Hip Pain on the Outside of the Hip: TFL, Glute Medius, IT Band, or Bursitis?

Pain on the outside of the hip gets labeled as bursitis all the time. Sometimes that is part of the problem. But lateral hip pain can involve the gluteal tendons, the TFL and IT band, altered pelvic control, or several of these structures at the same time.

That is especially true when the pain is worse lying on that side, walking for a long time, climbing stairs, or standing on one leg.

Bursitis Is Not the Only Explanation

The bursa is a small fluid-filled structure designed to reduce friction around the greater trochanter, the bony point on the outside of the hip. It can become irritated and painful.

But the broader term now used for many cases is greater trochanteric pain syndrome. Research and clinical reviews recognize that gluteus medius or minimus tendinopathy and tears are frequently involved, sometimes more commonly than isolated bursitis. IT-band friction and external snapping can also contribute.

In other words, the painful spot may be the same while the tissue creating the pain is different.

TFL Versus Glute Medius

The tensor fasciae latae, or TFL, sits at the front-outside of the hip and blends into the iliotibial band. It helps with hip flexion, abduction, and internal rotation. The gluteus medius and minimus also help abduct the hip and, most importantly during walking, stabilize the pelvis when you stand on one leg.

If the gluteal muscles are not controlling the pelvis well, the TFL may increase its contribution. That can create tenderness at the front-outside of the hip, tension through the IT band, and a hip that feels tight even though the bigger issue may be poor distribution of muscular work.

Watch the Pelvis When You Walk

One of the most useful things to watch is what happens to the pelvis when someone stands on one leg. If the opposite side of the pelvis drops, or the trunk has to lean to compensate, the lateral hip stabilizers are not managing the load normally.

Then I want to know what happens farther down. Does the femur rotate inward? Does the knee drift medially? Does the foot pronate excessively? And what happens above the hip? Is the quadratus lumborum hiking the pelvis from the spine because the hip abductors are not holding it from below?

This is why lateral hip pain can become a full-chain problem rather than a single tender bursa.

I discuss those neighboring areas in more detail in my articles on how the hip and foot affect knee mechanics and the muscles involved in lower-back pain. Looking at both helps put the hip findings in context.

The Adductors Matter Too

The adductors on the inner thigh oppose and coordinate with the lateral hip muscles. If one side of that relationship is not functioning well, the other side may become overactive. This is another place where simply stretching whichever muscle feels tight can miss the pattern.

I want to know who is producing force, who is controlling force, and who is simply hanging on because somebody else stopped doing enough.

The AK Perspective

In an Applied Kinesiology examination, I may separately evaluate the TFL, gluteus medius and minimus, adductors, quadratus lumborum, and other hip stabilizers. I also want to see whether the muscle response changes after walking or during a single-leg task.

That assessment is not a substitute for diagnosing a gluteal tendon tear or other structural problem. It is a way of asking how the system around the painful tissue is functioning. If the gluteal tendon is injured, that matters. If the tendon is structurally intact but the TFL is dominating every step while the gluteus medius is poorly recruited, that matters too.

This is the kind of assessment behind our chiropractic care. Before deciding what to work on, I want to understand how the hip is moving and how the surrounding muscles are sharing the work.

When Lateral Hip Pain Needs More Evaluation

A sudden traumatic injury, inability to bear weight, major loss of strength, significant swelling, fever, or deep groin pain with loss of hip motion deserves further evaluation. Persistent lateral hip pain that does not respond to appropriate conservative care may also warrant imaging to evaluate the gluteal tendons and other structures.

The Takeaway

Pain on the outside of the hip is a location, not a complete diagnosis. The bursa may be involved. The gluteal tendons may be involved. The TFL and IT band may be taking too much load. Pelvic and gait mechanics may be the reason those tissues never get a break.

Instead of asking only, "What is tender?" ask, "Why is this side of the hip carrying the load this way?"

Have questions about how we assess recurring hip pain? You can book a free 15-minute consultation. We’ll talk about what you’ve been noticing, answer your questions, and discuss whether our approach is a good fit.

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About the author: Orie Quinn, D.C., is the founder and lead chiropractor at Ozark Holistic Center in Fayetteville, Arkansas.

Sources

Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis. American Family Physician. 2021.

American Academy of Orthopaedic Surgeons (AAOS), OrthoInfo. Hip Bursitis.

Walther DS. Applied Kinesiology Synopsis. 2nd ed. Systems DC; 2000. See Tensor Fascia Lata, Gluteus Medius/Minimus, Adductors, and gait/foot sections.

Read the AAOS patient guide to hip bursitis and pain around the outside of the hip.