When hip pain needs a closer look

Some hip pain can settle with planned management, but two patterns around the hip joint deserve earlier attention. Ongoing pain on the outside of the hip — especially when walking, climbing stairs, or lying on that side is difficult — is often called 'bursitis', yet reviews of greater trochanteric pain syndrome show gluteal tendinopathy or an abductor tendon tear may be the real problem.

A different level of caution applies to groin pain linked to running, marching, or other impact loading. Femoral neck stress fractures account for only about 3% of sport-related stress fractures, but delayed diagnosis can allow an undisplaced injury to displace, with risks including avascular necrosis and later osteoarthritis. In active adults, that kind of pain should not be 'pushed through'; MRI and protected weight-bearing may be needed.

At Lincolnshire Hip, that early split matters because the outer-hip pathway is usually conservative-first, whereas exercise-related groin pain may need quicker imaging and escalation.

Outer hip pain or groin pain

A more useful split here is where the pain is felt around the hip joint, not which treatment might come later. Pain over the 'side of the hip' often flares with lying on that side, climbing stairs, single-leg loading, or a longer walk. Reviews of lateral hip pain describe this as part of the greater trochanteric pain syndrome picture, and the discomfort may spread into the outer thigh rather than stay in one neat spot.

Pain felt 'deep in the groin' or at the front of the hip tends to point towards the hip joint or the upper femur. In active adults, research on femoral neck stress injury describes an exercise-related ache that is often poorly localised and more noticeable with running, hopping, marching, or sudden increases in impact load, sometimes easing with rest.

Location still is not a diagnosis. The same hip can produce side pain, groin pain, or both, and different conditions can overlap. At Lincolnshire Hip, the practical next step is a hip assessment that combines the story with examination and, when appropriate, imaging rather than relying on a pain map alone.

Why outer hip pain is often not just bursitis

Reviews from 2016 and 2020 suggest the old habit of calling outer-hip pain simply “bursitis” often misses the main issue. A broader and usually more accurate label is greater trochanteric pain syndrome, or GTPS, which can involve gluteal tendinopathy and, in some cases, partial or complete abductor tendon tears at the side of the hip. Trochanteric bursitis can still sit within that picture, but it often co-exists rather than explaining everything on its own. These tendon-related problems are reported more often in women and become more common with age, even though the side of the hip is not an area where symptoms fit into one neat box.

The practical clue is usually the pattern on assessment: marked tenderness over the outer hip, pain during single-leg loading, and discomfort or weakness with resisted abduction. In suspected abductor insufficiency, the 30-second single-leg stance test and related clinical tests can help, while MRI is most useful when a tendon tear is suspected. Even then, the scan is support rather than verdict. A 2025 MRI analysis found tears in 42% of people with clinically diagnosed gluteal tendinopathy, mostly partial-thickness, and MRI severity did not neatly match pain or disability. That is why Lincolnshire Hip keeps the hip joint in the frame as well, checking for joint-based pain and other hip causes before settling on a tendon diagnosis.

What helps gluteal tendon pain

For most gluteal tendon problems at the side of the hip, the first move is not an injection or an operation. A 2025 systematic review found the strongest evidence for education plus exercise: reducing repeated aggravating positions, managing walking and stair load, and rebuilding strength in the hip abductors and surrounding control muscles step by step. A separate 2025 evidence review also argued against an older first-line model built mainly around rest and corticosteroid injections.

Progress is usually judged by function around the hip joint rather than by MRI alone. In practice, that means better sleep on the affected side, longer walking tolerance, easier stair use, and steadier single-leg control on tasks such as the 30-second single-leg stance. In a 2025 imaging study, 42% of people with clinically diagnosed gluteal tendinopathy had tendon tears, mostly partial-thickness, yet MRI severity did not closely match pain or disability.

Adjuncts such as corticosteroid injection, PRP or focused shockwave may be considered in selected cases, but the best sequencing is still evolving and none is an automatic next step. At Lincolnshire Hip, the pathway is usually rehabilitation-led first, with review based on pain, sleep and function rather than a scan alone. Surgery is the exception: if MRI confirms an abductor tear and symptoms remain function-limiting despite appropriate non-operative care, tendon repair may be discussed. A 2024 systematic review suggested endoscopic repair often improves patient-reported outcomes, although meaningful success rates remain variable.

Groin pain you should not train through

One hip pain pattern deserves a harder stop than the usual post-exercise ache. In active adults — particularly runners and people doing military-style training — exercise-related groin pain around the hip joint may represent a femoral neck stress fracture. Most groin pain is not this, but 2011 and 2018 reviews describe pain that worsens with running or weight-bearing and may settle with rest. Delayed diagnosis, especially if training continues, increases the risk of displacement.

Risk rises after a sudden increase in mileage or impact load, and women may be more vulnerable when low energy availability, amenorrhoea or other bone-health problems are present. The broad classification explains why that matters: compression-sided injuries may sometimes be monitored, tension-sided injuries are less stable, and a displaced fracture is urgent. If an undisplaced injury propagates, complications can include avascular necrosis of the femoral head, later osteoarthritis and, in severe cases, total hip replacement.

That is why suspected cases are reviewed promptly, with examination of the hip joint and upper femur and early imaging when the history fits; published reviews specifically emphasise MRI because early injury can be missed. At Lincolnshire Hip, the practical message is simple: persistent training-related groin pain that returns with loading is not a "test it out" running problem. It is a stop-and-assess problem.

What assessment at Lincolnshire Hip may involve

In practice, the endpoint is a clearer decision, not another generic list of scans. At Lincolnshire Hip, a consultant-led assessment of the hip joint starts with the story the pain is telling: outer-hip pain that has behaved like gluteal tendon overload is usually steered towards rehabilitation and load management first, whereas exercise-related groin pain that keeps returning with weight-bearing raises a different level of concern and may need faster imaging or fracture-pathway escalation. Examination then tests whether the working diagnosis fits the symptoms before any next step is chosen.

For Lincolnshire and nearby areas, that pathway can often stay local in Grantham or Sleaford for consultation, imaging, injections, physiotherapy and follow-up, with surgery arranged separately in London only when the clinical picture supports repair or replacement. Lincolnshire Hip is part of the MSK Doctors group and accepts patients without referral for hip assessment.

1. [1] Approximately 50% of Patients Report Favorable Clinical Outcomes After Endoscopic Repair of Hip Abductor Tendon Tears: A Systematic Review. (2024). https://doi.org/10.1016/j.arthro.2024.01.001 https://doi.org/10.1016/j.arthro.2024.01.001