursitis. Historically, most lateral hip pain was simply called bursitis, but current research indicates that tendon problems are the primary source of pain in the majority of cases.
Gluteal Tendinopathy involves the tendons of the gluteus medius and gluteus minimus muscles, which attach to the greater trochanter. These muscles are responsible for stabilizing the pelvis when you stand on one leg, a movement that occurs with every step you take while walking. When these tendons are overloaded or subjected to excessive compression, they can develop microscopic damage or degeneration, leading to pain. This condition is aggravated by walking, especially on inclines or climbing stairs, because these actions demand higher levels of stabilization from the gluteal muscles.
Trochanteric Bursitis refers to the inflammation of the bursa, a small, fluid-filled sac that acts as a cushion between the greater trochanter and the overlying tendons and skin. While the bursa can become inflamed, it is often a secondary issue that develops due to the underlying tendinopathy. The pain from both conditions is often intense when lying on the affected side at night, as this position directly compresses the irritated soft tissues against the bone. Repetitive motions, such as increased walking distance or intensity, place compressive force on these tissues, causing symptoms to worsen.
Immediate Strategies for Pain Relief at Home
The first step in managing lateral hip pain involves modifying daily activities to reduce the compressive load on the affected tendons and bursa. Activity modification is the most direct way to calm the irritated tissues and prevent further aggravation. This means temporarily reducing activities that trigger the pain, such as limiting the duration of walks or avoiding steep hills and stair climbing.
Proper positioning during rest and sleep is also a strategy. If you typically sleep on your side, you must avoid lying directly on the painful hip to prevent direct compression. When sleeping on the unaffected side, placing a pillow between the knees helps to keep the legs parallel and prevents the top leg from dropping and stretching the lateral hip structures.
Cold therapy can help manage localized symptoms by numbing the area and reducing inflammation. Applying an ice pack wrapped in a towel to the point of maximum tenderness on the outer hip for 15 to 20 minutes, several times a day, provides relief. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may also be used for a short period to reduce pain, but consult a healthcare provider before starting any new medication.
Professional Medical Treatment Pathways
When at-home strategies fail to resolve the pain after a couple of weeks, a healthcare provider can guide the next phase of treatment. Physical therapy is often the central component of professional treatment, as it directly addresses the underlying muscle weakness and movement patterns contributing to the pain. The goal of physical therapy is to restore strength and endurance to the gluteal muscles, particularly the gluteus medius and minimus, through a progressive loading program.
Physical therapy typically begins with low-load exercises, like isometric holds, which involve tensing the muscle without movement, to reduce pain sensitivity. The program then advances to eccentric strengthening, where the muscle lengthens while contracting, which is effective for tendon health. Core stability exercises are also incorporated to improve overall pelvic control, reducing the excessive side-to-side motion that compresses the hip tendons during walking.
For persistent pain, a physician may recommend a corticosteroid injection, often administered with ultrasound guidance for precise placement into the bursa or around the affected tendon. This injection delivers a potent anti-inflammatory medication that can provide significant short-term pain relief, typically lasting a few months. The injection is generally viewed as a window of opportunity for the patient to begin or intensify physical therapy without pain, rather than a standalone cure.
Advanced imaging, such as a Magnetic Resonance Imaging (MRI) scan, is not routinely necessary. However, it may be used to rule out other conditions or to determine the extent of a tendon tear if symptoms are severe or persistent.
Warning Signs That Require a Doctor Visit
While most lateral hip pain is due to common soft tissue issues, certain signs indicate the need for immediate medical evaluation. If the pain began following a specific trauma, such as a fall or accident, a doctor should check for a possible fracture. An inability to bear weight on the affected leg, or a sudden, severe increase in pain that prevents walking, suggests a more serious injury.
Systemic symptoms accompanying the hip pain also warrant prompt attention. These include developing a fever, chills, or unexplained weight loss, which can signal an underlying infection or other non-musculoskeletal condition.
If the pain is constant, deep, and throbbing, and it continues to worsen or wakes you from sleep despite attempts at rest and home care, schedule a professional consultation. Pain that persists or returns after two weeks of consistent self-management should be evaluated by a healthcare professional for an accurate diagnosis and treatment plan.