Hip pain when you walk, sleep or train?
Pain at the side of the hip, groin or buttock can behave very differently depending on what is being irritated.
We assess hip movement, glute strength, walking and single-leg control, while checking the lower back and nervous system when symptoms travel into the leg. Rehabilitation is then built around what you need to get back to.
Hip pain often becomes obvious during normal daily loading.
The way symptoms behave during walking, sleeping, sitting, stairs or training can help guide what needs to be assessed.
It hurts to sleep on one side
Pain over the outside of the hip can become uncomfortable in side-lying, especially when the area is sensitive to compression.
Stairs or hills make it worse
Walking uphill, climbing stairs and repeated single-leg loading can expose reduced tolerance around the hip and gluteal muscles.
The hip feels weak or unreliable
You may notice difficulty with step-down movements, standing on one leg or returning to running after symptoms have been present for a while.
Pain spreads into the buttock or leg
When symptoms travel, burn, tingle or feel numb, the lower back and nervous system may also need to be screened.
Hip pain does not always come from the same structure.
Location alone does not give a diagnosis, but it helps determine what needs to be examined and which movements are most relevant.
Lateral hip and gluteal tendon pain
Pain over the outside of the hip is commonly associated with greater trochanteric pain syndrome and can involve the gluteal tendons and surrounding tissues. Side-lying, hills, stairs and prolonged single-leg loading may aggravate it.
Front of the hip or groin pain
Anterior hip symptoms can behave differently and may be aggravated by deep squatting, hip rotation, lunging, running or prolonged sitting.
Buttock and posterior hip pain
Buttock pain can involve local muscles or tendons, but the lower back can also refer symptoms into this region. Sitting, hip hinging and running may help distinguish the pattern.
Pain that travels further down the leg
Burning, electric pain, tingling, numbness or weakness extending into the thigh, calf or foot makes lumbar and neurological screening more relevant.
We assess more than the spot that hurts.
The examination is matched to the pain pattern and the activities that are difficult. When necessary, we also look above and below the hip rather than treating it as an isolated joint.
Settle the irritation. Build strength. Return to normal loading.
Exercise should progress as your hip becomes more capable. Early exercises may be simple, but rehabilitation should eventually prepare you for the walking, work, gym or sport demands you actually have.
Settle
Temporarily adjust the positions and activities that repeatedly irritate the hip while maintaining useful movement where possible.
Strengthen
Progress from appropriate early exercises into stronger hip extension, abduction, squatting, hinging and single-leg work.
Return
Walking, work, gym, running or sport load is rebuilt gradually so the hip is prepared for normal activity again.
Hip strengthening should eventually look more like real life.
Bridges and clamshells can have a place early on, but they should not automatically become the whole programme. As capacity improves, exercise can move into stronger standing and single-leg work.
Why education and exercise matter for gluteal tendon pain.
A randomised clinical trial compared education and exercise with corticosteroid injection and a wait-and-see approach in people with gluteal tendinopathy.
What this shows These percentages represent participants reporting overall improvement. Education and exercise had the highest improvement rate at both follow-up points.
Important context This trial involved gluteal tendinopathy. The results should not be used to predict outcomes for every type of hip or buttock pain.
Reference: Mellor R et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy. BMJ. 2018;361:k1662. View study
Buttock and leg pain does not always start in the hip.
Hip and lumbar symptoms can overlap. If the symptoms do not behave like a local hip problem, the assessment needs to look further.
More consistent with local hip pain
Local hip structures become more relevant when symptoms are consistently reproduced by hip movement, local pressure, resisted muscle loading or specific single-leg tasks.
More reason to screen the back or nerves
Lumbar or nerve involvement becomes more relevant when symptoms travel further down the leg or include neurological features.
Seek urgent medical care for new bladder or bowel control problems, numbness around the saddle or genital region, rapidly worsening leg weakness, severe hip pain after major trauma with inability to bear weight, or a hot swollen hip with fever or significant illness.
From assessment to stronger movement.
The programme is adjusted according to the pain pattern, current capacity and the activity you need to return to.
Understand the pattern
We review where it hurts, how it started, what aggravates it and whether another area also needs screening.
Test what matters
Hip movement, strength and functional tasks are selected according to the symptoms rather than using the same assessment for everyone.
Start at the right level
Exercise range, resistance and activity volume are matched to current irritability and adjusted according to response.
Return to function
Strength and loading are progressed toward walking, work, gym training, running or sport rather than stopping once pain first improves.
Before your hip assessment.
Common questions about lateral hip pain, gluteal rehabilitation and referred symptoms.
Is pain on the outside of the hip always bursitis?
No. Lateral hip pain can involve the gluteal tendons, surrounding bursa or other local structures, and symptoms can occasionally be referred from the lower back. Assessment helps identify which pattern fits best.
Are bridges and clamshells enough for hip pain?
They can be useful starting exercises, but they are rarely the whole programme. As capacity improves, rehabilitation may progress into stronger standing exercises, squats, hinges, step work, single-leg loading and activity-specific training.
Should I stretch the outside of my hip?
It depends on the presentation. Some lateral hip tendon problems are sensitive to positions that increase compression around the gluteal tendons, so aggressive stretching is not automatically appropriate.
Can lower back or nerve pain feel like hip pain?
Yes. Symptoms from the lumbar spine or a nerve can be felt around the buttock, hip, thigh or lower leg. Tingling, numbness, burning pain or weakness may indicate that lumbar and neurological screening is appropriate.
Do I need an X-ray or MRI for hip pain?
Not everyone with hip pain needs imaging. Imaging is considered when the history or examination suggests it is clinically appropriate or when the result is likely to change treatment or referral.
Can I continue walking or training?
Often activity can be modified rather than stopped completely. The appropriate amount depends on the condition, symptom severity and how the hip responds during and after activity.
Can shockwave therapy help lateral hip pain?
Shockwave therapy may be considered for selected persistent lateral hip or gluteal tendon presentations after assessment. Rehabilitation and load management usually remain important parts of treatment.
Hip or glute pain not settling?
Book an assessment at Flow Clinic in Wairau Valley. We will identify the pattern that best fits your symptoms, assess the relevant movement and strength, and build rehabilitation from there.