RSM-REM-009
Written by Hironori Ikeda, MSc Sports Medicine
RSM International Academy · Chiang Mai, Thailand
What Should You Assess When Pain Is on the Outside of the Hip?
The client often shows the problem before explaining it: they shift away from one leg, avoid lying on that side, hesitate on stairs or touch the greater-trochanter region after walking. Side-lying pain and stair pain should be compared separately: the possible contributors include gluteal tendon load, local compression, hip-joint referral, lumbar referral or another regional contributor.
I first reproduce the client’s familiar walking, stair, single-leg or side-lying symptom and compare the local load response with hip and lumbar findings before treating the tender point. Use single-leg stance, resisted abduction, hip ROM and symptom location to decide whether a local lateral-hip strategy is supported. Trauma, inability to bear weight, progressive neurological change, fever, unexplained night pain or suspected fracture changes the plan and may require referral.
In this article, you will learn how to assess pain outside the hip, decide what deserves attention as a therapist, choose a treatment or load-management direction and re-test the same functional task.
In This Article
- What Should You Assess When Pain Is on the Outside of the Hip?
- In This Article
- 1. Clinical Problem & Differential: Pain on the Outside of the Hip
- 2. Muscle, Tendon, Bursa, Joint or Referred Pattern?
- 3. Differential Assessment: Single-Leg Stance & Resisted Abduction
- 4. Treatment Scope: Load the Tendon Without Feeding Compression
- 5. Symptom Re-Test: Repeat the Original Lateral-Hip Task
- Related RSM Clinical Blogs
- Study Remedial Massage at RSM
1. Clinical Problem & Differential: Pain on the Outside of the Hip
Lateral hip pain may reflect gluteus medius or minimus tendon sensitivity, local bursal irritation, hip-joint referral, lumbar referral or a less common neurological presentation. Several structures can be tender at the same time. The job is therefore not to find the sorest point; it is to identify which loading pattern best reproduces the person’s familiar complaint.
Ask about walking, stairs, running, standing on one leg, lying on the painful side, sitting with the legs crossed and sudden changes in training volume. Record the location and behaviour of symptoms. A focal ache over the greater trochanter that is aggravated by single-leg loading and hip adduction increases the relevance of GTPS. Symptoms strongly modified by lumbar movement, widespread sensory change or pain travelling below the knee require a broader screen.
A recent fall, inability to bear weight, rapidly worsening pain, systemic illness, marked loss of hip motion or progressive weakness changes the decision. These findings need medical assessment rather than deeper local pressure.
I do not begin by pressing the most tender point over the greater trochanter. I first compare gait and single-leg support, then observe whether hip adduction or side-lying compression reproduces the familiar pain. A trunk shift, locked knee or pelvic translation may unload the lateral hip in one task but increase demand elsewhere. If changing the hip position reduces symptoms, that helps guide load management and treatment positioning, but it does not by itself prove whether the tendon or bursa is the primary source.
2. Muscle, Tendon, Bursa, Joint or Referred Pattern?
Gluteal tendon pain is usually linked to load. Single-leg stance, resisted abduction, walking hills or prolonged compression may reproduce the familiar lateral pain. A bursa may be irritated within the same region, but “trochanteric bursitis” should not be used automatically. Imaging can show gluteal tendon changes in people without symptoms, so a scan or a tender spot must be interpreted with the clinical pattern.
Hip-joint symptoms may be felt laterally, especially when hip flexion and rotation are limited or groin pain is present. Lumbar referral becomes more plausible when spinal movement changes the complaint or the lateral hip tests fail to reproduce it coherently. Numbness, burning or altered sensation over the lateral thigh requires consideration of neural involvement rather than routine tendon treatment.
Gluteus medius and minimus contribute to hip abduction and pelvic control during single-leg support. Their tendons near the greater trochanter experience a different contact environment from the overlying muscle belly. I therefore compare a supported hip position before local pressure: reducing adduction may alter compression without changing tendon force capacity. Tendon and bursal involvement still cannot be separated by that response alone.
Anatomy note: In cadaver measurements, posterior gluteus medius fibres changed from external- to internal-rotation leverage as hip flexion increased; “hip abductor” alone misses this position-dependent role.
3. Differential Assessment: Single-Leg Stance & Resisted Abduction
Begin with the exact movement the person wants to improve. Then use the smallest useful test set:
- Observe gait, pelvic control and the original walking, stair or training task.
- Palpate the greater trochanter and gluteal tendon region gently. Familiar pain is more informative than tenderness alone.
- Perform a 30-second single-leg stance when safe. Record symptom onset time, intensity and pelvic strategy.
- Compare resisted hip abduction and, when appropriate, resisted external derotation.
- Use FABER or controlled hip adduction to learn whether compression or joint position changes the complaint; do not treat either test as independent proof.
- Compare hip internal rotation, external rotation and flexion.
- Screen lumbar movement and neural features when the history suggests referral.
Diagnostic research supports using a cluster rather than one manoeuvre. Palpation, FABER, resisted abduction and external derotation can contribute, while MRI abnormalities may also appear in asymptomatic people. A second study likewise found that combinations of clinical tests are more useful than isolated findings for MRI-confirmed gluteal tendinopathy.
4. Treatment Scope: Load the Tendon Without Feeding Compression
Hands-on treatment may reduce guarding in gluteus maximus, TFL or adjacent tissues, but pressure directly over an irritable greater trochanter is not automatically helpful. Position the hip to avoid sustained adduction and do not repeatedly compress the painful side. Pair any manual input with a practical load decision: walking volume, side-lying position, crossed-leg sitting, step height or exercise dose.
Education and progressive exercise have strong relevance in gluteal tendinopathy. In the cited trial, education plus exercise produced better global improvement and pain results than injection at eight weeks. At 52 weeks, global improvement remained better, while pain intensity did not differ between those two groups. For a massage clinician, the lesson is not to prescribe outside scope; it is to avoid presenting passive treatment as the entire solution.
If the hip/lumbar comparison does not support a local tendon pattern, change the plan. Persistent unexplained pain, worsening function or a neurological deficit warrants referral or co-management.
In side-lying, I support the upper thigh rather than letting it cross into adduction. If an accessible gluteal muscle finding remains relevant, I compare a short, broad contact away from the most irritable trochanteric region. Comfort from the support alone is already useful information; it does not require an additional deep-tissue explanation.
5. Symptom Re-Test: Repeat the Original Lateral-Hip Task
Repeat the same baseline with the same footwear, support, duration and instruction. If the baseline was 30-second single-leg stance, record the new onset time and symptom intensity. If the complaint occurred on stairs or during walking, repeat the same step height or distance. A different test after treatment cannot show whether the original problem changed.
Immediate improvement records a short-term change after treatment; it does not by itself establish a treatment effect. It does not prove that a tendon, bursa or joint was permanently corrected. No change is equally useful: reconsider the tissue, dose, lumbar contribution or need for referral.
Related RSM Clinical Blogs
Browse all Remedial Massage clinical guides
▷ Hip Pain or Pain Referred From the Back? — Remedial Massage · Broaden the differential assessment.
▷ Pain Outside the Hip: GTPS, Gluteal Tendon or Trigger Points? — Trigger Point Therapy · Develop the local palpation and contact distinction.
▷ Outside Knee Pain Running: Hip Control, TFL & Running Mechanics — Sports Massage · Connect the findings with the sport task and training exposure.
Study Remedial Massage at RSM
In practical training, learn to separate muscle contact from lateral-hip compression and explain what a tendon-versus-bursa assessment can establish. Work through the task, anatomical landmarks and hand-position choices with a clear reason for the next assessment.
▷ Remedial Massage — course details and entry requirements
About the Author
Hironori Ikeda, MSc Sports Medicine
Founder and lead instructor of RSM International Academy, Chiang Mai, Thailand. His teaching connects functional anatomy, clinical palpation, movement assessment and sports medicine manual therapy.