Do you experience a deep, aching pain on the outside of your hip? Does sleeping on your side at night trigger sharp discomfort that wakes you up?

If so, you are likely dealing with either greater trochanteric bursitis or gluteal tendinopathy (often grouped under the broader clinical term Greater Trochanteric Pain Syndrome).

Because these two conditions occur right next to each other, their symptoms overlap significantly. However, identifying which one is driving your outer hip pain is critical to choosing the right rehabilitation strategy. At Threshold PT, our physical therapy team specializes in differential diagnosis and targeted hip rehab to help you move and sleep comfortably again.

Understanding Lateral Hip Anatomy

The hip complex is layered with heavy musculature, thick tendons, and supportive fluid sacs. If you feel the outside of your hip, you will spot a prominent bony landmark: your greater trochanter.

The greater trochanter serves as a critical attachment point for essential hip stabilizers, including the gluteus medius and gluteus minimus.

Sitting directly beneath and around these muscular attachments are bursae—small, fluid-filled sacs that reduce friction between bones and tendons. The largest and most frequently irritated bursa in this area is the greater trochanteric bursa.

Trochanteric Bursitis vs. Gluteal Tendinopathy: What’s the Difference?

While both conditions generate pain over the outer hip, their root physiological causes are distinct:

1. Greater Trochanteric Bursitis

Bursitis occurs when the greater trochanteric bursa becomes compressed and inflamed. It is general cause of sharp, sensitive pain. You may be more prone to bursitis if you are a side sleeper, have altered your walking mechanics due to a prior injury, or spend extended periods standing on hard surfaces.

2. Gluteal Tendinopathy

Tendinopathy develops when the workload placed on the gluteus medius or minimus tendons exceeds their current strength and load capacity. This causes breakdown at a cellular level, triggering localized inflammation or long-term degenerative stiffness. It is common in runners, active adults who rapidly increase their training volume, or individuals returning to heavy exercise after a break.

Physical Therapy Treatments for Outer Hip Pain

Whether you are dealing with bursitis, tendinopathy, or a combination of both, non-surgical physical therapy is the primary recommended treatment.

1. Nighttime Positioning & Activity Modification

If side-sleeping triggers your hip pain, small adjustments can dramatically lower your discomfort:

• Sleeping on your non-painful side: Place one or two firm pillows between your knees and ankles. This keeps your top leg in neutral alignment, preventing it from dropping inward (adduction) and compressing the outer hip structures.
• Avoid sleeping directly on the painful hip: If you must lie on that side, place a mattress topper or extra padding underneath your hip to cushion the trochanteric bursa.
• Modify daily loads: Temporarily scale back high-impact running, step-ups, or heavy squatting to establish a manageable baseline of symptoms.

2. Targeted Soft Tissue Relief

Tightness in the Tensor Fasciae Latae (TFL) and IT band can increase compressive forces across the outer hip.

Clinical Tip: When using a foam roller or soft tissue massager, work above and around the bony bump—never press hard directly on top of an inflamed bursa, as added compression will aggravate symptoms.

3. Progressive Gluteal Loading Exercises

To heal tendinopathy, the gluteal tendons must be progressively re-loaded to rebuild strength and capacity.