Outer Hip Pain: Why You Can’t Lie On That Side

Pain on the bony point at the side of your hip, worse lying on that side at night, sore when you climb stairs or stand on one leg to put trousers on. It often gets called bursitis, and in most cases the tendons are the real problem.

What’s actually going on

The gluteal tendons attach to the bony point of the hip, and a small fluid-filled sac sits nearby to reduce friction. For years this was labelled trochanteric bursitis, implying an inflamed sac.

Imaging studies changed that.

In most cases the tendons themselves are the source, and the current term is gluteal tendinopathy. That matters because the treatments differ: an inflamed sac suggests rest and injection, while a struggling tendon needs graded loading. The same correction happened with tennis elbow and the Achilles.

It’s most common in women over 40, and after a change in activity such as more walking, more hills, or a return to running. See also menopause and joint aches and IT band and runner’s knee, which follows the same load pattern.

The compression problem

The tendons get squashed against the bone when the thigh crosses the midline. So the positions that feel like a good stretch are often the ones keeping it going.

Worth avoiding for now:

• Crossing your legs when sitting
• Standing with your weight slumped onto one hip
• Sleeping on the painful side, and sleeping on the other side without a pillow between your knees
• The classic figure-four or knee-across-body stretch, which compresses exactly the wrong spot. Those same two stretches are useful for buttock and piriformis pain, which is why getting the diagnosis right matters.
• Foam rolling directly on the bony point. See muscle knots, heat and a massage ball for where pressure does help.

That last pair surprises people. Stretching and rolling feel productive here and usually aren’t.

Where heat fits

Warmth over the outer hip and buttock before your exercises makes them more comfortable. Lie on the opposite side with the pad draped over the painful hip, cover on, lowest setting, 15 minutes. Don’t lie on the pad, and don’t lie on the painful side to do it.

Then do your loading work. Heat here is the warm-up, not the treatment: “my physio said use heat” — but how, exactly?

What does change it

Loading the tendon gradually. Isometric holds to start: lying on your back, press the outside of your knee into a wall or band and hold. Then progress to bridges, and later to standing single-leg work. Built over months, not weeks.

A physiotherapist is genuinely worth it here, because the dose and the progression are hard to judge alone, and because the exercises people pick for themselves are often the compressive ones.

Fixing the night. Sleep on the good side with a firm pillow between your knees and ankles, so the top leg stays in line rather than dropping across. Many people get their first real improvement from this alone. Heat before bed can help you settle, but the pad goes off first: sleeping with a heating pad and warmth before bed.

Load management. Cut back on hills and long walks until it settles, then rebuild gradually.

How long

Months rather than weeks, and progress is measured in how long you can lie on that side or how far you can walk before it complains. That’s normal, not failure.

See a doctor or physio if…

• Pain is in the groin rather than the outer hip, which points to the joint itself. See stiff hips in the morning.
• Pain, numbness or weakness runs down the leg. See sciatica and heat.
• You’re limping, or the leg gives way
• It started after a fall, especially if you’re older. Get seen the same day.
• The area is hot, red and swollen, or you have a fever
• It hasn’t improved after six to eight weeks of loading and changing the aggravating positions

Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.