Hip pain can catch you as you go up the stairs, when you roll over in bed or when you climb out of the car.
At Sundial we find that the first thing most people want to know is where it’s coming from and what’s causing it.
In midlife and beyond, the usual suspects are the hip joint itself and the tendons on the outside of the hip. Early on they can feel much alike, but they behave differently and they don’t respond to the same things.
Where does it hurt?
Pain on the outside of the hip, over the bony point you can feel at your side, is most often a gluteal tendon problem. These are the tendons of the muscles that keep your pelvis steady when you walk or stand. Tendons and muscles are continuous tissue, with muscle fibres interlocking with the tendon’s collagen. However, a tendon can hurt while its muscle feels fine because the tendon takes the heaviest strain. In the hip, it is also squeezed against bone and has a poorer blood supply. As the tendon adapts more slowly than muscle, it is more easily overloaded.
Gluteal tendinopathy
In this case, the tendon is the main source of pain, not the bursa (a fluid-filled sac that acts as a cushion between a tendon or muscle and a bone). The pain of gluteal tendinopathy can run down the outside of the thigh. It’s usually worse when you lie on that side at night, climb stairs, stand on one leg or sit with your legs crossed. Most people who get it are over 40 and women outnumber men by roughly 4 to 1. This is because women’s hips are built a little differently. A wider pelvis and a different thigh bone angle mean the tendons on the outside of the hip are pressed against the bony bump more, especially when walking or standing on one leg. Tendons handle being pulled far better than being squashed.
Hip osteoarthritis
Pain in the groin or deep at the front of the hip, sometimes travelling to the thigh or knee, points more towards the source being in the joint. With hip osteoarthritis you’d typically also notice stiffness and trouble with socks and shoes or feel a painful catch when getting in and out of a car. NICE says that in anyone aged 45 or over, osteoarthritis can usually be diagnosed from their history and an examination, without scans, as long as the pain comes on with activity and morning stiffness lasts no more than 30 minutes.
You can have both conditions. Pain around the hip can also be referred from the lower back. That’s a big reason a careful assessment is worth more than the label on a scan report.
What the research says
Gluteal tendinopathy
The best trial we have on gluteal tendinopathy followed 204 adults aged 35 to 70 whose outer hip pain had lasted more than three months. They were split into three groups. One group had a physiotherapist-led programme of education and exercise over eight weeks; one group had a single corticosteroid injection; and the third group had a “wait and see” approach. At eight weeks both active treatment approaches beat the wait-and-see approach, and education plus exercise beat the injection. At one year, the exercise group still reported better overall improvement than the injection group, although pain scores were about the same.
So an injection may ease things for a while, but learning how to load the tendon and strengthening the muscles around it seems to have a longer-lasting benefit. The exercise plan in the trial was fairly structured and supervised, which may indicate that physiotherapy-led care rather than home treatment is the most effective way to ease gluteal tendinopathy.
Hip osteoarthritis
For hip arthritis, NICE puts exercise, education and support for self-management at the centre of care, with weight management where it’s relevant. Exercise is the foundation of hip arthritis care but the average effect is modest, so it works best alongside the rest of a plan and with realistic expectations.
A major Cochrane review of exercise for hip osteoarthritis was updated in July 2026. It pooled 18 trials covering 1,368 people, mostly women aged between 53 and 74. On average, exercise probably reduces pain by about 7 points on a 100 point scale. Experts tend to want around 12 points before someone would notice a difference in daily life. However, following a plan of exercise and personalised treatment helps in more ways than one, improving your general health and mood too.
What you can do now
If the pain is on the outside of the hip, start by becoming aware of the positions that squeeze the tendon. Physiotherapists commonly suggest sleeping on your back or on the pain-free side with a pillow between your knees so the top leg doesn’t drop across your body. Try not to cross your legs or stand with your weight hanging on one hip. Deep stretches that pull the sore leg across the body can aggravate the tendon too.
For a stiff, achy joint, keep moving little and often. Short walks, a gentle warm-up before activity and strengthening movements for the hips and thighs (like the ones outlined below) all can help. If weight is a factor, even modest changes can ease the load on the hip.
- Sit to stand. Sit on the edge of a sturdy chair with your feet flat and hip-width apart. Lean slightly forward, push through your feet to stand up fully, then lower slowly back down with control. Keep your knees pointing in line with your toes, and use your hands only if you need to.
- Step ups. Stand facing a sturdy step or low platform. Place one foot fully on the step, then push through that heel to lift your body up until you’re standing tall on top. Lower back down slowly with control, keeping your knee in line with your toes, then repeat on the same leg before switching sides.
- Glute bridge. Lie on your back with your knees bent and feet flat, hip-width apart. Squeeze your buttocks and push through your heels to lift your hips until your body forms a straight line from shoulders to knees. Pause briefly at the top, then lower slowly with control, keeping the effort in your glutes rather than your lower back.
With either kind of pain, build up gradually. A little discomfort during exercise that settles within a day is usually fine. Sharp pain or a flare up that carries into the next day is telling you to ease off, not stop altogether. Complete rest tends to leave hips stiffer and muscles weaker. For pain relief, ask your pharmacist or GP.
When it is worth getting checked
Get hip pain looked at if it has:
- lasted more than a few weeks,
- wakes you at night,
- makes you limp,
- comes with groin pain and stiffness
- starts cutting your walks, stairs or sleep short.
The earlier you come in for assessment, the more options may be available for treatment.
Some situations need urgent help. After a fall, if you can’t put weight on your leg, go to A&E. A hot, swollen hip with a fever or feeling unwell, needs same-day advice from your GP, NHS 111 or urgent care. Hip or leg pain with numbness around the saddle area or any loss of bladder or bowel control, is an emergency.
How we approach hip pain at Sundial
Our physio Sakshi Maheshkar explains what you can expect when you come to Sundial for hip pain.
“We’ll usually start by working out where the pain is coming from. So we’d take a history, watch how you stand, walk and move and also test the hip, lower back and surrounding muscles. That separates the potential sources of the problem, like tendon pain, joint pain and pain referred from the back. This is important because the treatment plan differs for each. Scans aren’t usually needed. We’ll always make sure you understand what is aggravating the problem and how to adjust it.”
Gluteal tendinopathy means you should avoid positions that squeeze the tendon, such as lying on the sore side, crossing your legs or standing with your weight hanging on one hip. Your Sundial physiotherapist can suggest progressive strengthening for your hip and thigh muscles, tailored to your pain levels, with the load increased gradually. Physiotherapists use some hands-on techniques such as mobilisation, soft tissue work or similar, which can ease pain and stiffness in the short term, in order to make it easier to exercise.
If you need extra relief, a corticosteroid injection (available here at Sundial) can help manage the pain while you build up strength through structured exercise. How long it takes to recover varies. Tendon problems tend to need weeks to months of consistent loading rather than a quick fix, so it is important to set realistic expectations early.
If hip pain is getting in the way of your daily life, you can book an assessment at either clinic. If you’d like to read more about what we do at Sundial, try our guides on knee pain and joint replacement rehab or strength training over 50 .
Frequently asked questions
Why does my hip hurt when I lie on my side? Pain on the outside of the hip when you lie on that side is a classic sign of gluteal tendinopathy, because the position squeezes the tendons against the bone. A pillow between your knees and a different sleeping position often help while the tendon settles.
Is pain on the outside of my hip bursitis? Usually the main problem is the gluteal tendon, not the bursa. That’s why the condition is now called gluteal tendinopathy or greater trochanteric pain syndrome. An assessment can confirm what’s going on.
Does hip arthritis mean I will need a hip replacement? Not necessarily. Many people manage with exercise, education, pain relief and everyday adjustments. Surgery is generally considered when pain and function remain severely affected despite those measures, and your GP or a specialist can talk it through.
Should I rest a painful hip? Easing off the activities that flare the pain makes sense for a short while. Complete rest usually leaves the hip stiffer and weaker, so staying active within a comfortable range and building up gradually is generally better.
References
Grimaldi A, Fearon A (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic & Sports Physical Therapy 45(11):910-922.
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.
National Institute for Health and Care Excellence (2022). Osteoarthritis in over 16s: diagnosis and management (NG226).
Hall M, Lawford BJ, Hinman RS et al. (2026). Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews 2026, Issue 7:CD007912.
Cochrane. Is exercise an effective therapy for hip osteoarthritis?
About Matthew Bennett, Chiropractor Brighton
Matthew Bennett is the founder and principal chiropractor at Sundial Clinics Brighton, established in 1991. With over 35 years of clinical experience, Matthew qualified from the Anglo-European College of Chiropractic in 1987 and served as President of the British Chiropractic Association for four years. As a Fellow of the Royal College of Chiropractors and former team chiropractor for Brighton and Hove Albion FC and the British Alpine Ski Team, Matthew combines evidence-based chiropractic treatment with sports performance expertise. His authority in musculoskeletal health has been recognised through national media appearances, expert witness roles and contributions to professional publications. Matthew’s commitment to clinical excellence ensures patients receive the most effective chiropractic care in Brighton.