Gluteal Tendinopathy (Outer Hip Pain): Why It Hurts to Lie on Your Side and How to Fix It
Gluteal tendinopathy is an irritation of the tendons that attach your glute muscles to the bony point on the side of your hip, and it is the most common cause of outer hip pain in adults. The telltale sign is pain on the outside of the hip that flares when you lie on that side at night, climb stairs, or stand on one leg. The best-supported treatment is not rest and not an injection: it is a combination of manual therapy to calm the pain, a progressive strengthening program to rebuild the tendon, and education about which positions compress it. Here is how to know if this is your hip pain, and what actually fixes it.
What is gluteal tendinopathy?
Your gluteus medius and minimus tendons anchor onto the greater trochanter, the bony bump you can feel on the side of your hip. When those tendons are underloaded, then suddenly overloaded, or repeatedly compressed, they become painful and less tolerant of load. Some people call it glute tendinitis, and because the outer upper hip sits so close to the low back, it can even be mistaken for a back problem. It shows up most often in women over 40, in runners who ramped up quickly, and in people who started a new walking or stair routine.
What makes these tendons so easy to irritate is the job they do. The gluteus medius and minimus are the main stabilizers of your hip, and every step you take is a brief single-leg balancing act: when your foot hits the ground, that side's glute med is what keeps your pelvis level instead of letting it drop. Standing, walking, stairs, and especially running load that system with every stride, thousands of times a day. When the muscle is weak or deconditioned, the tendon is forced to absorb the work the muscle should be doing, and a tendon repeatedly asked to do more than it can handle is exactly how tendinopathy starts. That is why the pain shows up during and after time on your feet, and why strengthening that muscle, not resting it, is what actually fixes the tendon.
One of the main patterns we see with gluteal tendinopathy is a hip drop, known clinically as a Trendelenburg sign: when you put weight through the affected leg, the opposite side of the pelvis dips because the glute med is too weak or too painful to hold it level. You can often see it in something as simple as standing on one leg, and it is the same failure we look for in the evaluation. If this is what is going on with you, our hip and groin physical therapy page walks through how we work it up.
Why does my hip hurt when I lie on my side?
Lying on your side presses the greater trochanter and its tendons directly into the mattress, and lying on the opposite side lets the sore leg fall across midline, which stretches and compresses the tendon from the other direction. That is why hip pain when lying on your side is the signature complaint, and why nights are often worse than days. A pillow between the knees keeps the top leg level and usually improves sleep within days while the strengthening work takes hold.
In my practice, the first thing I check when someone has outer hip pain is:
- Resisted abduction, testing the strength of that glute med.
- Palpation, which is touching the muscle itself to see how reactive it is.
- Single-leg stance test, which will tell if you are able to control the glute med or if you have pain and the muscle collapses as you stand on one single leg.
Is it hip bursitis or gluteal tendinopathy?
Most outer hip pain that gets called hip bursitis is actually a tendon problem. Imaging studies of people with lateral hip pain consistently show the gluteal tendons as the main culprit, with the bursa irritated as a bystander. The distinction matters for treatment: a tendon needs progressive load to recover, and treating it like a pure inflammation problem, with rest alone or repeated injections, tends to disappoint. The location differs too. Bursitis pain sits right over the bony point on the side of your hip, while glute tendinopathy feels like a deeper ache in the surrounding soft tissue and muscle. Clinically, the whole picture is often grouped under greater trochanteric pain syndrome.
What causes outer hip pain to flare up?
The big drivers of outer hip pain are compression habits and load spikes. Sitting with legs crossed, standing with your hip hung out to one side, and sleeping without support all compress the tendon. On the load side, a sudden increase in walking volume, stairs, hills, or running asks more of the tendon than it is currently conditioned for. Fixing the habits calms it down. Building strength keeps it gone. Getting that build-up right is a matter of progressive overload, adding load at a rate the tendon can actually keep up with.
How physical therapy treats gluteal tendinopathy: the approach that beats injections
Glute tendinopathy has great research to show improvement of the condition with conservative management such as physical therapy versus injections. In the LEAP trial published in the British Journal of Sports Medicine, adults with gluteal tendinopathy were randomized to education plus exercise, a corticosteroid injection, or wait and see. At 8 weeks, 77 percent of the education plus exercise group reported global improvement versus 58 percent with injection and 29 percent with wait and see.
At one year the exercise group was still ahead of the injection group. Strengthening wins, and the result lasts. The problem with injections for pain, such as corticosteroid shots, is that they only temporarily reduce inflammation and pain, and if the underlying impairment is not addressed, the tissue will continue to have problems in the future.
Dry needling and manual therapy for gluteal tendinopathy
Due to how deep the glute med sits underneath the glute maximus and several layers of tissue, foam rollers, a massage gun, or even hands pressing from the surface have a tougher time reaching the tissue that is actually irritated.
That is what makes dry needling so valuable here: a thin needle can travel through those layers and treat the deep trigger points directly, where nothing else can. Adding electrical stimulation to the needles helps decrease localized inflammation, drives blood flow into the area around the tendon, and decreases pain receptor sensitivity, which means less pain with walking, stairs, and lying on that side. Essentially it kickstarts the healing process and prepares us for the long-term fix of stabilizing that hip and the muscles.
Cupping and scraping ease the myofascial tension in the surrounding hip muscles, and manual therapy keeps the hip joint itself moving well. None of this replaces the strengthening, it calms the area down enough to load the tendon properly, which is what fixes it long-term.
How we treat gluteal tendinopathy at Reclaim
At Reclaim Physical Therapy, we combine load management coaching with a progressive glute strengthening program, and we use dry needling and manual therapy to settle the overworked muscles around the hip, including the TFL and glute max, when they are amplifying the pain. Because we are a concierge, in-home practice serving Miami Lakes and the surrounding area, we set up your program with the actual stairs, bed, and equipment you use every day.
For most tendinopathies, pain usually starts improving within the first four weeks of treatment, and for the gluteal tendons, sleeping through the night is often the first win. The tendon itself takes longer to rebuild: most cases return to normal activity over six to 12 weeks, while more severe or long-standing cases need a few months of progressive loading to fully recover. If your goal is getting back on the road, the same staged approach we use in a return to running plan applies once the hip tolerates single-leg load.
Outer hip pain keeping you up at night?
Book an in-home visit with Reclaim Physical Therapy and we will get you sleeping through the night again. Serving Miami Lakes and nearby.
Ready to move past the pain?
Gluteal tendinopathy doesn't have to be your "new normal." At Reclaim Physical Therapy, we specialize in gluteal tendinopathy recovery for patients in the Miami Lakes area. Experience concierge-style care tailored to your lifestyle, brought right to your door.
Frequently asked questions
What is the fastest way to relieve gluteal tendinopathy pain?
Reduce compression first: pillow between the knees at night, stop crossing your legs, avoid hanging on one hip. Then start a graded strengthening program, ideally built by a physical therapist around your specific weaknesses, since that is the approach that beat injections in the research.
Should I stretch my glutes or IT band for outer hip pain?
Usually no. Deep stretching compresses the irritated tendon against the bone and often makes it worse. Strengthening is the better lever, and a physical therapist can show you how to load the tendon without compressing it.
Do I need an injection or imaging first?
Usually not. A physical therapist can diagnose gluteal tendinopathy with a hands-on exam, and education plus exercise outperformed injection in a randomized trial at both 8 weeks and one year.
Do I need a referral to see a physical therapist for hip pain?
No. In Florida, direct access lets you be evaluated and treated by a physical therapist without a referral or prescription, so you can start right away.