It starts as a nuisance. A deep ache on the outside of the hip, over the bony point you can feel through your trouser pocket. It is worse going up stairs, worse on a hill, worse after standing in a queue. Then one night you roll onto that side in your sleep and it wakes you, and from then on it owns your sleep as much as your walking.
Most people in Ireland get the same sequence after that. A GP visit. An X-ray. A result that says mild wear and tear, which is true of almost every hip after 50 and explains almost nothing. And then, very often, the offer of a steroid injection, because that is what has been done for this for decades.
The injection is not a scandal. But it is not the first answer either, and the condition it is usually aimed at is not the condition most people actually have.
TL;DR
- Pain on the outside of the hip after 50 is usually gluteal tendinopathy, not bursitis. Trochanteric bursitis is present in fewer than 20% of people with lateral hip pain.
- It is the most common lower-limb tendinopathy, more common than Achilles or plantar heel problems, and about three times more common in women than men.
- In the landmark LEAP trial, physiotherapist-led education plus exercise beat a steroid injection at both 8 weeks (77% versus 58% reporting meaningful improvement) and at 52 weeks (78% versus 57%).
- Scans do not tell you how bad it is. In 202 people with confirmed gluteal tendinopathy, MRI severity was not associated with pain, function or disability, and 42% had a tendon tear without it predicting their symptoms.
- An Irish trial run from RCSI with the Mater has shown a six-session version is deliverable here. Only 3% of its participants reached it through their GP.
- Physiotherapy qualifies for 20% tax relief in Ireland, but only if a practitioner prescribed, referred or advised it, so get it noted at the appointment.
The name is wrong four times out of five
The old label is trochanteric bursitis: inflammation of the fluid-filled sac that sits over the greater trochanter, the bony prominence at the top of the thigh bone. The name shaped the treatment. If the problem is an inflamed bursa, then rest it and inject it with a steroid.
Imaging told a different story. Work published by Long and colleagues in 2013 found that a trochanteric bursitis was present in fewer than one in five people with lateral hip pain. What is almost always there instead is a tendinopathy: degenerative change in the gluteus medius and gluteus minimus tendons where they attach to the greater trochanter. These are the muscles on the side of your pelvis that hold you level every time you stand on one leg, which is to say every single step you take.
That reframing matters, because a degenerative tendon and an inflamed bursa want opposite things. An irritated bursa might settle with rest. A tendon that has lost its load tolerance needs load, applied carefully and progressively, which is exactly what rest takes away.
This is not a rare problem. In a Dutch general-practice study that counted five lower-limb tendinopathies in a population of over 10,000 person-years, greater trochanteric pain syndrome was the most common of the lot: a prevalence rate of 4.22 per 1,000 person-years, ahead of plantar fasciopathy at 2.44 and Achilles tendinopathy at 2.35. It is around three times more common in women than men, and it clusters in the years either side of 50. Research by Fearon and colleagues found it produces levels of hip dysfunction and reduction in quality of life comparable to end-stage hip osteoarthritis. People are routinely told they have a minor nuisance when the measured impact on their life sits in the same range as a hip heading for replacement.
How to tell it apart from the other things
The pattern is quite distinctive once you know what to look for.
- Where it hurts. On the bony point of the outer hip, often spreading down the outside of the thigh towards the knee. Pain in the groin that is worse with twisting and putting on shoes is more likely the hip joint itself.
- Touch. Pressing on that bony point reproduces the pain, sharply and reliably. Hip joint arthritis is usually not tender to press from outside.
- Lying on it. Night pain when you roll onto that side is close to a signature of this condition. Many people also find lying on the good side hurts, because the top leg drops across the body.
- Standing on one leg. Single-leg standing, stairs, hills and getting out of a car all load the gluteal tendons and all tend to flare it.
- Sitting. Sitting is usually fine, unless you cross your legs, which many people find they can no longer do on that side.
Numbness or pins and needles travelling below the knee points elsewhere, usually to the lumbar spine, and is worth reading about in our guide to sciatica after 50.
What a scan will and will not tell you
A 2025 analysis of the imaging from 202 people with confirmed gluteal tendinopathy found plenty to report: 64% had changes in both the gluteus medius and gluteus minimus tendons, 42% had a tear in one or both, and 36% had calcification visible on plain X-ray. Of the 99 tears, 78% were partial-thickness and 22% were full-thickness.
And here is the finding that should travel further than it does: the severity of the changes on MRI was not associated with the person’s pain, function or disability. Someone with a full-thickness tear on the report was not reliably worse off than someone with mild change.
Imaging can be useful to rule other things out, and your clinician may well want it. But a scan report is not a prognosis, and the word “tear” on a page is not, on its own, a reason to panic or to assume surgery. These tendon changes are common in people over 50 who have no hip pain at all.
The trial that moved the first line of treatment
In 2018, the LEAP trial was published in the BMJ. It randomised 204 adults aged 35 to 70 with MRI-confirmed gluteal tendinopathy, 167 of them women, average age 54.8, into three groups: an eight-week physiotherapist-led programme of education on tendon load management plus targeted exercise; a single ultrasound-guided corticosteroid injection; or a wait-and-see approach.
At eight weeks, the proportion reporting they were at least moderately better was 51 of 66 in the education and exercise group (77%), 38 of 65 in the injection group (58%), and 20 of 68 in the wait-and-see group (29%). At 52 weeks, a year on from a treatment that had lasted eight weeks, it was 51 of 65 (78%), 36 of 63 (57%) and 31 of 60 (52%).
Now the honest caveats, because the headline is often reported more aggressively than the data support. At 52 weeks the average pain scores for exercise and injection were not meaningfully different; the gap was in global improvement. A 2024 meta-analysis reached the same mixed conclusion, finding exercise superior to minimal intervention for function but similar to injection for pain intensity, with the certainty of the evidence rated low to very low. A 2025 systematic review in Clinical Rehabilitation concluded that exercise and education “can be cautiously recommended as the core approach”, potentially supplemented by an injection or shockwave therapy.
That is a fair summary and it is the one worth carrying into a consultation. Education and exercise is the backbone. An injection is a legitimate tool, particularly for someone in too much pain to start loading anything, but it is a way of buying a window rather than a cure, and there is a reason to be careful with repeats: corticosteroid exposure has been associated with making tendons more vulnerable to tearing. What the evidence does not support is the sequence most people still get, which is an injection instead of a programme rather than alongside one.
The Irish part, and the number that gives the game away
Here is where it stops being an Australian trial and starts being about Ireland.
A research team at the School of Physiotherapy in RCSI, working with the Department of Rheumatology at the Mater Misericordiae University Hospital and funded by the Health Research Board, set out to find whether LEAP could actually be delivered in the Irish health system. They could not simply copy it. LEAP used 14 physiotherapy sessions over eight weeks. As the Irish team noted in their published protocol, public and private physiotherapy in Ireland typically provides five or six. So they built EDX-Ireland: the same education and exercise programme compressed into six sessions, and ran it as a feasibility randomised trial in Dublin against usual care.
The results were published in 2026. Sixty-five people were randomised, 89% of them women, average age 53.1. Retention was 92% at eight weeks. The feasibility thresholds were met, and a full-scale trial would need 134 participants. All good news, and a properly powered Irish trial of this is now a realistic prospect.
But look at where the 65 participants came from. Eighty-three per cent were recruited through social media and the community. Fourteen per cent came from orthopaedics or rheumatology. Three per cent, which is two people, came from general practitioners.
That is a recruitment statistic and not a measure of how any individual GP practises, so it should not be stretched into an accusation. But it is still telling you something real about how this condition moves, or fails to move, through the Irish system. The same research team wrote in their protocol that usual care for gluteal tendinopathy by the medical practitioners people first present to in Ireland “is currently unknown”. Nobody has measured it. A condition this common, with this much impact, and the standard Irish pathway for it has never been described.
What load management actually means in daily life
The mechanism explains the advice. The gluteal tendons are thought to be compressed against the greater trochanter by the iliotibial band whenever the hip moves into adduction, which means whenever the thigh crosses towards or past the midline. Weak hip abductors make it worse, because the pelvis then drops or shifts sideways every time you take weight on that leg.
So the everyday offenders are all positions of adduction, and most of them are things people do without noticing:
- Sitting with your legs crossed. The single most common one. Stop it on both sides.
- Standing hanging on one hip, with the weight slumped onto one leg and the hip pushed out. Stand with weight evenly on both feet.
- Side-lying at night. Lying on the sore side compresses it directly. Lying on the other side lets the top leg fall across the body, which does the same thing. A firm pillow between the knees and ankles fixes both.
- Stretching it. This is the cruel one. The classic “glute stretch”, pulling the knee across the chest, feels like exactly what a tight sore hip wants and is precisely the position that compresses the tendon. It gives temporary relief and keeps the problem going. The same trap catches people with plantar heel pain, where aggressive stretching also feels productive and often is not.
- Low chairs, deep steps and long hills, all of which load the tendon heavily. Not forbidden, but worth spacing out while things settle.
The exercise half is progressive strengthening of the hip abductors and learning to control that sideways drop during walking and stairs. In LEAP it was four to six exercises done daily at home, with the clinic sessions used for teaching and progression rather than passive treatment. That distinction matters for expectations: you are not going to physiotherapy to have something done to you, you are going to be taught a programme you then do every day.
That strength work pays a second dividend: steady hips on uneven ground are also the foundation of falls prevention.
Getting it seen in Ireland
Access. HSE primary care physiotherapy is accessed through a GP referral. You can also self-refer privately without any referral at all, though see the tax note below before you do. Expect five or six sessions either way.
Check the register. Physiotherapists in Ireland are regulated by CORU. The Register of Physiotherapists opened on 30 September 2016, and the titles “physiotherapist” and “physical therapist” both became legally protected on 30 September 2018, with both professions admitted to the same register. Anyone using either title must be registered, and you can search the register free on coru.ie before you book.
The tax relief nobody mentions. Revenue allows standard-rate relief of 20% on qualifying health expenses, and physiotherapy is explicitly on the list, along with chiropractic, osteopathy and bone setting. The condition is that you were “prescribed, referred or advised to” by a practitioner. A course of private physiotherapy you booked yourself, with nothing on your file, may not qualify. So when you see your GP, ask them to note the referral or advice in your record, even if you intend to go privately. The four-year rule applies to claims, so expenses from the last four tax years can still be claimed.
What to say at the appointment. Be specific, because the specifics are diagnostic: “The pain is on the bony point on the outside of my hip, not in my groin. It is tender to press. It wakes me when I lie on that side. Stairs and standing on one leg are the worst. I would like to be referred for physiotherapy for gluteal tendinopathy, and I would like that noted for the health expenses claim.”
When it is not this
Lateral hip pain is usually benign and usually mechanical, but a few things need a different pace:
- Sudden severe hip pain after a fall, or inability to weight-bear, needs assessment the same day.
- A hot, swollen, red area with fever or feeling unwell needs urgent review.
- Pain that is constant and unrelated to position, especially with unexplained weight loss or night sweats, should always be reported.
- Groin pain with stiffness and loss of rotation suggests the hip joint rather than the tendons, and is a different conversation.
- New numbness, weakness or pins and needles below the knee points to the lumbar spine.
The reasonable expectation
Tendons are slow. The LEAP participants were still improving at a year, which is a useful corrective to the hope that six weeks of exercises will settle it. But the trajectory was genuinely good, from an eight-week programme, in people who had already had the pain for more than three months before they started.
What you want to avoid is the loop: an X-ray that says wear and tear, an injection that helps for six weeks, a return of the pain, a conclusion that nothing works, and years of sleeping badly on one side. The exit from that loop is a correct name for the problem, a stop to the daily compressive habits, and a progressive strength programme you actually do.
At Críonna Health we keep coming back to a particular kind of condition: common, treatable, and quietly mislabelled in a way that sends people down the wrong path for years. Lateral hip pain after 50 is one of the clearest examples we have written about. If you have been living with it and were told it was just bursitis, the advice has changed, and it is worth going back.
This article is general information and not a substitute for individual medical advice. If you have new, severe or worsening hip pain, contact your GP.
📷 Photo by Artur Uber on Unsplash
