What is hip bursitis?
A bursa is a thin, fluid-filled sac that reduces friction between bone, tendon and muscle. The hip has several. The trochanteric bursa lies over the greater trochanter, the bony prominence on the outer side of the hip. The iliopsoas bursa sits at the front of the hip, and the ischial bursa under the buttock. When irritated or inflamed, they cause pain. In many people, outer hip pain involves the gluteal tendons (gluteus medius and minimus) as much as the bursa, hence the term greater trochanteric pain syndrome. See dolores en la cadera derecha (Spanish).
Symptoms
- Sharp, aching or burning pain on the outer hip, sometimes spreading down the outer thigh.
- Tenderness when pressing over the bony point of the hip.
- Pain lying on the affected side at night.
- Pain climbing stairs, standing from a chair, walking uphill or after prolonged sitting.
- Pain after sitting cross-legged or standing with weight on one leg.
- Stiffness and a feeling that the hip is weak or catching.
- Pain that eases with gentle movement but returns after overactivity.
- Typically no swelling or redness unless infected.
Causes and risk factors
- Overuse and repetitive activity: running, cycling, climbing stairs, prolonged standing.
- Weak gluteal muscles and poor hip control.
- Tight iliotibial band, hip muscles or a stiff lower back.
- Direct trauma: a fall on the hip or lying on a hard surface.
- Leg length discrepancy, flat feet or poor footwear.
- Lower back conditions and arthritis of the spine or hip.
- Female sex and age 40–60, where gluteal tendon problems are more common.
- Obesity and sudden increases in activity.
- Rheumatoid arthritis, gout, diabetes and previous hip surgery.
- Rarely infection (septic bursitis).
How it is diagnosed
A clinician examines the hip, presses over the tender area, tests hip movement and strength, and checks the back and leg. Pain reproduced by lying on the side, single-leg stance for 30 seconds or resisted hip abduction supports the diagnosis. Imaging is usually unnecessary, but ultrasound or MRI may be used if the diagnosis is uncertain, if there is a suspected tear of the gluteal tendons or if treatment fails. X-rays help rule out hip arthritis and other conditions. Pain deep in the groin more often points to the hip joint itself, and back pain referred to the buttock and leg can mimic bursitis. See lower back strain.
Self-care for the first weeks
- Relative rest: reduce activities that provoke pain (hills, stairs, running) but keep gently moving.
- Avoid lying on the painful side; sleep on the other side with a pillow between your knees, or on your back.
- Avoid crossing legs, sitting on low soft sofas and standing with the hip pushed out to one side.
- Cushion: use a pillow or foam mattress topper if the bed is hard.
- Ice or heat: 10–15 minutes of whichever eases the pain.
- Pain relief: paracetamol or, if suitable, anti-inflammatories for a short time.
- Shoes: supportive, cushioned footwear; treat flat feet if relevant.
- Weight management reduces hip load.
Physiotherapy and exercises
Exercise is the most effective long-term treatment. Strengthening the gluteus medius and minimus improves hip control and reduces stress on the bursa and tendons. A typical progression, to be tailored by a physiotherapist and kept within a tolerable pain level, is:
- Isometric hip abduction: standing next to a wall, press the outer knee into the wall for 30–45 seconds, 3–5 times.
- Bridges: lying on your back with knees bent, lift the hips; 2–3 sets of 10–15.
- Clamshells: lying on your side, knees bent, lift the top knee; 2–3 sets of 10–15 (not on the painful side if it hurts).
- Side-lying leg lifts and standing hip abduction with a band.
- Single-leg stance and step-ups for balance and control.
- Sit-to-stand and mini-squats, then progress to loaded versions.
Avoid deep stretching that compresses the tendon, such as pulling the knee across the body toward the opposite shoulder, in the early stage. Progress over 6–12 weeks.
Gentle stretches
- Hip flexor stretch in half-kneeling, 30 seconds.
- Gentle glute and piriformis stretch lying on your back (figure-four), if not aggravating.
- Hamstring stretch lying on your back with a strap. See hamstring stretches.
- Gentle iliotibial band and quadriceps stretching, as comfortable.
- Avoid stretches that cause sharp pain over the side of the hip.
Injections, shockwave and surgery
A corticosteroid injection can give weeks to months of relief for some, and may help you start exercise, but benefits fade and repeated injections can weaken tendons. Platelet-rich plasma and shockwave therapy have some supportive evidence in persistent cases. Surgery (bursectomy or gluteal tendon repair) is rarely needed, mainly for gluteal tendon tears or cases that fail months of conservative care. Most people improve over 6–12 weeks with exercise, though some need several months.
Returning to activity
- Resume walking first, then flat cycling or swimming, then running.
- Increase by no more than about 10% per week.
- Warm up and strengthen the glutes before activity.
- Vary surfaces and avoid steep camber and hills while recovering.
- Stop and ease off if pain climbs above mild or lingers after activity.
- Maintain strengthening twice a week after pain settles to prevent recurrence.
When to see a doctor
- Hip pain after a fall, or inability to bear weight.
- Fever, redness and warmth over the hip.
- Groin pain or limited hip movement, suggesting a joint problem.
- Numbness, tingling or weakness in the leg, or loss of bladder or bowel control.
- Pain not improving after 6 weeks of self-care.
- Night pain with weight loss or unexplained symptoms.
Three common situations
A runner with outer hip pain after mileage increase: reduce load, strengthen glutes, build back gradually.
A woman in her 50s who cannot lie on her side: pillow between knees, avoid crossing legs, start abductor exercises.
Groin pain with stiffness and limping: see a doctor to check the hip joint.
Key points to remember
Outer hip pain, tender over the bony point and worse lying on that side, is often trochanteric bursitis or gluteal tendon pain. Reduce irritation, avoid crossed legs and side sleeping on the sore side, and build glute strength gradually. Seek care for red-flag symptoms or lack of progress. Our physiotherapy team can design your programme.
This guide is for general information and does not replace an assessment by your own doctor or therapist.
Questions about hip bursitis
These answers are general information and do not replace an examination or individual medical advice.
What does hip bursitis feel like?
Aching or sharp pain on the outer hip, worse lying on that side, climbing stairs or after sitting.
How long does hip bursitis take to heal?
Often 6–12 weeks with exercise and activity changes; some cases take longer.
What is the best sleeping position?
On your back or on the opposite side with a pillow between the knees.
Should I rest or exercise?
Reduce aggravating activities but keep moving; gradual strengthening is the key treatment.
Do cortisone injections work?
They can relieve pain for weeks to months, but exercise is needed for lasting results.
Is walking good for hip bursitis?
Gentle walking is usually fine if pain stays mild; avoid hills and long distances at first.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.