What hip bursitis actually is
Hip bursitis is the name most people recognise for pain over the bony point on the outer side of the hip. The more accurate term is greater trochanteric pain syndrome, because the pain usually comes from the gluteal tendons that attach to that bone, not the bursa itself. It is one of the most common causes of hip pain in adults, and it is often confused with hip arthritis, which is a different problem in a different place.
The greater trochanter is the bony prominence on the side of your upper thigh. The gluteal tendons, the trochanteric bursa and the iliotibial band all meet here. Pain usually arises from the tendons and surrounding tissue rather than the bursa, which is why the name changed and why treatment focuses on the tendon.
Typical symptoms
- Pain over the bony point on the outer hip, often tender to press
- Pain worse lying on that side, which may wake you at night
- Pain on stairs, standing on one leg, or getting out of a chair or car
- Pain that may spread down the outer thigh, but usually not below the knee
Night pain on the affected side is one of the most distinctive features. Many people have learned to sleep on the other side, and rolling onto the painful hip wakes them.
Why it is not hip arthritis
Hip arthritis affects the ball-and-socket joint, which sits deep and towards the front. Its pain is felt in the groin, and is typically worse with weight-bearing, rotation and stiffness.
Greater trochanteric pain syndrome affects the outer hip. The pain is felt on the side, is tender to touch, and is often worse at night lying on that side. The hip joint itself may move perfectly well.
How it is diagnosed
The diagnosis is made clinically, from what you describe and what is found on examination. Pressing over the trochanter reproduces the pain, and tests that load the gluteal tendons confirm the involvement. A weight-bearing X-ray is often arranged to check the hip joint, because arthritis is the main condition to distinguish from this. An ultrasound or MRI is only needed if the diagnosis is unclear, a tendon tear is suspected, or symptoms are not settling as expected.
Treatment
Because the main problem is usually the tendon, the cornerstone of treatment is progressive loading. Tendons do not improve with rest alone; they respond to controlled, gradually increasing load.
- A structured physiotherapy program that builds tendon and hip muscle capacity, including isometric and eccentric exercises
- Modification of aggravating activities, rather than complete rest
- Addressing contributing factors such as hip weakness, weight, and footwear or training load
- Simple pain relief such as paracetamol to take the edge off while loading takes effect
A corticosteroid injection can provide short-term relief, particularly when sleep is badly disturbed, but it does not change the long-term outcome on its own, and repeated injections may weaken the tendon. Its best role is as a bridge to settle pain enough to start a loading program.
Platelet-rich plasma (PRP) injection is another option being used for tendon problems, including greater trochanteric pain syndrome. A small sample of your own blood is spun in a centrifuge to separate the plasma, which is rich in platelets and their growth factors, from the red and white cells. This concentrated plasma is then injected back into the painful area. The idea is to use the body's own healing signals to support tendon repair. The evidence is still developing, and PRP tends to be reserved for cases that have not settled with a loading program, often as an alternative to repeated steroid injections. As with any injection, it works best alongside ongoing rehabilitation rather than in place of it.
How long it takes
Most people see meaningful improvement over six to twelve weeks of consistent loading, with continued gains over three to six months. A small proportion have persistent symptoms that need more detailed assessment, occasionally including surgical review. The condition is common, treatable, and most people improve without surgery.
Questions to ask
- Is my pain coming from the tendons on the outer hip, or from the hip joint itself?
- Is there evidence of gluteal tendon involvement, or is the bursa the main problem?
- What loading program is right for me, and who will guide it?
- Should I have an injection, and if so, how many and how often?
- Could I also have hip arthritis, and does that change the treatment?
Common questions
Is hip bursitis the same as hip arthritis?
No. Hip bursitis, or greater trochanteric pain syndrome, affects the tendons and bursa on the outer point of the hip. Hip arthritis affects the ball-and-socket joint itself, deeper and towards the front, and is usually felt in the groin. The two cause pain in different places, have different causes, and are treated differently. They can occur together in the same person.
Why does it hurt more to lie on that side?
Lying on the affected side places direct pressure on the greater trochanter and the tender structures attached to it, and it also compresses the gluteal tendons against the bone. This is why pain over the outer hip that wakes you at night, or starts when you roll onto that side, is one of the most characteristic features of the condition.
Will a steroid injection fix it?
A corticosteroid injection into the bursa can give short-term relief, typically for a few weeks to a couple of months. The evidence shows it does not change the long-term outcome, and repeated injections may actually weaken the gluteal tendons. The condition is primarily a tendon problem, and tendons respond best to progressive loading. An injection may be useful to settle things enough to start a loading program, but it is not a cure on its own.
Can I keep walking and exercising?
Yes, and you should, but the type and amount may need adjusting. Activities that load the tendons aggressively, such as hill walking, long distances on hard surfaces, or exercises that compress the hip, can aggravate the condition. A physiotherapist can help you find a level of activity that keeps you moving without provoking the tendons, and build it up gradually.
Does my weight matter?
It can. Greater trochanteric pain syndrome is more common in people carrying extra weight, and managing weight is one part of treatment. This is not a judgement but a mechanical reality: the tendons on the outer hip work harder when there is more load to stabilise. Even modest weight loss can reduce symptoms, and it also reduces load through the hip joint itself.
Do I need a scan?
Usually not. The diagnosis is made clinically, from the description of the pain and a focused examination. An X-ray of the hip may be arranged to check the joint itself, because the two conditions are often confused. An ultrasound or MRI is only needed if the diagnosis is unclear, if a tendon tear is suspected, or if symptoms are not settling as expected.
Can it come back?
Yes. Greater trochanteric pain syndrome can recur, especially if the factors that contributed to it, such as weak hip muscles, a sudden increase in activity, or being overweight, are not addressed. This is why treatment focuses on building tendon capacity and muscle strength rather than on injections alone. A well-structured loading program reduces the chance of recurrence.
Common questions.
Is trochanteric bursitis the same as hip arthritis?
No, and they are frequently confused. Gluteal tendinopathy causes pain on the outer hip that is tender to press and painful to lie on. Hip arthritis causes groin pain that is worse on weight bearing and is not tender from outside. You can have both.
Why does it hurt most at night?
Lying on the affected side compresses the tendons directly against the bone. Lying on the other side with the top leg falling forwards stretches and compresses them too. A pillow between the knees, and avoiding lying on the painful side, often helps within a few nights.
Will a cortisone injection fix it?
It often helps in the short term, but randomised evidence shows education plus a progressive exercise programme gives better results by twelve months. The best use of an injection is to reduce pain enough to let the strengthening programme proceed.
How long does it take to settle?
Longer than most people expect. A tendon loading programme is measured in months, typically three to six, and progress is not linear. Stopping early is the most common reason it recurs.
Do I need surgery?
Almost never. The great majority settle with load management and strengthening. Surgical repair is reserved for a small number of full-thickness tendon tears and is not performed in this practice.
References.
- Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662.
- Grimaldi A, Mellor R, Hodges P, et al. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Med. 2015;45(8):1107-1119.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.