The side one is a tendon, not a sac. Lateral hip pain has been called trochanteric bursitis for fifty years and it is almost always wrong: scan the hip and the fluid sac is fine, the gluteal tendon underneath is the diseased tissue 1. That changes the fix, because a damaged tendon wants heavy load; anti-inflammatories miss the target.
Exercise beat the shot, badly. Put against a single cortisone injection and against wait-and-see, an 8-week exercise programme left 77% of people with gluteal tendinopathy much better, versus 58% and 29% 2. By a year the injection had lost almost all its edge over doing nothing. The default primary-care shot is the worst of the three.
A bump on the bone is not a verdict. The cam shape that drives impingement shows up on imaging in between one in six and three in four adults who have no pain at all 3, so it alone is no reason to operate. And where surgery is done, it beats structured physiotherapy by only about 7 points on a 100-point score, below the bar for clinically important 4.
Sort out which one you have, then load it heavily.
What comes back, and in what order.
- Weeks: for the side one, sleep on the bad hip returns first, once the daytime compressive habits stop.
- Week six to eight: walking tolerance, then stairs, then standing in a line without shifting weight.
- Three months: about three in four who stick with the side-hip programme rate themselves much better 2.
- The groin one is slower: squat, lunge, and sport return over months, roughly matching what surgery delivers 4.
Surgery is second-line for both: gluteal-tendon repair after 3–6 months of failed rehab with a real MRI tear 5; arthroscopy for impingement only when physiotherapy has plateaued, the morphology matches the pain, and the joint isn't already arthritic 4.
The fine print — when to skip it, and what people get wrong
Stretching the side hip makes it worse: the standing IT-band stretch and crossed-leg sitting put the tendon in the exact position that drives the disease. Groin pain in a young athlete stuck for three months is impingement, not a lingering strain.
Rehab fails when the exercises are done but the daily positions aren't fixed, or when the loading stays too light to remodel a tendon. For the groin, early rotation and hip-flexor stretches reproduce the pinch and make people quit.
- 1Grimaldi A, Fearon A (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic and Sports Physical Therapy. link
- 2Mellor R, Bennell K, Grimaldi A, et al. (2018). 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. link
- 3van Klij P, Heerey J, Waarsing JH, Agricola R (2018). The prevalence of cam and pincer morphology and its association with development of hip osteoarthritis. Journal of Orthopaedic and Sports Physical Therapy. link
- 4Griffin DR, Dickenson EJ, Wall PDH, et al. (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. The Lancet. link
- 5Ebert JR, Bucher TA, Ball SV, Janes GC (2015). A review of surgical repair methods and patient outcomes for gluteal tendon tears. Hip International. link
დაკავშირებული სახელმძღვანელოში (9)
- — Loading rehab is the cure; a daily collagen-plus-vitamin-C scoop before you train is a low-risk way to give the tendon more to repair with.
- — The loading rehab that fixes these hips leans on slow, controlled strength work like this.
- — Learning to hinge from the hips loads your glutes the way rehab wants — strength without the deep flexion that flares these tendons.
- — The fix isn't rest — it's months of progressive loading. Knowing how to train a muscle and tendon under load is the whole rehab.
- — Another load-driven tendinopathy with the same fix — progressive loading over weeks, not rest.
- — A tendinopathy sibling — different tendon, same heavy-slow-loading playbook and the same patience.
- — Same story at the shoulder: a scan finding isn't the diagnosis, and surgery is often oversold over rehab.
- — Hip problems refer pain into the buttock and are routinely mistaken for both sciatica and piriformis syndrome.
- — Another tendon that responds to graded loading rather than rest or a quick injection.