Pain on the outside of your hip most commonly comes from irritation of the tendons, bursa, or soft tissues around the bony bump near the top of your thighbone, called the greater trochanter. This is the widest, most prominent part of your hip, and it’s a hotspot for friction and overuse. The umbrella term for this type of pain is greater trochanteric pain syndrome (GTPS), and it covers several overlapping conditions. Less commonly, a compressed nerve or a tight band of tissue running down the leg can produce similar outer hip pain.
The Most Common Cause: Tendon Irritation
The gluteal tendons, which connect your buttock muscles to the outside of your hip bone, are the most frequent source of lateral hip pain. When these tendons become irritated or partially damaged from repetitive stress, the condition is called gluteal tendinopathy. It’s especially common in women around or after menopause. Women naturally have greater range of motion in their hips than men, which, somewhat counterintuitively, can be part of the problem. That extra flexibility means the hip muscles need to work harder to keep the joint stabilized, and when strength doesn’t match mobility, the tendons take the load.
Gluteal tendinopathy has a very recognizable pattern. The pain tends to feel worse when you:
- Climb stairs or walk uphill
- Get out of bed in the morning
- Lie on the affected side at night
- Sit for a long time or sit cross-legged
- Stand on one leg, like when pulling on pants
If your pain checks several of those boxes, tendon irritation is the most likely explanation. The pain is usually a deep ache right over that outer bony prominence, sometimes spreading down the outside of the thigh.
Hip Bursitis: Often Diagnosed, Less Often the Real Culprit
For years, outer hip pain was almost automatically labeled “trochanteric bursitis,” meaning inflammation of a small fluid-filled sac (bursa) that cushions the bone. This diagnosis is still common, and bursitis can certainly play a role, but imaging studies have shown that most people with lateral hip pain actually have tendon problems rather than isolated bursa inflammation. The two often coexist, which is why clinicians now tend to use the broader term GTPS rather than defaulting to bursitis. From your perspective the distinction matters mostly for treatment: if the underlying issue is a weakened tendon, simply calming inflammation won’t fix the root cause.
IT Band Tightness and Friction
Your iliotibial (IT) band is a thick strip of connective tissue that runs from your hip down to your knee along the outside of your thigh. When it’s too tight, it repeatedly rubs across the greater trochanter with every step. That friction creates inflammation in the tendon and pain in the hip. IT band-related pain is common in runners and cyclists, and it can affect both the hip and the outer knee. If your pain gets worse with repetitive activity and you also notice discomfort near the outside of your knee, IT band irritation is worth considering.
Nerve Compression: A Different Kind of Pain
Not all outer hip pain comes from muscles and tendons. A condition called meralgia paresthetica occurs when a sensory nerve running along the front and side of your thigh gets compressed. The pain feels distinctly different from tendon or bursa problems. Instead of a deep ache, you’ll notice tingling, burning, numbness, or heightened sensitivity to light touch on the outer thigh. These symptoms typically appear on one side and get worse after walking or standing for a while.
The key difference is that this nerve only affects sensation. Your leg strength stays normal, and you won’t feel the same bony tenderness when you press on the outside of the hip. Tight clothing, weight gain, pregnancy, and prolonged standing are common triggers. If your outer hip pain has a burning or electric quality rather than a dull ache, nerve compression is more likely than a tendon or bursa issue.
How Your Doctor Figures Out the Cause
A physical exam usually provides the answer without imaging. One of the most useful observations is how you walk. A specific gait pattern called the Trendelenburg gait, where your pelvis drops on the opposite side when you stand on the affected leg, is both sensitive and specific for GTPS and gluteal muscle problems. Your doctor may also press directly over the greater trochanter to reproduce the pain, or ask you to resist movement while lying on your side to test the gluteal tendons.
If the exam suggests something deeper inside the joint rather than on the outer surface, specific positioning tests can help. A test that combines flexing, spreading, and rotating the hip outward (sometimes called FABER) has a sensitivity above 95% for detecting joint impingement. Imaging is typically reserved for cases that don’t respond to initial treatment or when a tear is suspected. Standard MRI picks up some problems well but misses others: for labral tears inside the joint, a specialized MRI with contrast dye is far more accurate (about 90% sensitivity compared to only 30% for a regular MRI).
What Actually Helps
Exercise-based rehabilitation is the most effective long-term treatment for outer hip pain caused by tendon or bursa problems. A 2024 systematic review of randomized trials found that exercise outperformed corticosteroid injections for meaningful, lasting improvement. Steroid injections can reduce pain in the short term, sometimes within days, but the relief tends to fade. Exercise produces better results over months because it addresses the underlying weakness that caused the problem.
The typical approach starts with isometric exercises, where you contract the muscles without moving the joint. Think of pressing your leg outward against a wall and holding. These reduce pain and begin loading the tendon safely. Over weeks, you progress to movements with resistance, like side-lying leg lifts and single-leg balance work, gradually increasing the demand on the gluteal muscles. Consistency matters more than intensity. Most people notice meaningful improvement within 6 to 12 weeks of regular exercise, though full recovery from a stubborn tendinopathy can take several months.
A few practical changes also help while you’re recovering. Avoid sleeping on the painful side, or place a pillow between your knees to reduce compression. Don’t sit cross-legged or stand with your hip hitched out to one side, both of which increase strain on the tendons. If you run or walk for exercise, temporarily reducing your distance and avoiding hills can lower the repetitive load on the area while you rebuild strength.
When the Pain Points to Something Else
Most outer hip pain traces back to the soft tissues around the greater trochanter, but occasionally the pain is referred from somewhere else. Hip joint arthritis typically causes groin pain, but it can radiate to the side. Lower back problems, particularly issues with the nerve roots in the lumbar spine, can send pain into the hip and thigh. A stress fracture of the femoral neck is rarer but more urgent, producing a deep pain that worsens with weight-bearing and doesn’t ease with rest.
Red flags worth paying attention to include pain that wakes you from sleep and doesn’t improve in any position, pain after a fall or impact (especially in older adults), unexplained weight loss alongside hip pain, or hip pain with fever. These patterns suggest something beyond a tendon or bursa issue and warrant prompt evaluation.