Muscle, joint & pain

The Lateral Hip Pain That Wakes You at Night

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The greater trochanter is the bony bump you can feel on the side of your hip, where the gluteal tendons anchor. When those tendons and the nearby bursa become irritated, the result is a deep, tender ache that flares with side-lying and stairs. It is common, rarely dangerous, and one of the more fixable hip complaints — but only if it is not mistaken for arthritis.

Last updated: July 2026

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What is greater trochanteric pain syndrome?

Greater trochanteric pain syndrome, or GTPS, is the umbrella name for pain and tenderness centred on the greater trochanter — the bony knob you can feel on the outer hip, roughly where the side seam of your trousers sits. The pain is felt on the side of the hip, not in the groin, and it is often tender to press or to lie on. It is one of the most common causes of lateral hip pain, particularly in women from midlife onward.

The greater trochanter is the anchor point for the gluteus medius and gluteus minimus — the muscles that hold your pelvis level when you stand on one leg. Their tendons attach right at that bony point, and a fluid-filled cushion called a bursa sits between tendon and bone. When people describe 'hip bursitis,' this is the region they mean. Current understanding places most of the trouble in the tendons themselves, with the bursa often irritated secondarily, which is why the broader label GTPS has largely replaced 'trochanteric bursitis.'

GTPS is common, rarely dangerous, and one of the more responsive hip problems to treat. That does not make it trivial — the night pain can be genuinely wearing — but it does mean the outlook is usually good once the problem is correctly named and the load on the tendons is managed.

Why does it wake you at night?

The night pain of GTPS has a mechanical explanation. Lying on the affected side presses your body weight directly onto the tender tendons and bursa over the greater trochanter. Lying on the other side lets the top leg drop across the body, which stretches and compresses those same tendons against the bone. Either way, the sore structures get loaded exactly when you are trying to rest, so nocturnal hip pain — pain that wakes you or stops you settling — is one of the condition's signatures.

The same compression explains the daytime triggers: standing on one leg to pull on trousers, climbing stairs, walking up a hill, or sitting with legs crossed. Each of these squeezes or tensions the gluteal tendons where they wrap over the bone. People often notice the first few steps after sitting are the worst, easing a little once they get going — a pattern shared by several tendon problems.

Night hip pain that drives you to a spare bed, a pile of pillows, or a nightly search for a comfortable position is worth naming to a clinician, because it is both characteristic of GTPS and treatable. The position changes that reduce it — a pillow between the knees, avoiding the fully side-on sleep posture — are also part of the treatment, not just a way to cope.

How is it told apart from hip arthritis or back pain?

The most important distinction is where the pain sits. GTPS causes pain on the outside of the hip, while hip osteoarthritis typically causes pain in the groin or deep in the front of the hip, along with stiffness and a grinding limit to movement 1. Femoroacetabular impingement, another joint-based problem, likewise tends to produce groin or deep front-of-hip pain rather than side pain 2. Sorting groin pain or side pain is the first useful split — a difference of a few inches that points to entirely different structures. Side-of-hip pain points to the gluteal tendons; groin pain points to the joint. This is the crux of hip arthritis vs bursitis: arthritis is a joint problem felt in the groin, whereas GTPS is a tendon problem felt on the side.

Lower-back and sacroiliac problems can also refer pain toward the outer hip and buttock, which is why some lateral hip pain is really a spine issue in disguise. When someone cannot tell whether it is their hip or their back, the site of tenderness helps: GTPS is exquisitely tender to press directly on the bony point, whereas pain referred from the spine usually is not. Deep buttock pain that is worse when sitting points in yet another direction — toward the structures beneath the buttock rather than the trochanter.

That sorting matters because the treatments diverge. Hip osteoarthritis is managed first with education, exercise, and activity modification rather than early surgery 3; and where a joint problem such as impingement is confirmed, even surgery buys only a modest advantage over good physiotherapist-led care, at substantially higher cost 2. When you are making sense of hip pain more broadly, the lesson for lateral hip pain is that the joint is usually not the culprit, and the fix is rarely a scalpel.

What causes GTPS, and why does loading help?

GTPS behaves like a tendinopathy — a tendon overloaded relative to what it can currently tolerate, rather than one that is simply 'inflamed.' It often follows a change in activity: a new walking routine, a spell of extra stair-climbing, a limp from another injury that overloads the opposite hip, or a period of weakness after inactivity. Weak or deconditioned gluteal muscles leave the tendons doing more work than they can handle, and the compression against the bone in certain postures adds insult.

That mechanism is why rest alone tends to disappoint. Tendons adapt to load; remove the load entirely and they weaken further, so the pain returns the moment normal life resumes. The best-studied evidence for how tendons recover comes from the Achilles, where clinical guidelines strongly support progressive loading — controlled, gradually heavier exercise — to reduce pain and rebuild function 4. Gluteal tendinopathy is managed on the same loading principle, with one twist: deep stretches and crossed-leg positions compress the tendon against the bone and can aggravate it, so early rehabilitation usually favours strengthening over aggressive stretching.

In practice, that means a graded programme of hip and buttock strengthening, guided by how the tendon feels over the following day, plus small changes to how you stand, sit, and sleep to take the compression off. The tendons behind lateral hip pain respond to patient, progressive load the way most tendons do. In runners, the same overload that irritates the gluteal tendons can travel down the outside of the leg and show up as it band syndrome at the outer knee, so the whole lateral chain is worth thinking about together.

What actually helps — the sequence of care

The sequence of care for GTPS starts with the least invasive steps and escalates only if they fall short. First-line care is load management and gluteal strengthening, combined with simple changes that reduce compression: sleeping with a pillow between the knees, avoiding standing with the hip 'hitched' out to one side, and not sitting with the legs crossed for long stretches. These address the mechanism directly, and for most people, given time, they are enough 4.

When symptoms are stubborn, a corticosteroid injection around the tendon can settle pain in the short term and is sometimes used to make rehabilitation possible. Its relief tends to be temporary, and leaning on repeated steroid injections carries its own drawbacks. The clearest cautionary data come from knee osteoarthritis, where repeated corticosteroid injections every three months over two years produced no pain benefit over placebo and were associated with greater cartilage loss 5. That is a different joint and a different problem, but it is a useful reminder that a shot which feels good today is not the same as a durable fix.

Newer options aimed at the tendon are used in some clinics, but for lateral hip pain the evidence base is thinner than the case for loading exercise. The through-line is the sequence: rehabilitation first, injections as a bridge rather than a destination, and procedures reserved for the minority who genuinely need them.

When is a procedure or surgery the right call?

Surgery is uncommon for GTPS, and it is a considered step rather than a routine one. It becomes reasonable to discuss when imaging confirms a substantial tear of the gluteal tendon — not just tendinopathy, but an actual torn tendon — and the hip remains painful and weak despite a genuine trial of several months of well-structured rehabilitation. In that specific situation, surgical repair of the torn tendon can be appropriate, and naming that threshold clearly matters as much as the general advice to start conservatively.

The reason the bar is set there is the same reason it is set high across musculoskeletal care: for joint problems where surgery has been tested head-to-head against good physiotherapy, the surgical advantage is often modest and comes at higher cost and risk 2. When the structure is genuinely torn and rehabilitation has been given a fair chance, that calculus changes and surgery earns its place. The purpose of the sequence is not to avoid procedures on principle — it is to make sure each step is the one the problem actually calls for.

A persistent limp, night pain that never lets up despite months of good care, or weakness that makes standing on that leg fail are the features that move a case from 'keep rehabilitating' toward 'reassess and image.' Most people never reach that point.

How can you track whether it is improving?

Because GTPS improves slowly and unevenly, a steadying habit is to track specific functions rather than a general sense of pain. Can you lie on that side for a night? Climb a flight of stairs without a catch at the hip? Stand on that leg to dress? Watching these shift over weeks tells you more than a daily pain score, which bounces around with whatever you did that day.

Clinicians use validated questionnaires for the hip, such as the HOOS (Hip disability and Osteoarthritis Outcome Score), which rates pain, symptoms, daily activities, sport, and hip-related quality of life; it was developed and validated as a patient-reported measure for hip conditions 6. You do not need the formal instrument to borrow its logic: choose a handful of tasks that matter to you, rate them the same way each month, and let the trend — not any single bad day — tell you whether the plan is working.

If a well-run programme brings no change over a couple of months, that is itself useful information and a reason to revisit the diagnosis rather than simply push harder. Lateral hip pain that refuses to budge sometimes turns out to be a spine referral, a stress reaction in the bone, or a tendon tear that needs a closer look.

Common questions

It is what most people mean by hip bursitis, but the name has shifted. The bursa over the greater trochanter can be irritated, yet current understanding places most of the problem in the gluteal tendons that attach there. GTPS is the broader, more accurate label because it covers the tendons and the bursa together. The practical difference is that treatment aimed at loading and strengthening the tendons works better than treating a bursa alone.

Lying on the sore side presses your body weight straight onto the tender tendons and bursa over the bony point of the hip. Lying on the other side lets the top leg fall across the body and stretch those same tendons. Both positions load the painful structures just as you try to rest. A pillow between the knees and avoiding the fully side-on posture often reduce the night pain and are part of the treatment.

Complete rest usually disappoints, because tendons weaken without load and the pain returns once normal activity resumes. The aim is not rest or hard exercise but the right amount of graded load — strengthening the gluteal muscles while temporarily easing the positions that compress the tendon against the bone. A clinician can set the starting level and progress it by how the hip feels over the following day rather than in the moment.

It typically improves over weeks to several months with a consistent strengthening programme and changes to sleeping and standing habits, though the course is uneven and setbacks are common. Progress is easier to see if you track specific tasks — lying on that side, climbing stairs, standing on the leg — month to month. If a well-run programme brings no change over a couple of months, it is worth revisiting the diagnosis.

Often not at first. GTPS is usually recognised from the location of pain and tenderness and the pattern of triggers, and most cases improve with rehabilitation without any imaging. A scan becomes more useful when the diagnosis is unclear, when pain persists despite good treatment, or when a gluteal tendon tear is suspected. Asking what a scan would change before booking one is a fair question to raise with a clinician.

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When outer-hip pain needs prompt attention

  • —Hip pain that starts right after a fall, especially in an older adult, with an inability to put weight through the leg — a possible hip fracture
  • —The leg looks shortened or turned outward after a fall or injury
  • —Fever with a hot, swollen, intensely painful hip
  • —Steady night pain that does not ease with any change of position, especially alongside unexplained weight loss or a history of cancer

If the hip cannot bear weight after a fall, or the leg looks shortened or rotated, go to an emergency department — a hip fracture needs prompt imaging; call 911 if the person cannot be moved safely.

This article explains a common cause of lateral hip pain; it does not diagnose your hip or replace an in-person evaluation. A clinician can confirm whether pain on the outside of the hip is greater trochanteric pain syndrome or something else and tailor a plan to it.

References

  1. 1.American Academy of Orthopaedic Surgeons (OrthoInfo) (2024). Osteoarthritis of the Hip. OrthoInfo — AAOS. link ✓Hip osteoarthritis causes progressive groin and hip pain with stiffness and is managed first with nonsurgical measures such as activity modification, exercise, and NSAIDs — distinguishing it from side-of-hip pain.
  2. 2.Griffin DR, Dickenson EJ, Wall PDH, et al. (UK FASHIoN) (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. The Lancet. doi:10.1016/S0140-6736(18)31202-9Femoroacetabular impingement is a joint-based cause of groin/front-of-hip pain; hip arthroscopy produced only a modest improvement in hip function over personalised conservative care at 12 months, at substantially higher cost.
  3. 3.Cibulka MT, Bloom NJ, Enseki KR, et al. (2017). Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.2017.0301 ✓Hip osteoarthritis is managed with physical-therapy interventions including patient education, manual therapy, and exercise, ahead of early surgery.
  4. 4.Martin RL, Chimenti R, Cuddeford T, et al. (2018). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.2018.0302 ✓For Achilles tendinopathy, strong evidence supports progressive mechanical loading (eccentric or heavy-slow-resistance exercise) to reduce pain and improve function — the loading principle applied to tendinopathy.
  5. 5.McAlindon TE, LaValley MP, Harvey WF, et al. (2017). Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. PMID 28510679 ✓In knee osteoarthritis, repeated intra-articular corticosteroid injections every 12 weeks over two years produced no pain benefit over saline and were associated with greater cartilage volume loss — a caution against relying on repeated steroid injections.
  6. 6.Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM (2003). Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskeletal Disorders. PMID 12777182 ✓The HOOS is a validated patient-reported outcome for the hip, scoring pain, symptoms, daily activities, sport/recreation, and hip-related quality of life, usable to track hip function over time.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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