Hip Bursitis (Greater Trochanteric Pain Syndrome)

What causes outer hip pain

The greater trochanter is the bony bump on the outside of the upper thigh. Several structures attach here:

• the gluteus medius and minimus tendons, which stabilize the pelvis when standing on one leg
• the iliotibial band, which runs over the trochanter
• several bursae, fluid-filled sacs that reduce friction

Research using ultrasound and MRI shows that most "hip bursitis" is actually gluteal tendinopathy, wear and irritation of these tendons from compression and overload. Bursa inflammation is often secondary. That is why the umbrella term greater trochanteric pain syndrome is now preferred.

Risk factors

• female sex and age 40 to 60, possibly related to hormonal changes and pelvic shape
• weak hip and buttock muscles
• obesity
• sudden increases in walking, running or stair climbing
• sitting with legs crossed or standing hanging on one hip, which compresses the tendons
• lower back problems, knee or hip osteoarthritis, and leg length differences
• direct falls onto the hip
• rarely, rheumatoid arthritis, gout or infection

Symptoms

• aching or sharp pain on the outside of the hip, sometimes spreading down the outer thigh toward the knee
• tenderness when pressing on the bony point
• pain lying on the affected side, and sometimes on the other side when the top leg drops across
• pain getting up from a low chair, climbing stairs or hills, and standing on one leg
• stiffness after sitting
• a limp in more severe cases

Pain does not usually go into the groin or below the knee. Groin pain suggests a hip joint problem such as arthritis of the hip, and pain below the knee with tingling suggests a nerve root problem such as sciatica.

Diagnosis

A doctor or physical therapist will:

• press over the trochanter to find tenderness
• test single-leg standing for 30 seconds, which reproduces pain in gluteal tendinopathy
• test hip strength and movements
• examine the back and hip joint to rule out other causes

Imaging is not always needed. Ultrasound or MRI can show tendon thickening, tears and bursa fluid, and X-rays look for hip arthritis or calcium deposits. Blood tests and fluid drainage are used if infection or gout is suspected.

Treatment

Reduce tendon compression and load

• avoid lying on the painful side. When lying on the other side, put a pillow between the knees
• do not cross your legs or stand hanging on one hip
• avoid low chairs. Sit with hips higher than knees
• temporarily reduce hills, stairs and long walks, then build back gradually

Exercise therapy (most effective long-term)

A program from a physical therapist usually progresses over 8 to 12 weeks:

1. isometric holds: gently pressing the leg outward against resistance without moving, to ease pain
2. strengthening: bridges, side-lying leg raises (only when pain allows), standing hip hikes, step-ups and squats
3. functional training: single-leg balance, walking and sport-specific work

Aggressive stretching of the iliotibial band can compress the tendons and worsen pain, so guided exercise is better than stretching alone.

In the LEAP trial, education plus exercise gave better results at 8 weeks and 1 year than a steroid injection or a wait-and-see approach.

Pain relief

• ice or heat for 15 to 20 minutes
• acetaminophen (paracetamol) or NSAIDs such as ibuprofen for short periods, at the label dose. Avoid NSAIDs with kidney disease, stomach ulcers or blood thinners unless your doctor agrees
• topical NSAID gels

Injections and other treatments

• corticosteroid injection can relieve pain for weeks to a few months, but symptoms often return and repeated injections may weaken tendons
• shockwave therapy helps some people with persistent symptoms
• platelet-rich plasma injections are being studied
• weight loss reduces load on the tendons

Surgery

Rarely needed. Options include repair of torn gluteal tendons and bursa removal for persistent pain after 6 to 12 months of good non-surgical care.

Outlook

Most people improve within 3 to 6 months with load management and exercise, though symptoms can be stubborn and may recur. Keeping the hip muscles strong helps prevent flare-ups.

See also bursitis and iliotibial band syndrome.

Frequently asked questions

What does hip bursitis feel like?

Hip bursitis causes pain and tenderness on the outside of the hip, sometimes spreading down the outer thigh. It is often worse lying on that side at night, getting up from a chair, climbing stairs and standing on one leg. The bony point of the hip is sore to press.

What is the best treatment for hip bursitis?

A targeted strengthening program for the hip and buttock muscles, combined with avoiding positions that compress the tendons, works best long-term. Pain relievers, ice and steroid injections can help in the short term, but exercise gives more lasting results.

How long does hip bursitis take to heal?

Most people improve within 6 to 12 weeks of starting the right exercise program and load changes, and many recover fully within 3 to 6 months. Some cases last longer or come back, especially without continued strengthening.

Should I sleep on my side with hip bursitis?

Avoid lying on the painful side. If you sleep on the other side, place a pillow between your knees to stop the top leg dropping across, which stretches and compresses the sore tendons. Sleeping on your back is another option.

Is walking good for hip bursitis?

Moderate walking on flat ground is usually fine and helps keep you active, but long walks, hills and stairs can aggravate pain early on. Build walking back gradually as strength improves, and avoid crossing your legs or hanging on one hip when standing.