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Lateral (Outer) hip pain

What is it?  

A number of terms have been used to describe pain on the outside of the hip.  Commonly it may be called trochanteric bursitis, gluteal tendinopathy or greater trochanteric pain syndrome (GTPS).

It is caused by irritation to the tendons of the buttock muscles (gluteals), there may also be irritation of a fluid sac on the outside of the top of the thigh bone which reduces friction called the bursa.

It is more common in females and in people older than 40. It can sometimes be brought on by a change in the amount or type of exercise or activity you do or a trauma such as a fall. Symptoms frequently start without an obvious cause.

Outer hip pain – Greater trochanter pain syndrome (GTPS)

Common area of pain, outer hip shown by the blue arrow

 

What are the common symptoms?

Pain is often worse when lying on your side or aggravated by activities such as running, climbing stairs or prolonged standing – especially cross legged. It can sometimes spread down the outside of your thigh.

How to manage it? 

A number of things have been shown to help with lateral hip pain. It is something that typically improves with time but there are lots of things you can to do help

Modify your activity

This is key to settling down a flare up of lateral hip pain.

Limit activities, movements and positions that aggravate the area.  Common irritable habits are crossing your legs when sitting, lying on either side and standing with weight biased on one leg.  If you do lie on your side place a pillow between your legs.

Exercises

Strengthening muscles around the hip has been shown to be very effective in improving this condition. It is important to gradually build up your exercises and strength.

Please see the descriptions below for an example of rehabilitations exercises for hip strengthening. These exercises will help activate and strengthen the gluteal muscles. With each exercise start repetition of 8-10.

It is important to get control of your hips and pelvis. Try to avoid leaning heavily on one side, if you do, try to change position regularly.

By working on the below exercises regularly you will help strengthen your gluteal muscles, core muscles and improve your control.

 

Sit to stand

Sitting in a chair.  Stand up and sit down slowly. Make sure you are putting equal weight through your feet. 

Try not to use your hands if possible.

Make this harder by standing from a lower height.

Side stepping

Start by standing shoulder width apart. Lead with your injured leg. Side step one way for 10 steps and then side step back. Rest for 1 minute and then repeat 3 times.

Mini squat

In standing with feet apart, hold on to something in front. Keeping your back upright, slowly let your knees bend and return to upright.

Gradually progress to a deeper dip.

Squat

Stand tall with feet slightly wider than hip-width apart. Toes pointing forward or turned a few degrees outwards.
Squat down by sitting back and bring your arms forward. Push back up through the heels, chest up, and straighten your hips.

Bridge

Lie on your back with legs bent.
Squeeze your buttock muscles and roll your pelvis off the floor.
In a controlled manner, return to the starting position.

Single leg stand with control

Stand close to a wall. Lift your unaffected leg and stand on the injured.
Try to maintain control and good alignment from your hip, knee and foot. Squeeze your buttock muscles and do not let you pelvis drop away from the wall.
Hold for 10 seconds and repeat 3 times.

Remember changes to the muscles and tendons takes time, you may need to do the exercises for a number of months to aid recovery.  Be patient and continue to do them regularly.

A mild discomfort during exercise is acceptable but if you get severe pain or increased symptoms stop. Try to return to the exercises again, but at a lower intensity.

If you are having difficulty or need guidance on the right exercises, speak to a physiotherapist.

Weight loss

Losing weight will reduce the amount of pressure on the tissues around the outside of the hip and can improve it and reduce of the chances of it coming back.

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice or heat therapy 

Heat may be helpful in the form of a hot water bottle, wheat pack or hot shower. This can help to relax the muscles around your knee and may allow exercises to be more effective.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing hip pain. Click here to self-refer to a physiotherapist.

Important information to note: 

If you have had a significant fall and pain is keeping you awake at night and / or you are having difficulty weight bearing it is important to seek an opinion from a healthcare professional.

How to prevent and manage future flare ups?

Simple advice such as keeping the hip moving, strengthening your muscles, becoming active and keeping your weight under control can often help. If you follow this and the advice above you can make some very positive measures to prevent future problems

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