Why Lateral Hip Pain Isn’t “Just Bursitis” — And Why Women Experience It More As They Age

Last Friday and Saturday, I had seven different patients walk into my clinic—same age range, same complaint:

Pain on the outside of the hip.

That’s not a coincidence.

One of those patients, a dentist, came in already confident in her diagnosis. She had done her research and said, “I think I have Greater Trochanteric Pain Syndrome.”

She was right—and honestly, that’s something I love to see. Because the more you understand your condition, the better decisions you can make about your care.

But here’s the problem…

Greater Trochanteric Pain Syndrome is Probably Not “Hip Bursitis”

For years, lateral hip pain was labeled as bursitis.

But research has shifted.

Most cases are now understood as:

Gluteus medius/minimus tendinopathy
With or without irritation of the bursa

In simple terms:
The issue is usually the tendon, not just inflammation.

What’s Actually Causing the Pain?

The gluteal tendons attach to the Greater Trochanter (the outside of your hip).

Every time you:

Walk
Stand on one leg
Sit with your legs crossed
Sleep on your side

…those tendons experience compression against the bone.

Here’s the key:

A healthy tendon tolerates this
A deconditioned or irritated tendon does not!

So the pain isn’t random—it’s a load problem.

It’s not that your body is “breaking”… it’s that your tissues can no longer tolerate what you’re asking them to do.

Why Women Are Affected More (Especially With Age)

This is where things get interesting—and often misunderstood.

1. Hormonal Changes Matter

As women approach perimenopause and menopause:

Estrogen levels decline
Tendons lose some ability to adapt and repair
Collagen organization becomes less efficient

This doesn’t mean tendons “fail”—but it does mean:
They become less tolerant to repeated stress

2. Biomechanics Play a Role

Women generally have:

A wider pelvis
Increased hip adduction (bringing your leg towards your midline) during movement

This leads to:
More compressive force on the lateral hip tendons

3. The Biggest Factor: Load vs Capacity

Here’s the part most people miss:

As we age:

Activity levels often decrease
Strength declines (especially in the lower body)
Tendon capacity drops

But lifestyle?
Usually stays the same

That creates a mismatch:

The load stays the same, but your capacity to handle it decreases!

And that’s when pain shows up.

The Two Biggest Mistakes I See

1. Resting Too Much

This is the most common mistake.

Yes, avoiding pain feels natural—but in this case:
Too much rest = further weakening of the tendon

Sometimes you have to:

“Go through the storm before you get to the calm.”

2. Relying Only on Injections

Cortisone injections can:

Reduce pain quickly
Provide short-term relief

But here’s the reality:

They don’t improve tendon capacity
They don’t fix the underlying issue

Research consistently shows:

Short-term → injections may help
Long-term → exercise and load-based rehab outperform them

If nothing changes in your lifestyle or strength:
The pain cycle often comes back

How We Actually Treat This (The Right Way) At Chiro 4 All Health Center

At my clinic, the focus is simple:

1. Pain Education First

If you understand what’s happening:
You make better decisions
You’re less fearful of movement

2. Load Management (This Is Everything)

We start with:

Low, tolerable loads
Gradual progression

Avoiding the:

“Boom and bust” cycle
(all-in → flare-up → stop → repeat)

3. Build Strength and Capacity

The goal is:
Make the tendon stronger than your daily demands

Not just “pain-free”—but resilient

4. Adjunctive Therapies (Support, Not the Solution)

When needed, we may use:

Shockwave therapy
Dry needling
Class IV laser
Joint mobilization

These help:

Reduce pain
Improve tolerance

But they are not the foundation—loading is. These therapies help facilitate our patients’ ability to load the tendons more efficiently.

The Takeaway Most People Need to Hear

This condition isn’t just about age or hormones.

It’s about preparation!

Tendons that have been trained over time are far more resilient than those that haven’t.

Which is why I strongly believe:

If more women consistently trained strength and load tolerance before perimenopause…
We would likely see far fewer cases of this condition later in life. Even my very active women that play sports still are susceptible to this condition.

Final Thought

Take care of your body like a high-performance machine.

Because the truth is:

Your body adapts to what you give it
Or it deteriorates from what you don’t

And when it comes to lateral hip pain…

It’s not just about getting out of pain

It’s about building a body that can handle life again.

This isn’t just a female issue Although women at 4:1 more likely to experience this compared to their male counterparts. Men can develop this condition as well.

If This Sounds Like You

If you’re dealing with: