Written and reviewed by the BPR clinical team. Last reviewed: 30 July 2026. This article is for education and is not a substitute for individual assessment, diagnosis or treatment by a qualified healthcare professional.
If you have pain on the outside of your hip that flares when you lie on that side at night, climb stairs or stand for a while, you're describing one of the most common hip complaints we see. It used to be labelled simply “bursitis,” but our understanding has moved on — and that shift changes the treatment for the better.
What is it?
Greater trochanteric pain syndrome (GTPS) is pain over the bony point on the outside of the hip — the greater trochanter. For a long time it was assumed to be inflammation of the bursa (a small fluid-filled cushion). We now know it's usually a tendon problem: an overload of the gluteal tendons (gluteus medius and minimus) where they attach to that bony point, sometimes with the bursa involved as well (Grimaldi and Fearon, 2015). That reframing matters, because a tendon overload is managed very differently from a simple inflammation.
Why does it happen?
The gluteal tendons don't like being compressed against the bony point, and certain positions do exactly that — sitting with your legs crossed, standing with your weight slung onto one hip, or lying on the painful side. Add in weakness of the hip muscles and a change in activity, and the tendon becomes overloaded and painful. It's more common in women and around midlife, though it can affect anyone.
What does it feel like?
The hallmark is pain over the outside of the hip that's worse lying on that side — so it frequently disturbs sleep — and with stairs, hills and prolonged standing or walking. It can radiate down the outside of the thigh, and pressing on the bony point usually reproduces the tenderness.
How it's assessed
We'll press over the greater trochanter to find the tender spot and use tests that load the gluteal tendons — such as standing on one leg for half a minute or resisting hip movements — to reproduce your pain. We'll also assess your hip strength and check that the pain isn't coming from the hip joint itself or being referred from the back, both of which can feel similar.
What the evidence says
- Education plus exercise outperforms injection. In a landmark randomised trial, a programme of education and exercise gave better outcomes at 8 weeks than a corticosteroid injection or a wait-and-see approach, and the benefit held up at 52 weeks (Mellor et al., 2018).
- It's a load problem, so load is the solution. Reframed as a gluteal tendinopathy, management centres on reducing compression and progressively loading the hip abductors (Grimaldi and Fearon, 2015).
- Injections aren't the answer for most. They may give short-term relief but don't beat a well-run exercise programme over time (Mellor et al., 2018).
How it's treated
The core of treatment is twofold: load the tendon progressively to rebuild its capacity, and reduce the compression that's aggravating it. The education part is deceptively powerful — simply learning to avoid the positions that compress the tendon often takes a lot of heat out of the problem. Hands-on treatment can help you feel more comfortable, but the loading and the load-management advice are what drive lasting recovery.
Expect a gradual improvement over a couple of months, with sleep often among the first things to get better once you protect the tendon at night.
What you can do yourself
Start with the positions: avoid crossing your legs, try not to stand with all your weight on one hip, and put a pillow between your knees at night (or sleep off the painful side) to ease the pressure. Then commit to a progressive hip-strengthening programme. Avoid aggressive stretching of the outside of the hip, which tends to compress the tendon and make things worse.
When to seek help
When to seek help. See someone if the pain is disturbing your sleep, limiting stairs and walking, or not settling with these self-care steps. It's also worth an assessment to make sure the pain isn't coming from the hip joint (groin pain, restricted rotation) or the back instead.
Frequently asked questions
Is it bursitis?
Usually not in the way the name suggests. GTPS is mostly a gluteal tendon overload, sometimes with some bursal involvement — which is why loading, not rest and repeated injections, is the mainstay.
Why does it hurt so much at night?
Lying on the affected side compresses the gluteal tendons against the bony point of the hip. A pillow between the knees or sleeping off that side often helps.
Should I get a cortisone injection?
For most people, education and exercise work better over time than injection (Mellor et al., 2018). An injection may occasionally help short-term, but it isn't the long-term answer.
What exercises help?
Progressive hip-abductor strengthening, introduced carefully and built up over time. A clinician can tailor this and make sure you're not compressing the tendon.
How long does it take?
Typically a couple of months of consistent loading and position changes, with night pain often improving first.
How BPR can help
At BPR we'll confirm it's the gluteal tendons, teach you the position changes that make an immediate difference, and build a loading programme that gets you sleeping and moving comfortably again. You can book an assessment at bpr.rehab.
References
- Mellor, R., Bennell, K., Grimaldi, A. et al. (2018) 'Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial', BMJ, 361, k1662. doi:10.1136/bmj.k1662.
- Grimaldi, A. and Fearon, A. (2015) 'Gluteal tendinopathy: integrating pathomechanics and clinical features in its management', Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp. 910–922. doi:10.2519/jospt.2015.5829.