Blog 3: The Athlete’s Guide to Hip Pain: From Anatomy to Performance
Part 3: Lateral Hip Pain — What's Causing Pain on the Outside of Your Hip
Welcome back! In Part 2, Dr. Keirstyn dove into anterior hip pain — the deep groin and front-of-hip issues that plague so many athletes. Now we're shifting to lateral hip pain — that nagging ache on the outside of your hip that shows up in runners, cyclists, and anyone with weak hip stabilizers.
If you've experienced:
Pain on the side of your hip that's worse lying on that side
Outer hip pain during or after runs
Aching on the outside of your hip after long rides
Pain radiating down the side of your thigh
...this blog will help you understand what's going on and what to do about it.
The Anatomy: What's on the Side of Your Hip?
Key Structures:
Greater Trochanter: The bony prominence on the outside of your hip where multiple muscles and tendons attach
Gluteus Medius and Minimus: Hip stabilizer muscles that prevent your pelvis from dropping when you stand on one leg
Trochanteric Bursa: Fluid-filled sac that reduces friction between the IT band and greater trochanter
IT Band: Thick fascial band running from your hip to your knee along the outside of your thigh
When any of these structures become irritated or overloaded, you get lateral hip pain.
1. Greater Trochanteric Pain Syndrome (GTPS)
What It Is:
GTPS is an umbrella term for pain on the outside of the hip. It was previously called "trochanteric bursitis," but research shows it's usually not bursitis — it's gluteal tendinopathy (tendon damage/degeneration).
What It Feels Like:
Pain on the outside of the hip, often at the bony prominence
Worse lying on the affected side at night
Pain walking up stairs or hills
Aching after activity (running, cycling, standing for long periods)
May radiate down the outer thigh
Who Gets It:
Runners, especially those increasing mileage or adding hills
Cyclists with poor bike fit or weak glutes
Middle-aged athletes (40-60, especially women)
Anyone who sits a lot then trains hard
Why It Happens:
Your glute medius and minimus control pelvic stability during single-leg stance (every step of running, every pedal stroke). When they're weak or fatigued:
Your pelvis drops on the opposite side (Trendelenburg gait which Dr. Keirstyn can determine with a gait analysis)
The gluteal tendons work overtime to compensate
Repetitive overload leads to tendon degeneration
Pain develops gradually over weeks to months
The Compressive Element:
Lying on the affected side, crossing your legs, or sitting with legs crossed compresses the tendons against the bone, worsening pain. That's why night pain is so common.
2. Gluteal Tendinopathy
What It Is:
Tendinopathy is tendon degeneration from chronic overload without adequate recovery. The glute med/min tendons attach to the greater trochanter and are under constant demand during running, cycling, and any single-leg activity.
What It Feels Like:
Localized pain on the outside of the hip
Pain with resisted hip abduction (pushing leg out against resistance)
Pain with single-leg stance
Often worse in the morning or after sitting
Who Gets It:
Distance runners (repetitive single-leg loading)
Cyclists (prolonged hip position + weak glutes)
Triathletes (high training volume, multiple disciplines)
Post-menopausal women (tendon health influenced by hormones)
Why Stretching and Massage Don't Help:
Many athletes with gluteal tendinopathy aggressively foam roll, stretch, or massage the area. This makes it worse. Compressing degenerative tendons increases pain and delays healing.
What Actually Helps: Progressive loading (strengthening the tendon gradually) and avoiding compressive positions.
3. IT Band Issues (Secondary to Hip Weakness)
What It Is:
The IT band is a thick fascial structure that runs from your hip to your knee. When your hip stabilizers (glute med/min) are weak, the IT band tightens to compensate, creating lateral hip pain (and often knee pain too).
What It Feels Like:
Tightness or pain on the outside of the hip and thigh
May extend down to the outside of the knee
Feels like a "band" that needs to be stretched or rolled
Often bilateral (both sides)
Who Gets It:
Runners with weak glutes
Cyclists with poor positioning
Anyone increasing training volume rapidly
The Truth About the IT Band:
You can't "stretch" the IT band — it's fascial tissue, not muscle. Foam rolling may provide temporary relief but doesn't address the root cause: weak hip stabilizers.
What Actually Helps: Strengthening the glute medius and minimus so the IT band doesn't have to work overtime.
4. Hip Abductor Weakness Compensation
The Pattern:
Weak hip abductors (glute med/min) create a cascade of issues:
Pelvis drops during single-leg stance
Hip adducts (falls inward)
Knee tracks inward (valgus)
IT band, TFL, and lateral hip structures overwork to stabilize
Pain develops from chronic compensation
The Test:
Stand on one leg in front of a mirror. Does your pelvis drop on the opposite side? Does your hip shift outward? Does your knee fall inward? All signs of weak hip abductors.
Who's at Risk:
Runners transitioning from low to high mileage
Cyclists who don't do off-bike strength work
Dancers with hypermobility but poor control
Anyone returning from injury without proper rehab
How to Tell Them Apart
Self-Assessment Clues:
GTPS/Gluteal Tendinopathy:
Point tenderness on greater trochanter (bony prominence)
Pain lying on affected side
Pain with resisted hip abduction
Night pain common
IT Band Issues:
Tightness along the entire outer thigh
Often bilateral
Temporary relief from foam rolling
Associated knee pain
Hip Abductor Weakness:
Trendelenburg gait (pelvis drops when standing on one leg)
Fatigue in outer hip during activity
Compensatory patterns (hip hiking, lateral trunk lean)
What You Can Do Right Now
If You Suspect Lateral Hip Pain:
1. Avoid Compressive Positions
Don't lie on the affected side
Avoid crossing legs
No aggressive foam rolling or stretching
2. Strengthen Hip Abductors
Single-leg stance: 3 sets x 30 seconds each leg
Lateral band walks: 2 sets x 15 steps each direction
Single-leg deadlifts: 2 sets x 8 reps each leg
3. Modify Training Temporarily
Reduce mileage or intensity by 30-40%
Avoid hills and cambered surfaces (increase hip abductor demand)
Focus on building strength, not just logging miles
4. Address Bike Fit (Cyclists)
Ensure saddle height and cleat position aren't forcing hip compensation
Check for leg length discrepancies
What Doesn't Work (and Why)
Stretching: The pain isn't from tight muscles. It's from weak, overloaded muscles and degenerative tendons. Stretching doesn't address this.
Aggressive Foam Rolling: Compressing inflamed or degenerative tendons worsens the issue.
Cortisone Injections: May provide temporary relief but don't fix the underlying weakness. Research shows cortisone can weaken tendons long-term.
Complete Rest: Some activity modification is needed, but complete rest leads to deconditioning. Progressive loading is the key to tendon healing.
Seek Professional Help From Dr. Keirstyn When:
Pain lasting more than 3-4 weeks
Night pain disrupting sleep
Pain limiting your training or daily activities
You've tried strengthening but aren't seeing improvement
At Endurance Therapeutics, we:
Assess hip strength and movement patterns
Identify compensations creating overload
Create progressive loading programs for tendon healing
Address contributing factors (bike fit, running mechanics, training errors)
What's Next
In Part 4, we'll cover movement patterns that break hips — the biomechanical faults and training errors that create hip pain in the first place. We'll show you how running form, cycling position, and sport-specific demands contribute to hip issues.
If you're dealing with lateral hip pain right now, don't let it become chronic. Book an assessment with Dr. Keirstyn to identify the root cause and build a plan to get back to pain-free training.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161 | 🔗 https://endurance.janeapp.com/#staff_member/1
Coming up next: Part 4 — Movement Patterns That Break Hips