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Back‑of‑hip pain can make simple tasks like sitting, climbing stairs or sleeping feel agonizing. The discomfort often radiates from the outside of the hip into the buttock or thigh and may worsen when you lie on the painful side. Because the hip joint, muscles, tendons and even the lower spine all contribute to sensation, it can be confusing to know what’s wrong. At Unpain Clinic we understand how frustrating it is to hear “just rest” without a clear plan. This guide explains why hip pain persists, summarizes scientific evidence and outlines effective treatment options so you can find lasting relief.
Disclaimer: This article is for educational purposes only and does not replace professional medical advice. Results may vary; always consult a healthcare provider about your specific condition.
Physiotherapist explaining causes of back of hip pain
Greater trochanteric pain syndrome (gluteal tendinopathy). The most common cause of lateral hip pain is degeneration of the gluteus medius and minimus tendons where they attach to the greater trochanter, rather than true inflammation of the bursa. This condition, often called gluteal tendinopathy or GTPS, arises when repetitive hip adduction (crossing legs, sleeping on one side) or weakness in the hip abductors compresses the tendons. Over time, compressive overload leads to micro‑tearing and poor healing, producing aching or burning pain along the outside of the hip.
GTPS is more common in women aged 40–60 and affects up to 10–25 % of the general population. Risk factors include sudden increases in activity, prolonged pressure on the hip, obesity, leg‑length differences, spine or foot problems, hip instability and weak hip abductors. Because tendinopathy results from failed healing rather than inflammation, simply resting the tendon often leads to muscle weakness and further.
Hip osteoarthritis causes a deep aching in the groin or front of the hip, but pain can radiate to the buttock, thigh or knee. Stiffness is usually worse in the morning or after sitting, and later stages may involve pain at rest or night. Non‑pharmacological treatments emphasize low‑impact aerobic exercise, aquatic therapy and strengthening/stretching the muscles around the hip. Weight management is critical because each 10‑lb gain adds about 60 lb of extra load on the joint.
Back‑of‑hip pain sometimes arises from irritation of the sciatic nerve, leading to pain, burning or tingling that travels from the low back into the buttock and down the leg. Common causes include lumbar disc herniation and spinal stenosis. Treatment focuses on relieving nerve irritation through targeted stretching, postural correction, core strengthening and addressing the underlying spinal pathology.
Other causes and red flags. Sudden onset without injury or pain that disrupts sleep should prompt evaluation. Numbness or leg weakness suggests nerve involvement, and pain accompanied by fever, weight loss or inability to bear weight warrants urgent care.
Education and exercise outperform injections. A randomized clinical trial compared education plus specific exercise, a single corticosteroid injection and a “wait‑and‑see” approach. At eight weeks, education/exercise and injection both improved pain; however, education/exercise achieved higher success rates and greater pain reduction. One year later, education/exercise maintained better global improvement than the injection group. Injections may offer quick relief, but education and exercise build resilience and deliver longer‑term.
Shockwave therapy and mechanical loading. Extracorporeal shockwave therapy (ESWT) has gained popularity for tendon disorders. A 2023 crossover trial found that both shockwave therapy and therapeutic exercise significantly reduced pain and disability in GTPS, with shockwave therapy resulting in greater functional improvement. Shock waves stimulate blood flow and tissue regeneration.
Understanding compressive load. GTPS is fundamentally a compression‑based tendinopathy. The iliotibial band exerts pressure on the gluteal tendons when the hip moves into adduction; weak hip abductors exacerbate this. Programmes that avoid provocative positions and gradually strengthen the abductors while managing daily loads show the best.
At Unpain Clinic we take a whole‑body approach to back‑of‑hip pain. After a comprehensive assessment to identify the root cause, our clinicians design a personalised roadmap that may include:
Sara, a 52‑year‑old gardener, came to Unpain Clinic after months of persistent back‑of‑hip pain. An ultrasound confirmed gluteal tendinopathy, and she learned that her hip abductors were weak. We provided three sessions of shockwave therapy, a couple of EMTT sessions and taught her targeted exercises along with simple changes to her sleeping and sitting positions. Within eight weeks Sara reported minimal pain and returned to gardening with modifications. A year later she remained pain‑free.
While professional assessment ensures the best outcomes, you can start gentle, evidence‑informed practices at home. Always listen to your body and stop any exercise that causes sharp or worsening pain.
Modifying sleep and sitting. Use a pillow between your knees when lying on your side or lie on your back with a pillow under your knees. Sit with both feet flat on the floor and knees slightly apart; stand up every 30 minutes. Pain often flares during sleep because prolonged pressure reduces blood flow.
Activity and lifestyle tips. Increase activity gradually, avoid crossing your legs or prolonged single‑leg stance, and maintain a healthy weight to reduce stress on the hip joint.
When to seek medical help. See a healthcare provider if pain persists longer than two weeks, occurs suddenly without clear cause, radiates down the leg with numbness or weakness, worsens at night or is accompanied by fever, weight loss or inability to bear weight.
Sitting and lying compress the gluteal tendons against the greater trochanter, reducing blood flow and irritating the tendon. Adjust your sitting and sleeping positions and strengthen your hip abductors.
There are no instant cures, but a combination of education, specific exercises, manual therapy and shockwave therapy can accelerate healing. Corticosteroid injections may reduce pain quickly, but research shows that education and exercise deliver better long‑term relief.
Hip osteoarthritis usually causes a deep ache in the groin or front of the hip, but the pain can radiate to the buttock, thigh or knee. Stiffness is most pronounced in the morning or after sitting.
No physician referral is required. You can book an initial assessment directly through our website.
Back‑of‑hip pain can sap your energy and limit the activities you love, but you don’t have to live with it. The most common cause—gluteal tendinopathy—responds well to a combination of education, load management, progressive strengthening and modalities like shockwave therapy. Research consistently shows that such comprehensive approaches provide better long‑term results than quick fixes like injections. At Unpain Clinic we blend science with compassion, investigating why you hurt rather than simply where you hurt.
At Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?”
If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole‑body approach so you leave with clarity, not more questions.
What’s included: Comprehensive history & goal setting; orthopedic & muscle testing; motion analysis; imaging decisions (if needed); pain pattern mapping; personalised treatment roadmap; benefit guidance.
Important details: 60 minutes, assessment only; no treatment in this visit.
Who you’ll see: A licensed Registered Physiotherapist or Chiropractor.
What happens next: If you’re a fit, we schedule your first treatment and start executing your plan.
Why choose Unpain Clinic: Whole‑body assessment, root‑cause focus, non‑invasive where possible, no long‑term upsells.
Outcome: You’ll walk out knowing what’s wrong, why it hurts and the fastest path to fix it.
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Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
