Joints and bones
Hip pain: load it, stop compressing it
For pain on the outside of the hip, a landmark trial found education plus exercise beat both a steroid injection and waiting it out.
What it is
Pain on the outside of the hip, over the bony point, is most often gluteal tendinopathy: the tendons of the buttock muscles where they attach to that bony point have become sensitive and are not tolerating their load. It was called bursitis for years, and that name is largely out of date, because the tendon rather than the bursa is usually the problem. Pain deep in the groin is a different pattern and more often comes from the joint itself.
How it behaves day to day
Lying on that side at night is the complaint that brings most people in. Sitting with the legs crossed, standing with the weight hanging on one hip, and going up stairs are the other classic provokers. What those have in common is compression: they press the tendon against the bone it attaches to.
What tends to feed it
- Lying on the painful side, or on the other side without a pillow between the knees
- Sitting cross-legged or with the knees together and feet apart
- Standing with the weight hanging on one hip
- Aggressive stretching across the body, which compresses rather than lengthens the tendon
What the research recommends
The LEAP trial, published in the BMJ in 2018 by Mellor and colleagues, randomised 204 people with confirmed gluteal tendinopathy to education plus exercise, a corticosteroid injection, or a wait and see approach. Education plus exercise outperformed waiting at every time point and outperformed the injection, particularly at eight weeks, on global improvement, function, quality of life and self-efficacy. The education part is as specific as the exercise part: it is about avoiding positions that compress the tendon against the bone, plus advice on how to load it. The exercise progressed in stages, from familiarisation, through early loading and movement optimisation, to graduated loading. For hip osteoarthritis, which presents differently, the guideline picture is the same as for the knee: exercise is a core treatment.
Sources
- 1Mellor et al., education plus exercise versus corticosteroid injection versus wait and see for gluteal tendinopathy, LEAP randomised trial (BMJ 2018)
Education plus exercise outperformed both a corticosteroid injection and a wait and see approach on global improvement and pain, in 204 people with confirmed gluteal tendinopathy.
- 2NICE NG226, osteoarthritis in over 16s (2022)
Therapeutic exercise tailored to the person, including local muscle strengthening, is offered to everyone with osteoarthritis, hip included.
Where Vinys is different
- Vinys treats hip work as graded loading rather than stretching. For a compressed tendon, the aggressive stretch that feels productive is often the thing keeping it sore.
- The load builds in stages, which is how the LEAP protocol was actually delivered, rather than starting at the level that provoked it.
- Sessions adapt on a day when the hip is reactive, so the loading continues at a lower level instead of stopping.
- Modifications are authored per movement, so a position that compresses the outside of the hip has a version that does not.
- Where yoga meets physiotherapy: the education and the loading in one place, at home, which is where this work actually has to happen.
A short session to try
- 1
Clamshell · 10 to 12 each side
Loads the side of the hip without pressing the tendon into the bone, which is the balance this condition needs.
- 2
Glute bridge · 10 slow lifts
Strengthens the back of the hip in a position that keeps the sore side off the floor.
- 3
Bird-Dog · 5 each side
Trains hip and trunk control together, which is what movement optimisation means in practice.
- 4
Gate pose · 30 seconds each side
Length through the side of the body without dragging the leg across the midline.
- 5
Shallow chair pose · 5 slow reps
Graduated loading through both legs, the stage the protocol builds towards.
Avoid pulling the knee across the body to stretch the outside of the hip. That position compresses the tendon, which is why it often feels good briefly and sore later.
Movements often used for this
Hips · 30–60 seconds of controlled repetitions per side
Clamshell
A small movement aimed at a muscle that keeps your pelvis level every time you take a step.
Hips and lower back · 30–60 seconds, or slow repetitions with a short hold
Glute bridge
Lifting your hips is easy. Lifting them with the glutes rather than the back is the exercise.
Stability / Core · 30 to 60 seconds
Bird-Dog: Classic
A key spinal stability exercise that trains your body to resist rotation while extending opposite limbs, building the deep motor control that protects your back in daily life.
Spinal Mobility · 30 to 60 seconds
Gate Pose: Classic
A kneeling side bend that stretches your lateral chain: the muscles along the side of your body, improving lateral flexibility and reducing one-sided tightness.
Stability / Core · 30 to 60 seconds
Chair Pose: Shallow
A shallower version that reduces demand on your knees and back while still building functional leg strength: accessible for bodies still building capacity.
Restorative · 120 to 180 seconds
Banana Pose
A deeply restorative supine side-body stretch that releases tension along your entire lateral line, from your outer hip through your side ribs and waist.
Restorative · 120 to 240 seconds
Butterfly
A gentle, grounding pose that opens your inner thighs and deep hip rotators with minimal joint loading, allowing long passive holds that gradually release fascial tension.
Restorative · 120 to 180 seconds
Deer Pose
An asymmetrical seated pose that simultaneously works internal and external hip rotation, improving the balanced rotational mobility your pelvis needs for comfortable movement.
Restorative · 120 to 180 seconds
Dragonfly
A wide-legged seated stretch that targets your inner thigh and adductor muscles, providing a deep and sustained release that improves hip abduction range over time.
Hip Mobility · 120 to 180 seconds
Dragonfly: Half
One leg stretches wide while the other supports you, giving your inner thigh and hip a gentle, sustained release: sitting tall works perfectly; folding forward is optional.
Restorative · 120 to 180 seconds
Half Butterfly
A one-sided seated forward fold that targets the hamstring and posterior hip of your extended leg, providing focused posterior chain release with a stable, supported base.
Restorative · 120 to 180 seconds
Happy Baby
A gentle bilateral hip decompression that combines flexion and abduction with gravity assistance, releasing tension in your hips and inner thighs in a comfortable, nurturing position.
These are movements the clinical library marks as especially beneficial for this movement pattern, with anything it flags as a caution for the same pattern removed. A pattern is not a diagnosis, and your own session is built from your answers on the day.
Common questions
Is this bursitis?
That name is largely out of date for pain on the outside of the hip. The tendon is usually the structure involved, which is why loading rather than resting is the approach.
Should I get an injection?
That is a decision for your clinician. What the LEAP trial found is that education plus exercise outperformed a corticosteroid injection, particularly at eight weeks.
Why does it hurt most at night?
Lying on that side compresses the tendon against the bone for hours. A pillow between the knees when on the other side is one of the more useful changes there is.
Get it assessed if the hip pain followed a fall, if you cannot bear weight, if there is pain deep in the groin with a loss of rotation, or if there is night pain with fever or weight loss.
Also called lateral hip pain, gluteal tendinopathy, greater trochanteric pain syndrome, hip bursitis. Movements are drawn from the clinically authored Vinys library, and the guidance above is sourced to the publications listed. This page is general movement information, not medical advice, and it is not a diagnosis. How the method works.