Side Hip Pain After 40 Is Usually the Glute Tendon

You roll onto your right side at 2am and the bony point of the hip wakes you. Stairs are fine on the way down and sharp on the way up. After a long meeting, the first steps to the pantry sting. Six weeks ago a steroid injection, for what the GP called trochanteric bursitis, turned the volume down. This week it is back.

Side hip pain after 40, in the women I see from Subang, PJ, and Shah Alam, is usually gluteal tendinopathy: the gluteus medius or minimus tendon on the outer hip. The wider name is greater trochanteric pain syndrome. A walk or a pickleball hour that felt ordinary at thirty-five can flare it now. It puts up with less load than it used to.

Gluteal tendinopathy shows up more often than bursitis

The injection helped, so the bursitis label feels earned. Ultrasound of this pain usually finds the tendon. In a large series, fewer than one scan in ten showed bursitis as the only finding (Long, Surrey, and Nazarian, 2013). The shot can still quiet a sensitive spot for weeks to a few months. If the pain has been too sharp to start strengthening, use that quieter window to begin. Resting through it leaves the tendon less ready for next month's stairs.

A scan helps when the story does not fit, such as groin pain or a fall. Tendon changes also show up in women with no pain, so the report alone does not explain this week. If the ache also moves through fingers and knees, and the X-ray was clear, that wider pattern is covered in perimenopause joint pain.

Daily positions that keep poking the tendon

The tendons sit on the bony bump at the side of the hip. They get squeezed when the thigh drifts inward. Side hip pain after 40 often flares on the days that squeeze adds up:

• Weight hung on one hip, in a queue or at the kopitiam counter
• Sitting cross-legged, or with the knees together
• Sleeping on the sore side, or on the good side with the top leg dropped across
• Pulling the knee across the body, or a long stretch down the outside of the thigh

A pillow between the knees takes load off the top hip. Shorter, flatter walks beat a long mall lap while the tendon is irritable. Hills and stairs add time on one leg. In our heat, a long outdoor walk is a poor stand-in for the glute work this tendon needs.

Ease pickleball while the outer hip is reactive. Side-shuffles are change of direction, and that belongs after slower strength work is tolerable. How the sport loads a week is in pickleball injuries in Malaysia.

Oestrogen receptors sit in tendon, and the tissue behaves differently across menopause (Chidi-Ogbolu and Baar, 2019). If you are considering hormone therapy, that conversation is with your doctor. I would not use it as the plan for this hip.

What helped more than a single steroid injection

The LEAP trial followed 204 people with this pain for more than three months, mostly women, average age about 55 (Mellor et al., 2018). One group learned the positions that compress the tendon and did progressive loading, about fourteen sessions over eight weeks. One group had a single corticosteroid injection. One group had one advice visit and waited.

At eight weeks, education plus loading beat both the injection and waiting. People felt better, and pain scores were lower. At one year, loading was still more likely to leave someone feeling clearly better. Pain scores by then were similar for loading and injection, and both were a little ahead of waiting. A single injection, given alone, matched waiting for that "clearly better" rating.

The exercises started with gentle static holds for the muscles that keep the hip from collapsing inward, then slower, heavier glute strengthening. Pain around 5 out of 10 was allowed during strengthening only if it settled quickly, and the hip was not worse that night or the next morning. A worse night means the day asked too much. Change one thing: distance, stairs, or the exercise.

If standing on that leg brings the outer-hip pain on within about half a minute, get it checked before you load it hard.

When the outer hip is the wrong explanation

Pain you can point to on the bony side, with shoes and socks still manageable, fits this tendon. These need a different look:

• Groin pain, or a hip that locks, clicks, and gives way
• Pain straight after a fall, or a leg you suddenly cannot stand on
• Night pain with fever, sweats, or feeling unwell

Waking because you rolled onto the sore side is ordinary for gluteal tendinopathy. Waking with a fever needs a doctor. Surgery for this tendon is uncommon, and a sore outer hip is not the usual path to a joint replacement.

If side hip pain after 40 is why you avoid one side of the bed, WhatsApp us to book an assessment at Pinpoint Physiotherapy in Ara Damansara. We will sort the tendon from the joint and the back, and set a load that fits your week.