Hip pain usually starts as something you assume you can stretch out.
Then the stretching stops working. You cannot lie on that side at night, and turning over does not help much either because the top leg drops across and pulls on the sore hip.
Most patients reach us by the time it is affecting their sleep.
Outer hip pain like this is often labelled as bursitis. For many people, that turns out to be the wrong name because the main problem is the gluteal tendon.
Gluteal tendinopathy is now recognised as the most common cause of pain on the outside of the hip. This guide explains what it is, what it feels like and how a hip ultrasound helps identify it.
What is gluteal tendinopathy?
Tendinopathy means the tendon has become irritated and worn. Its fibres lose their orderly structure, the tendon thickens and it stops coping with load as well as it once did.
Two muscles run from the pelvis to the bony bump on the side of the hip: gluteus medius and gluteus minimus. Their tendons attach to this bump, called the greater trochanter.
These muscles hold the pelvis level while you stand on one leg. That happens during every step, so the tendons work throughout the day.
You may also hear the term greater trochanteric pain syndrome, or GTPS. This is an umbrella term for pain in the area involving the tendons, bursa and surrounding tissues. Gluteal tendinopathy is the specific diagnosis underneath it and is the finding seen most often.
It is considerably more common in women than men and usually appears between the ages of 40 and 60.
What does gluteal tendinopathy feel like?
Gluteal tendinopathy usually feels like a deep ache on the outside of the hip, centred over the bony point. It often spreads down the outside of the thigh but usually stops above the knee.
Four situations aggravate it for most people:
Lying on your side
Body weight presses the tendon into the bone. The opposite side can also hurt because the top leg drops across and compresses the painful hip.
Standing on one leg
Putting on socks, stepping into trousers or resting on one hip while standing can reproduce the pain.
Stairs and hills
Going uphill or upstairs is usually more uncomfortable than coming down.
Crossed legs and low seats
Sitting with crossed legs, or with the knees higher than the hips, can compress the tendon.
There is often stiffness after sitting, with pain during the first few steps before it settles.
Outer hip pain disrupting sleep deserves a clear diagnosis
A hip ultrasound assesses the gluteus medius and minimus insertions, trochanteric bursae and iliotibial band. Findings are explained during the appointment, with a written report to follow. No GP referral is required.
Book Hip UltrasoundWhy does gluteal tendinopathy happen?
Gluteal tendinopathy commonly develops because the tendon is repeatedly squeezed against the bone beneath it.
The iliotibial band is a thick strip of tissue running down the outside of the thigh, directly over the gluteal tendons. When the thigh moves inward towards the middle of the body, the band tightens and presses the tendons into the bone.
Research on hip specimens has shown that pressure on the tendon rises steeply as the hip moves further into this position.
The positions most likely to cause trouble are ordinary ones held for long periods:
- Standing with your weight slumped onto one hip.
- Sitting with your knees together or legs crossed.
- Sleeping on your side with the top knee dropping forward towards the mattress.
- Sitting in a low, soft chair or car seat.
- Stretching the outer hip forcefully, which may feel productive while compressing the tendon.
Symptoms can also flare when the amount of work placed on the tendon changes quickly, such as walking much more than usual or returning to the gym after time away. A tendon already under compression then receives a sudden increase in load.
Runners often notice symptoms after training on cambered pavements, where one hip drops slightly with every stride. If your pain began alongside a change in training, a sports injury ultrasound is designed for this type of assessment.
How is gluteal tendinopathy diagnosed?
Diagnosis is made in stages. Your GP or clinician will ask where the pain is and perform physical tests. A sonographer then uses imaging to define what is happening in the tissues.
Greater trochanter tenderness
Pressure over the bony point commonly reproduces pain. It is a sensitive but not highly specific test, so it is a useful starting point rather than a diagnosis on its own.
Single-leg stance
You stand on the painful leg for 30 seconds. Familiar outer hip pain appearing in that time makes gluteal tendinopathy considerably more likely.
Adduction-based tests
Positions such as FADER combine flexion, adduction and external rotation to compress the tendon and see whether this reproduces your pain.
These tests were investigated by Grimaldi and colleagues in the British Journal of Sports Medicine in 2017 by comparing clinical examination with MRI-confirmed gluteal tendinopathy in people with outer hip pain.
Physical tests cannot show how far the tendon has worn, whether there is a partial tear, whether the bursa is inflamed or whether calcium has formed in the tendon. These findings can change treatment, and they are what a hip ultrasound helps identify.
What does a hip ultrasound show?
A hip ultrasound shows the gluteal tendons live on a screen beside you. The probe passes over the outside of the hip, and the scan takes approximately 25 to 35 minutes per hip.
A healthy tendon has a tidy, organised fibre pattern. A worn tendon may appear thicker and darker, with disruption of that pattern. Doppler can show increased blood flow where the tendon is actively irritated.
The clinician assesses four main areas:
Gluteus medius and minimus
The tendon insertions are checked for thickening, degeneration, calcification and partial tears.
Trochanteric bursae
The bursae are assessed for genuine fluid and thickening rather than being assumed to be the source of pain.
Iliotibial band
The overlying tissue responsible for much of the compression is examined.
Dynamic movement
The hip is moved during scanning so the clinician can see what catches or compresses rather than relying on a still image.
The gluteal tendons sit close enough to the surface for high-resolution imaging, and the examination can be performed dynamically rather than with the hip held completely still.
Previously treated for bursitis without improvement?
A degenerative tendon needs progressive loading. An inflamed bursa can require a different approach. Imaging helps establish which tissue is actually involved.
Hip UltrasoundWhat is the treatment pathway for gluteal tendinopathy?
Gluteal tendinopathy has stronger treatment evidence than many tendon conditions.
The LEAP trial, published in the BMJ in 2018, compared three approaches in 204 people: education plus exercise, a single ultrasound-guided corticosteroid injection, and a wait-and-see approach.
At eight weeks, 77.3% of the education-and-exercise group reported success, compared with 58.5% in the injection group and 29.4% in the wait-and-see group.
Education and loading
Education and progressive loading are the first-line treatment and have the strongest supporting evidence. Learning which positions compress the tendon, then changing how you sit, stand and sleep, is part of treating the pain.
Loading gradually rebuilds tendon capacity, often beginning with isometric holds and progressing over weeks or months. Consistency is difficult, which is why a personalised rehabilitation programme can be based on your scan findings rather than a generic hip exercise sheet.
Corticosteroid injection
An ultrasound-guided corticosteroid injection can reduce pain enough to make loading possible. Live guidance helps place the medication at the intended site rather than the general area.
The injection provides a window of lower pain; tendon recovery still depends on physiotherapy or progressive strengthening. You may also find our guide to tennis elbow and corticosteroid injection helpful.
Shockwave therapy
Shockwave therapy may be considered for tendon symptoms that have not responded to a properly followed loading programme.
Platelet-rich plasma
Platelet-rich plasma is another option for persistent tendon problems and is delivered under ultrasound guidance so the injection reaches the tendon.
Is there a quick fix?
There is no quick fix for gluteal tendinopathy. Tendons adapt slowly by design, which is why targeted treatment and strengthening over time are important. Read more about this principle in our guide to heel pain, plantar fasciitis and Achilles tendinopathy.
Book a hip ultrasound with London Private Ultrasound
Outer hip pain is one of the most consistently mislabelled problems we scan. Some people arrive after being told it is bursitis or with a stretching sheet that has quietly been making the compression worse.
The answer comes from scanning the gluteus medius and minimus tendon insertions specifically, alongside the trochanteric bursae, iliotibial band and surrounding soft tissues.
Scanned by MSK specialists
Gluteal tendon insertions require regular experience. The clinician who performs your scan interprets it rather than sending it away to be read.
Assessed while you move
The hip is taken through positions that reproduce pain, helping compression problems show themselves.
Findings explained immediately
You see the images during the appointment, with a written report within 24 hours for your GP, physiotherapist or consultant.
Treatment in the same building
Loading programmes, guided injections, shockwave and PRP can be coordinated by the same team.
Same-day and next-day appointments
Appointments are available seven days a week, 9am to 7pm, without a GP referral at 27 Welbeck Street in the Harley Street medical district and 54–56 Victoria Street in St Albans.
What you can book with us
Hip ultrasound: A focused dynamic scan of the gluteal tendon insertions, trochanteric bursae and iliotibial band, with findings explained on the day and a written report within 24 hours.
Joint Pain Clinic: When a scan shows a condition requiring more than a report, loading programmes, guided injections, shockwave and PRP can be provided within the same clinic.
Related musculoskeletal services
Hip ultrasound
Dynamic assessment of the gluteal tendons, trochanteric bursae, iliotibial band and accessible soft tissues.
Hip UltrasoundSports injury ultrasound
Focused assessment when hip symptoms begin after running, training or a change in activity.
Sports Injury UltrasoundPersonalised rehabilitation
A progressive loading programme tailored to imaging findings, symptoms and functional goals.
Rehabilitation ProgrammeCorticosteroid injection
Image-guided treatment considered when pain prevents effective loading and rehabilitation.
Corticosteroid InjectionPlatelet-rich plasma
Ultrasound-guided PRP treatment for selected persistent tendon problems.
PRP TherapyOrthopaedic assessment
Specialist review when the diagnosis is unclear or symptoms persist despite appropriate rehabilitation.
Orthopaedic AssessmentOne-Stop Orthopaedic MSK Clinic
Coordinated specialist assessment, imaging and treatment planning in one clinical pathway.
One-Stop MSK ClinicFrequently asked questions
What kind of doctor should I see for gluteal tendinopathy?
Most people start with a GP or physiotherapist. A physiotherapist experienced in tendon loading often moves treatment forward fastest. If the diagnosis is unclear, or a properly followed loading programme has not helped, a consultant orthopaedic assessment alongside imaging is a sensible next step.
What really works for gluteal tendinopathy?
Learning which positions compress the tendon and following a gradual loading programme have the strongest evidence. In the LEAP trial, this combination performed better than either a corticosteroid injection or waiting at eight weeks and again at one year.
Is there a quick fix?
No. An injection can reduce pain enough to help you move and exercise, but the tendon still needs to be rebuilt progressively. Evidence supports loading over time.
Does gluteal tendinopathy affect women more?
Yes, considerably. It is most common in women between approximately 40 and 60, which is thought to relate partly to pelvic width and the angle at which the gluteal tendons pull on the greater trochanter.
Should I stretch my outer hip?
Not while it is painful. Stretches that pull the knee across the body press the tendon into the bone, recreating the compression that aggravates symptoms.
How should I sleep with gluteal tendinopathy?
Sleep on your back where possible. If you sleep on your side, try the less painful side and place a firm pillow between the knees so the upper leg stays level instead of dropping across the body.
Do I need a GP referral for a hip ultrasound?
No. You can book directly. If you want the results sent to your GP, physiotherapist or consultant, tell the clinic on the day.