Outer Hip Pain: Is Cortisone the Answer?

Pain on the outside of your hip, worse when you lie on that side, is usually greater trochanteric pain syndrome (GTPS), often from irritated gluteal tendons squeezed against the hip bone. A cortisone injection can ease it for weeks to months [1] but is rarely the whole answer: in a BMJ trial, education plus exercise helped more people [2].

If it doesn't settle, a doctor-led sports and exercise medicine assessment that looks at your hip, your training load and what is really driving the pain can help pin down the cause.

At a glance

• It is usually a gluteal tendon problem, and bursitis is often absent [3].
• Easing compression and gradually strengthening the hip come first [2].
• Cortisone can give short-term relief that makes rehabilitation easier [1][4]; results for PRP are mixed [5][6].

Why Does the Outside of My Hip Hurt When I Lie on My Side?

Lying on the sore side compresses irritated gluteal tendons against the greater trochanter, the bony point on the outside of your upper thigh. A review in the British Journal of General Practice (BJGP) describes pain that is worse with weight-bearing and side-lying at night, sometimes spreading down the outer thigh [4].

Is It Hip Bursitis or Gluteal Tendinopathy?

It is usually tendinopathy, an overloaded and painful tendon, rather than trochanteric bursitis, the older diagnosis, meaning an inflamed bursa (a small fluid-filled cushion over the bone) [4]. In a US study of 877 people scanned for this pain, published in the American Journal of Roentgenology, 79.8% had no bursitis, while 49.9% had gluteal tendon changes [3].

What Makes Hip Tendon Pain Worse?

Positions that squeeze the gluteal tendons against the hip bone tend to aggravate them: lying on the sore side, crossing your legs, standing with your weight hanging on one hip, and long climbs.

The BJGP review also advises against iliotibial band (ITB) stretches, often suggested for this pain, as they draw the hip across the body [4].

What Is the Best Sleeping Position for Outer Hip Pain?

Avoid lying on the painful hip. If you sleep on your other side, the BJGP review suggests one or two pillows between your legs to stop your top knee dropping across your body [4]. Lying on your back is another option.

Why Does It Hurt Running or Walking Uphill?

Climbing and running load one hip at a time, and a South African review in the SA Orthopaedic Journal lists both as aggravating activities [7]. On Cape Town's hills, stairs and trails, shorter, flatter walks and runs can keep you active while the tendon settles.

Is a Cortisone Injection the Answer for Outer Hip Pain?

Cortisone can calm pain on the outside of the hip quickly, but it is only one part of treatment: in the BMJ's LEAP trial, education plus exercise led to more overall improvement than one injection [2].

Cortisone, a corticosteroid, can settle pain and any inflammation around the tendon but does not repair it. When pain stops you sleeping or exercising, a doctor-administered cortisone injection can calm a painful flare and open a window for rehabilitation [4]. For everyday pain relief, ask your doctor or pharmacist whether paracetamol or an anti-inflammatory medicine is safe for you [4].

What Did the LEAP Trial Find?

LEAP compared 14 physiotherapy-led sessions of education and exercise over eight weeks, one corticosteroid injection and wait-and-see in 204 adults with MRI-confirmed tendinopathy, mostly women averaging 55 [2].

At eight weeks, 77% (51 of 66) felt moderately to very much better with education plus exercise, against 58% (38 of 65) after the injection and 29% (20 of 68) with wait-and-see [2].

At one year, the figures were about four in five, under three in five and about half, so the injection was no longer clearly ahead of waiting overall. Pain scores with the injection, though, stayed similar to exercise and below wait-and-see [2].

Reassuringly, that wait-and-see result came after just one advice session, and no serious side effects were reported [2].

How Long Does a Cortisone Injection for Hip Bursitis Last?

In trials, cortisone's benefit was clearest for two to three months; by a year, overall recovery was similar with or without an injection [1][2]. In a Dutch primary-care trial of 120 people, published in the Annals of Family Medicine, 55% of the injection group had recovered at three months, against 34% with usual care, but by 12 months it was 61% and 60% [1].

Mild soreness for a day or two is common, and relief may take days to two weeks. Repeat injections are usually limited and spaced out.

If you have diabetes, your doctor may suggest extra glucose checks for a few days. Seek help promptly if the injection site becomes increasingly red, hot or swollen, or you develop a fever.

What Exercises Help Gluteal Tendinopathy?

The mainstay of treatment is avoiding positions that compress the tendon while gradually strengthening the muscles on the side of your hip, the hip abductors. In LEAP, this included four to six home exercises a day [2].

Programmes often start with gentle static holds, such as pressing the leg outwards without moving it, then build to heavier, more functional work.

Rest alone can ease pain without rebuilding the tendon, for the same reason complete rest often fails a painful Achilles tendon: tendons need their load tolerance rebuilt gradually, not just time off. At Fluid Medical, a biokineticist and physiotherapist are available to guide this.

How Long Does Gluteal Tendinopathy Take to Settle?

Expect weeks to months rather than days: most people in LEAP's exercise group had improved by eight weeks [2], and the South African review notes that most cases settle [7].

Can PRP Help Gluteal Tendinopathy?

Platelet-rich plasma (PRP), a concentrate of platelets prepared from your own blood, may help some people whose tendon pain has not settled with rehabilitation, but the evidence is mixed. In one trial of 80 people, published in the American Journal of Sports Medicine, 82% reached a meaningful improvement 12 weeks after a single PRP injection, against 57% after a single corticosteroid injection [5]. There was no difference between them at two or six weeks [5].

In a 2025 placebo-controlled trial of 79 people with persistent pain, published in the Journal of Bone and Joint Surgery, PRP did no better than a saline injection over six months, although both groups generally improved [6].

Your doctor will discuss whether PRP suits you. At Fluid Medical, PRP is considered for stubborn tendon problems, including gluteal tendinopathy that hasn't settled after three months of rehabilitation, followed by progressive loading. You may also find a plain-language comparison of how PRP and cortisone injections differ in purpose, timeline and what you can expect afterwards useful.

Could Pain on the Outside of the Hip Be Something Else?

Pain in this area can sometimes come from the hip joint, the lower back or a bone stress injury rather than the gluteal tendons, so an examination comes before any injection.

• The hip joint: groin or front-of-hip pain suggests the joint itself, such as osteoarthritis [8], whereas people with GTPS can usually put on shoes and socks easily [4].
• The lower back: spinal problems can cause similar pain, and the South African review calls GTPS a "great mimicker" [7].
• A bone stress injury: in endurance runners, especially women, groin pain that builds with running can occasionally signal a stress fracture at the top of the thigh bone (femoral neck) [8], so stop running until a doctor has checked it.
• A fall or new weakness: after a fall, a hip fracture needs ruling out [7], and some fractures only show on an MRI [8]; hip weakness or a new limp can point to a torn gluteal tendon [8].

Runners can also review the warning signs that mean a running injury needs a doctor's assessment rather than another rest day.

When Should You Seek Prompt Medical Care?

Get same-day medical advice if hip pain comes with a fever or feeling unwell, a hot, swollen hip, or sudden difficulty bearing weight without an injury, as infection needs ruling out [8].

After a fall, severe pain, being unable to stand or walk, or new numbness in the leg needs emergency care: go to your nearest emergency unit or call 10177, or 112 from a cellphone. Constant pain at rest or at night in any position, or unexplained leg numbness or weakness, should also be checked promptly.

Book a Doctor-Led Hip Pain Assessment in Cape Town

If hip pain is disturbing your sleep, limiting your activity or not easing after a few weeks, a doctor can help find the cause and plan treatment with you.

Doctor-led, from consultation to treatment: that is how Fluid Medical, a multidisciplinary medical centre, approaches hip pain. Sports & Exercise Medicine doctors can examine your hip, discuss whether an injection makes sense and plan your rehabilitation, so each step builds on the last.

You can book a doctor-led hip pain assessment at Fluid Medical in Gardens online, call 021 200 2121 or WhatsApp 076 577 9287. All treatment is subject to individual clinical assessment.

This article is general health information and does not replace a consultation with a doctor.

References

[1] Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med. 2011;9(3):226-34. doi:10.1370/afm.1232. https://pmc.ncbi.nlm.nih.gov/articles/PMC3090431/

[2] Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. doi:10.1136/bmj.k1662. https://pmc.ncbi.nlm.nih.gov/articles/PMC5930290/

[3] Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083-6. doi:10.2214/AJR.12.10038. https://pubmed.ncbi.nlm.nih.gov/24147479/

[4] Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2017;67(663):479-80. doi:10.3399/bjgp17X693041. https://pmc.ncbi.nlm.nih.gov/articles/PMC5604828/

[5] Fitzpatrick J, Bulsara MK, O'Donnell J, McCrory PR, Zheng MH. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. Am J Sports Med. 2018;46(4):933-9. doi:10.1177/0363546517745525. https://pubmed.ncbi.nlm.nih.gov/29293361/

[6] Atchia I, Ali M, Oderuth E, Holleyman R, Malviya A. Efficacy of platelet-rich plasma versus placebo for the treatment of greater trochanteric pain syndrome: a double-blinded randomized controlled trial. J Bone Joint Surg Am. 2025;107(5):444-51. doi:10.2106/JBJS.24.00763. https://pubmed.ncbi.nlm.nih.gov/39804899/

[7] Hugo D, de Jongh HR. Greater trochanteric pain syndrome. SA Orthop J. 2012;11(1):28-33. https://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2012000100005

[8] Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014;89(1):27-34. PMID: 24444505. https://www.aafp.org/afp/2014/0101/p27