Why Does the Outside of My Hip Hurt? A Common Story for Women Getting Back to Exercise

The kids are finally back in school.

You’ve been telling yourself for months that once things settle down, you’re going to start taking better care of yourself again.

Maybe you used to run. Maybe you danced when you were younger. You love hiking and being active, but somewhere between work, raising kids, and everything else life has thrown at you, exercise slowly became less consistent.

So you decide to start simple.

You start walking.

And then your hip starts hurting.

At first, you assume it will go away. Maybe you did too much too quickly. Maybe you just need to stretch more.

But instead, the pain on the outside of your hip becomes harder to ignore.

It hurts when you sit too long, so you find yourself shifting onto the other side of your chair.

It hurts when you stand or walk for too long.

Sleeping on that side becomes uncomfortable.

Sometimes you even feel the pain travel down the outside of your leg.

You can’t seem to find a comfortable position.

And now you’re starting to worry.

Especially because you have a trip coming up that involves walking, hiking, sightseeing, and everything you’ve been looking forward to.

When Imaging Doesn’t Tell the Whole Story

This was the situation for one woman in her 40s who came to see me after months of trying to figure out why her hip was hurting.

She had a history of occasional back pain, so when she initially went to the doctor, imaging of her lumbar spine was ordered.

The imaging showed degenerative disc disease, or “DDD.”

That can sound scary, especially when you’re only in your 40s.

She was referred to physical therapy, where much of her treatment focused on strengthening her core and addressing her lower back.

It helped a little.

But the pain on the outside of her hip and down her leg didn’t really change. In fact, sitting was becoming increasingly uncomfortable.

Eventually, she saw a hip specialist.

X-rays showed mild hip osteoarthritis but were otherwise relatively unremarkable. She was given medication, including meloxicam, which helped take the edge off the discomfort but didn’t solve the problem.

She was frustrated.

She had done what she was told to do. She had seen multiple providers. She had tried medication and physical therapy.

But she still didn’t understand why her hip hurt.

The Location of Pain Matters (But So Does the Whole Story)

When she came to see me, we spent time going through the entire history of her symptoms rather than focusing only on what showed up on imaging.

Where exactly did it hurt?

What made it worse?

What positions bothered it?

How had her activity changed before the symptoms started?

What happened when she slept on that side?

What happened when she walked longer distances?

What happened when she sat at her desk?

Then we looked at her strength, movement, hip function, back, and several clinical tests.

Taken together, her symptoms and examination were much more consistent with gluteal tendinopathy, a condition involving irritation of the gluteal tendons along the outside of the hip.

That changed the way we approached her treatment.

Sometimes More Exercise Isn’t the Immediate Answer

One of the challenges with an irritated tendon is that the exercises you assume are “good for your hips” can sometimes aggravate it when the tendon is already sensitive.

That doesn’t mean exercise is bad.

It means the type, intensity, and timing of exercise matter.

Early in her treatment, we talked about ways to reduce unnecessary irritation while still keeping her moving.

That included modifying certain exercises, finding more comfortable positions during a flare-up, adjusting how she sat at her desk, and changing her sleeping position so she wasn’t spending hours compressing the painful side of her hip.

We also talked about something that is incredibly important with tendon rehabilitation:

You don’t want to avoid loading the tendon forever.

You want to find the amount of load it can currently tolerate and gradually build from there.

The Goal Wasn’t Just to Make Her Hip Stop Hurting

Her upcoming trip gave us a very clear goal.

She wasn’t trying to simply get a better number on a strength test.

She needed to tolerate a plane ride.

She needed to walk for hours while sightseeing.

She needed to navigate uneven surfaces and cobblestone streets.

And most importantly, she wanted to hike the Acropolis while she was in Greece.

So as her hip became less irritable, we gradually progressed her strengthening and walking tolerance.

The exercises became more challenging.

We worked on the strength and endurance she would need for longer periods of walking and standing.

Instead of asking only, “Does your hip hurt today?” we started asking questions like:

Can you sit comfortably for the length of your flight?

Can you walk several miles without your symptoms escalating?

Can your hip tolerate hills, stairs, and uneven terrain?

Can you recover after a busy day and do it again tomorrow?

Those were the benchmarks that actually mattered for her life.

A Few Visits Changed What She Thought Was Possible

Within the first few visits, her symptoms had already calmed down enough that she felt much more confident about her upcoming trip.

And then she went to Greece.

She tolerated the plane ride.

She walked the cobblestone streets.

She spent days sightseeing.

And she hiked the Acropolis.

When she came back, she told me how relieved she was that we had finally figured out what seemed to be driving her pain.

More importantly, she said she didn’t think she would have been able to enjoy the trip the same way if she hadn’t gotten her hip under control beforehand.

For her, this wasn’t simply about treating hip pain.

It was about being able to fully participate in a once-in-a-lifetime experience.

And She Didn’t Stop There

Once the trip was over, we kept building.

Her goal shifted from simply getting through Greece to getting back to the active person she remembered being.

She returned to longer walks.

She began hiking again.

She became more comfortable being active with her kids.

She started using the gym membership she already had.

And eventually, she signed up for her first 5K.

That progression is one of the things I love most about physical therapy.

Sometimes people come in wanting to get rid of pain.

But once they start trusting their body again, the goal becomes much bigger.

If Your Hip Pain Keeps Coming Back, It May Be Worth Looking Beyond the X-Ray

Pain on the outside of the hip can have several potential causes, and symptoms traveling down the leg don’t automatically mean that the problem is coming from your spine.

Likewise, findings such as mild arthritis or age-related changes on imaging don’t always explain why you’re hurting or what needs to be done next.

A thorough physical therapy evaluation looks beyond the image.

It considers your symptoms, your movement, your strength, your activity history, your goals, and how your body responds to different loads and positions.

Because ultimately, the goal isn’t simply to give your hip pain a name.

It’s to understand what is contributing to it and create a plan that helps you get back to the things you actually want to do.

Whether that’s walking around the neighborhood, sleeping comfortably, playing with your kids, hiking through Greece, or signing up for your first 5K.