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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.

Created by Lee Albert, NMT · 8 August 2026

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This isn’t a workout to push through. It watches how your body responds and adjusts as it goes.

“This is the first practice that seems to understand what my hips will and won't forgive.” Marcus H. · Hip pain

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 It was called bursitis for years, and that name is largely out of date, because the tendon rather than the bursa is usually the problem.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

1. 1
   Mellor 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.

2. 2
   NICE 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. 1

   Clamshell · 10 to 12, sore hip up

   Loads the side of the hip without pressing the tendon into the bone, as long as the sore hip stays on top. Lying on the sore side does the opposite: your own weight compresses the tendon exactly the way the note below warns against, so keep that hip up and padded, not underneath you.

2. 2

   Glute bridge · 10 slow lifts

   Strengthens the back of the hip in a position that keeps the sore side off the floor.

3. 3

   Bird-Dog · 5 each side

   Trains hip and trunk control together, which is what movement optimisation means in practice.

4. 4

   Gate pose · 30 seconds each side

   Length through the side of the body without dragging the leg across the midline.

5. 5

   Shallow chair pose · 5 slow reps

   Graduated loading through both legs, the stage the protocol builds towards.

Movements often used for this

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

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.