What Causes Greater Trochanteric Pain on the Side of the Hip?
Greater trochanter pain is usually caused by gluteal tendinopathy. This is when the tendons of the gluteus medius and gluteus minimus become irritated where they attach to the bony point on the outer hip. It is not always bursitis. Pelvic alignment, hip abductor weakness and habitual postures, such as sleeping on your side, can all contribute.
Key takeaways
- Pain on the outer side of the hip is more often linked to the tendons than to the bursa.
- Pelvic tilt, leg length discrepancy and hip abductor weakness are common contributing factors.
- Scans done lying down can miss alignment problems that only appear when you stand and bear weight.
- A standing whole-body image shows the pelvis, hips and legs together. It reveals where load is uneven.
- ScanAlign is a diagnostic imaging clinic, not a treatment provider.
What is greater trochanteric pain syndrome?
Greater trochanteric pain syndrome (GTPS) is the modern umbrella term for persistent pain over the bony bump on the outer side of your hip. This bump is called the greater trochanter. Clinicians used to label almost all outer hip pain as trochanteric bursitis, meaning inflammation of the small fluid-filled sac (bursa) that cushions the area. Research now shows that the bursa is only part of the picture. In most cases, the real problem lies in the gluteal tendons.
The gluteus medius and gluteus minimus are your main hip abductor muscles. They keep your pelvis level when you walk, climb stairs or stand on one leg. Their tendons attach directly to the greater trochanter. When those tendons become overloaded, frayed or compressed, the result is gluteal tendinopathy. This is the most common cause of GTPS.
Some people also have a reactive hip bursitis alongside the tendon problem. The two conditions can overlap. That is why the broader term GTPS is now preferred.
What does pain on the outer side of the hip feel like?
GTPS typically causes a deep ache on the outside of the hip. It can be sharp with certain movements and dull the rest of the time. Many people notice it most when lying on the affected side at night.
A focused ache right over the bony point on the outer hip. It sometimes spreads down the outer thigh.
Sleeping on your side puts pressure on the greater trochanter. This compresses the tendons and often wakes you.
Loading the hip abductors on a step puts extra demand on irritated tendons.
Weak gluteal muscles can cause your pelvis to dip on the opposite side when you walk. This is known as a Trendelenburg sign.
What causes greater trochanter pain?
Gluteal tendinopathy develops when the tendons are repeatedly compressed or overloaded. Several factors raise the risk.
Standing with your weight shifted to one hip, crossing your legs, or sleeping on the affected side compresses the tendons against the bone.
When the gluteus medius and minimus are weak, the tendons take more strain with every step.
A lateral pelvic tilt or uneven leg lengths changes how load is spread across each hip.
A sharp increase in walking, running or hill work can overwhelm tendons that are not conditioned for it.
How does alignment affect pain on the outer side of the hip?
Your body is a connected chain from your feet to your head. If one part is out of line, other areas compensate. A small pelvic tilt, for example, shifts more weight onto one hip. The gluteal tendons on that side work harder with every step. Over months or years, that extra load can lead to tendinopathy.
The same logic applies to a leg length discrepancy. Even a modest difference can make the pelvis sit unevenly. This compresses the tendons on one side and overstretches them on the other. That is why many people with GTPS only ever have symptoms on one side.
The difficulty is that these alignment problems are invisible on a standard scan done lying down. When you lie flat for an X-ray or MRI, gravity is removed, your muscles relax, and your pelvis may look perfectly level. Only a weight-bearing, standing image captures how your bones and joints actually line up under load.
What it shows: The pelvis, hips and legs under your full body weight, exactly as they work in daily life. Any pelvic tilt, uneven leg length or uneven joint loading becomes visible.
Why it matters for GTPS: You can see which side is bearing more load and whether the greater trochanter is being compressed by the iliotibial band or other structures.
What it shows: Bone structure in a position without gravity. Good for fractures and joint surfaces, but muscles relax and the pelvis often levels out artificially.
What it can miss: Functional alignment problems. A tilt that causes daily tendon compression may not appear at all when you are lying flat.
How does a standing EOS scan help with greater trochanter pain?
An EOS scan captures your full skeleton from head to feet in a single standing image. For GTPS, this is valuable because it shows the pelvis, both hips and both legs together, under load. Your clinician can see at a glance whether the pelvis is tilted, whether leg lengths differ, and how the hip joints are positioned relative to each other.
EOS uses about 90% less radiation than a standard X-ray, around ten times less. This makes it a practical option when a whole-body view is needed.
At ScanAlign standing imaging, a specialist diagnostic radiographer takes the scan at 19 Harley Street, London, and a consultant radiologist reports on it. The report is shared with you and, with your consent, with any clinician treating you, including one back home.
Want to find out whether a standing scan could explain the pain on the side of your hip before you plan a trip to London?
Book a free video consultationWhen MRI is the better tool: EOS shows bones, joints and alignment. If your clinician suspects a gluteal tendon tear, bursitis or soft-tissue inflammation, MRI is usually the better choice because it images tendons, muscles and fluid in detail. In many cases, the two scans complement each other.
What generally helps manage greater trochanteric pain?
Treatment for GTPS is guided by what is found on assessment and imaging. ScanAlign is a diagnostic imaging clinic, so we do not provide treatment. The approaches below are widely discussed in clinical guidance. They are worth raising with your doctor or physiotherapist.
- Load management. Adjusting activity levels so tendons are not repeatedly overloaded, then gradually rebuilding strength.
- Hip abductor strengthening. Targeted exercises for the gluteus medius and minimus are considered central to most rehabilitation programmes.
- Postural changes. Avoiding habitual leg crossing, shifting your weight onto one hip and sleeping on the painful side can reduce tendon compression.
- Addressing alignment. If a pelvic tilt or leg length difference is found, your clinician may factor this into your management plan.
Before you start treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
- Have had pain on the outer side of your hip for more than three months
- Have been told your imaging is "normal" but still have symptoms
- Suspect one leg may be longer than the other
- Want a full picture of your pelvis and hip alignment
- Sudden severe hip pain after a fall or injury
- Numbness, tingling or weakness in your leg
- Loss of bladder or bowel control
- Fever along with hip pain
If you have any of the warning symptoms listed above, contact your doctor straight away or go to your nearest emergency department.
Frequently asked questions about greater trochanter pain
Not exactly. Bursitis is inflammation of the bursa and can be one part of it. But most pain on the outer side of the hip is now understood to involve the gluteal tendons as well. Greater trochanteric pain syndrome (GTPS) is the broader term that covers both tendon and bursa involvement.
Gluteal tendinopathy is a condition where the tendons of the gluteus medius and gluteus minimus become irritated, thickened or partially torn where they attach to the greater trochanter. It is considered the most common cause of GTPS.
Lying on the affected side presses the greater trochanter directly against the mattress. This compresses the irritated tendons and bursa. This ongoing pressure can increase pain significantly and disturb your sleep.
Yes. A lateral pelvic tilt shifts more load onto one hip. Over time, this can increase compression and strain on the gluteal tendons. A standing scan is one way to check whether your pelvis is level under weight.
No. ScanAlign accepts self-referrals. You can book a standing hip and pelvis scan directly, without a letter from your doctor or a consultant.
EOS uses about 90% less radiation than a standard X-ray, around ten times less. This makes it one of the lowest-dose skeletal imaging options available.
EOS images bones and joint alignment, not soft tissue in fine detail. If a gluteal tendon tear is suspected, MRI is usually the better tool. EOS and MRI often complement each other: one shows alignment and the other shows tendon or muscle detail.
It varies widely. Some people improve within weeks with load management and exercise. Others find symptoms last for months or longer, especially if an underlying alignment factor is not addressed.
It can contribute. Even a small difference in leg length can tilt the pelvis and change the load on each hip. A full standing image of both legs and the pelvis is a simple way to check.
The price for patients travelling from abroad is confirmed during the free video consultation, where you can also discuss whether a scan is right for you.
Could alignment be behind the pain on the side of your hip?
A free video consultation with our specialist diagnostic radiographer can help you decide whether a standing scan is worth the trip to London.
Book a free video consultationSources
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy. 2015;45(11):910-922.
- Mellor R, Bennell K, Grimaldi A, et al. 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. 2018;361:k1662.
- NHS. Hip pain in adults. nhs.uk. Available at: https://www.nhs.uk/conditions/hip-pain/
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.