Hip bursitis: outer hip pain, gluteal tendinopathy and what helps
Pain on the outside of the hip, over the bony point you can feel at the side, is very common, especially from middle age, and is usually called hip bursitis or trochanteric bursitis. We now know that in most people the main source is the gluteal tendons rather than the bursa, which is why the condition is also called gluteal tendinopathy or greater trochanteric pain syndrome. That matters, because treatment works best when it's aimed at the tendon.
What does hip bursitis feel like?
The typical pattern is an ache or sharp pain on the outside of the hip that may spread down the side of the thigh. It's often worse lying on that side at night, getting up after sitting, climbing stairs or hills, standing on one leg (for example getting dressed), crossing your legs, and after long walks. The area over the bony point is usually tender to press.
Is it hip bursitis or gluteal tendinopathy?
The two often occur together, and an ultrasound may report bursitis, but the tendon is usually the main problem. A review of the research describes tendinopathy of the gluteus medius and minimus tendons as a primary local source of outer hip pain, most common in mid-life and more common in women (Grimaldi et al., Sports Medicine, 2015). The distinction matters because the tendon responds best to the right kind of loading, not just rest or injections.
What makes hip bursitis worse?
The tendons dislike being compressed against the bone. That happens when the hip drops inwards across the body, such as crossing your legs, sitting with your knees together, standing with your weight sunk into one hip, sleeping on your side with the top knee dropped forward, and stretching across the outside of the hip. Sudden increases in walking, running or stairs can also flare it.
What is the best treatment for hip bursitis?
Education and exercise. In a randomised trial of 204 people, a program of education about load management plus targeted exercise led to better results than a corticosteroid injection or a wait-and-see approach at eight weeks. At one year, education and exercise still gave better overall improvement than the injection (Mellor et al., British Journal of Sports Medicine, 2018).
In practice that means reducing the positions that compress the tendon, then building strength with a progressive program, often starting with gentle static holds and building towards side-lying, standing and single-leg exercises, step-ups and functional work.
Should I stretch my outer hip?
Usually not. Stretches that pull the leg across the body, such as the classic ITB or figure-four stretch, compress the tendon and often make the pain worse, even though they can feel satisfying at the time.
How should I sleep with outer hip pain?
If you sleep on your painful side, place a soft layer such as an egg-crate topper under your hip. If you sleep on the other side, put a pillow between your knees and ankles so your top hip doesn't drop forward and across. Sleeping on your back with a pillow under your knees is another option.
Do cortisone injections help hip bursitis?
They can give short-term relief, but in the trial above, education and exercise outperformed the injection at eight weeks and gave better overall improvement at one year. An injection may still have a role when pain is severe or stopping you from doing your exercises, but it works best alongside a loading program rather than instead of one.
How long does hip bursitis take to get better?
Tendons adapt slowly. Many people notice improvement in pain and sleep within a few weeks of changing their habits, but rebuilding tendon capacity usually takes around three months of consistent exercise, and longer-standing cases can take more.
Can I keep walking or running with hip bursitis?
Usually yes, with adjustments. Walking is generally fine if you shorten the distance, avoid steep hills for a while and keep a steady pace on flat ground. Runners often do well reducing volume and hills temporarily and running with a slightly wider step width so the hip doesn't drop across. Pain that settles within a day is a reasonable guide; pain that builds day to day means the load is too high for now.
Can an osteopath help hip bursitis?
Yes. We confirm the diagnosis, rule out pain from the hip joint or lower back, explain which positions to avoid, and build a progressive strengthening program that fits your life and activity levels.
When should outer hip pain be checked?
Book in if your pain isn't improving after a few weeks or is affecting your sleep or walking. See a doctor promptly if hip pain follows a fall, especially if you can't bear weight, or comes with fever, unexplained weight loss, or pain in the groin with a limp.
For more on hip pain, see our hip and pelvic pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
For more, see our posts on hip pain when sleeping on your side and menopause and joint pain.
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Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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