Hip Bursitis: Symptoms, Causes and Treatment

What is hip bursitis?

Hip bursitis, or trochanteric bursitis, is the traditional name for pain on the outer side of the hip, over the bony point you can feel at the top of your thigh.¹ A bursa is a small fluid-filled cushion that stops tendons rubbing on bone, and for a long time this pain was put down to an inflamed bursa.

That view has changed. In a study of 877 people with this pain who had an ultrasound, only 20 per cent had bursitis. Half had changes in the gluteal tendons, which attach the buttock muscles to the bone, and more than a quarter had a thickened band of tissue running down the outer thigh.²

For that reason, clinicians now use the term greater trochanteric pain syndrome, or gluteal tendinopathy. The tendons of the gluteus medius and minimus muscles are recognised as the main source of the pain.³ If you have been told you have hip bursitis, this is very likely the same condition.

Hip bursitis symptoms

• Pain and tenderness on the outer side of the hip, sometimes spreading down the outside of the thigh
• Pain lying on that side at night, which disturbs sleep³
• Pain climbing stairs, walking uphill or standing on one leg, for example to get dressed
• Pain getting up after sitting, especially from a low chair or with legs crossed

Who gets it?

It mostly occurs in mid-life, in people who exercise and people who don’t, and women are affected more than men.³ In a large community study of older adults, 15 per cent of women and about 7 per cent of men had the condition on one side. It was more common in people who also had low back pain or knee osteoarthritis. Body weight made no difference.⁴

Is it hip bursitis or hip arthritis?

The site of the pain is the best clue. Arthritis in the hip joint is usually felt in the groin or the front of the thigh. One study comparing the two found that trouble putting on shoes and socks pointed towards arthritis. People with outer hip pain who could do that easily, and who were tender over the bony point of the hip, were likely to have greater trochanteric pain syndrome.⁵ See hip pain and hip arthritis.

Why does it happen?

Tendons adapt to the loads placed on them. The combination thought to do most damage here is the tendon being squeezed against the bone while it is under tension. That happens when the hip drops inwards, across the midline of the body.³

Everyday positions that do this include:

• Standing with your weight on one leg and your hip pushed out to the side
• Sitting with your legs crossed or knees together
• Lying on your side with the top knee dropped across in front of you

How is hip bursitis treated?

Change the positions that provoke it

• Stand with your weight evenly on both feet
• Sit with your knees apart and uncrossed, in a chair that isn’t too low
• Sleep on your back, or on the good side with a pillow between your knees
• Cut back on hills and stairs for a while

Exercise

Strengthening the hip muscles is the first-line treatment. A 2024 review of six randomised trials with 733 people concluded that exercise slightly reduces pain and improves function over the long term, and recommended it as the first treatment to try.⁶ A physiotherapist can show you the right exercises. Avoid stretches that pull the leg across the body, which compress the tendon.

Education counts for a lot. In a trial of postmenopausal women with this condition, everyone was taught how to manage it. Half also did a targeted exercise program and half did sham exercises. Both groups improved over the following year, with no difference between them.⁷

Ice and pain relief

Ice packs and simple pain relief from a pharmacy can help in a flare-up.¹

Injection

For severe pain, your doctor may suggest an injection near the bursa.¹ A systematic review found injections gave better pain relief than other treatments for up to three months.⁸ Over the longer term, exercise comes out ahead: people who exercised were more likely than those who had an injection to report a meaningful overall improvement.⁶

How long does it take to get better?

This is a slow-changing condition. With the right loading and habits, most people improve over several months. Flare-ups along the way are common and don’t mean the plan is failing.

When to see a doctor

• Outer hip pain that is disturbing your sleep or limiting your walking
• Pain that hasn’t improved after a few weeks of self-care
• Pain in the groin, or stiffness that makes it hard to put on shoes and socks
• Hip pain after a fall, or you can’t put weight on the leg. Seek urgent care⁹
• Hip pain with a fever⁹

References

1. healthdirect. Bursitis.
2. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083-6.
3. Grimaldi A, Mellor R, Hodges P, et al. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med. 2015;45(8):1107-19.
4. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88(8):988-92.
5. Fearon AM, Scarvell JM, Neeman T, et al. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med. 2013;47(10):649-53.
6. Kjeldsen T, Hvidt KJ, Bohn MB, et al. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy. 2024;123:69-80.
7. Ganderton C, Semciw A, Cook J, et al. Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. J Womens Health (Larchmt). 2018;27(6):815-829.
8. Barratt PA, Brookes N, Newson A. Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med. 2017;51(2):97-104.
9. healthdirect. Hip pain.