Lateral hip pain is often called “trochanteric bursitis,” but this label is usually misleading. In most cases, the main problem is not inflammation of the bursa. It is gluteal tendinopathy, involving the gluteus medius and/or gluteus minimus tendons.

A review article said that the way we explain the condition affects how patients understand it and how we manage it.

It is usually a tendon problem, not bursitis

For many years, pain around the greater trochanter was blamed on an inflamed bursa. However, imaging and surgical studies show that gluteal tendon pathology is usually the primary finding. Bursal changes can occur, but they often appear together with tendon changes and are rarely the only problem.

So, instead of telling patients they have “inflammation,” it is often better to explain that the tendons around the side of the hip are sensitive and overloaded. This helps shift management away from rest and injections, and toward education, load management, and progressive strengthening.

Who gets gluteal tendinopathy?

Gluteal tendinopathy is common in post-menopausal women, but therapists should not assume it only occurs in this group.

It can also occur in men, younger women, post-partum runners, people with hip osteoarthritis, people after total hip replacement, and people with hip dysplasia. The key is to assess the person in front of you, not just rely on the “typical” patient profile.

Palpation alone is not enough

Tenderness over the greater trochanter is useful, especially if it is absent. If the area is not tender, gluteal tendinopathy becomes less likely. But many people without symptoms can also be tender there, so palpation alone should not be used to confirm the diagnosis.

A better clinical approach is to combine palpation with loading tests, such as resisted hip abduction or a 30-second single-leg stance test. If palpation and loading both reproduce the patient’s familiar lateral hip pain, the diagnosis becomes more likely.

Imaging should not drive the whole diagnosis

MRI or ultrasound can show gluteal tendon changes, but these findings are also common in people without pain. Imaging can be helpful when the diagnosis is unclear, symptoms are unusual, or the patient is not improving as expected. But imaging findings should always be interpreted alongside the history and clinical examination.

A scan does not treat the patient. The therapist treats the whole clinical presentation.

Avoid provoking compression

A key concept in gluteal tendinopathy is compression. The gluteal tendons are compressed around the greater trochanter, especially when the hip moves into adduction.

This is why some common advice can make symptoms worse. Stretching the ITB or pushing the hip into adduction is often provocative rather than helpful. Patients may also need to reduce positions such as side-lying on the painful hip, sitting with crossed legs, standing with the hip hanging out to one side, or exercises that allow excessive hip adduction.

The goal is not to avoid loading forever. The goal is to reduce provocative compression while gradually building tendon and muscle capacity.

Education and exercise are first-line treatment

The strongest first-line approach is education combined with exercise. Patients need to understand what the condition is, what loads irritate it, and how to manage symptoms while gradually rebuilding strength.

Useful education includes:

Avoid prolonged compression of the painful side.

Modify sleeping positions, such as using a pillow between the knees.

Avoid crossing the legs or sitting in deep hip adduction.

Avoid sudden spikes in walking, running, hills, stairs, or gym load.

Monitor the 24-hour response: if pain is worse that night or the next morning, the load was probably too much.

Exercise should be progressive and targeted. Isometric hip abductor loading may help early pain control. Over time, rehabilitation should progress toward functional strengthening, including weight-bearing tasks, hip control, step work, squats, hinges, and eventually running or sport-specific demands where appropriate.

Be careful with clams and ITB stretches

The clamshell exercise is often prescribed for the gluteus medius, but it may not be the best choice for gluteal tendinopathy. It can place the hip into positions that create compression and friction around the greater trochanter, and it may not provide enough stimulus to build meaningful abductor capacity.

Similarly, ITB stretching is not well supported and may aggravate symptoms by increasing compressive load on the irritated tendon.

Therapists should choose exercises based on the patient’s irritability, strength, movement control, and goals rather than relying on traditional “glute” exercises.

Corticosteroid injection is not the best first-line option

Corticosteroid injections can provide short-term pain relief, but they are not the best long-term solution for most people with gluteal tendinopathy. Education and exercise have shown better outcomes than corticosteroid injection in both short- and long-term global improvement.

Injections may also encourage a “quick fix” mindset and reduce engagement with load management and rehabilitation. They may still have a role in selected cases, but they should not replace a clear rehabilitation plan.

Tendon tears do not always mean surgery

Patients can become very worried when imaging reports mention a gluteal tendon tear. But many tendon tears, especially partial-thickness tears, can be managed non-surgically.

Surgery is usually reserved for more severe cases, particularly when there is substantial tendon detachment, persistent Trendelenburg gait, major abductor weakness, pain, and disability despite at least three months of appropriate rehabilitation.

A tear on imaging is not automatically a surgical problem.

Key message for therapists

Gluteal tendinopathy is not simply “hip bursitis.” It is usually a tendon-related condition influenced by load, compression, muscle capacity, movement patterns, pain sensitivity, and sometimes systemic factors such as hormones, body weight, or metabolic health.

The best management is not passive rest, repeated injections, or stretching the ITB. It is clear education, careful load modification, progressive strengthening, and person-centred rehabilitation.

For therapists, the simple clinical message is this: reduce provocative compression, build capacity gradually, monitor the 24-hour pain response, and help the patient return confidently to the activities that matter to them.