Hip Bursitis
Hip bursitis is inflammation of a small fluid-filled sac that helps tissues move around the hip. Outer-hip pain labelled bursitis often also involves the gluteal tendons. Bursae at the front of the hip can cause a different pain pattern; this page's rehabilitation outline mainly concerns assessed, noninfectious outer-hip pain.
Key points
- What usually helps
- Taking the squeeze off the outer hip and gradually strengthening the buttock muscles.
- What you can do now
- Change how you lie at night. Uncross your legs and stand evenly.
- How long it takes
- Meaningful change usually takes 6 to 12 weeks; lasting strength takes 3 to 6 months.
- When to see a doctor first
- Some signs need medical care the same day. Check the list before you start treatment.
Symptoms
Does this sound like you?
- Pain in one area over the irritated bursa (a small fluid-filled cushion)
- Pain when the area is pressed
- Pain with movements that squeeze or stretch the bursa
- Pain that may spread down the outside of the thigh along the IT band (with bursitis on the side of the hip)
Often alongside it
- Night pain, especially when lying on the painful side
- Pain with prolonged walking or stair climbing
- Stiffness in the hip region
- Difficulty with activities that move the hip
It often develops after an injury or overuse, or as a result of another hip condition. Bursitis on the side of the hip (trochanteric bursitis) causes pain on the outer hip, while bursitis at the front (iliopsoas bursitis) causes pain at the front of the hip and in the groin.Book an assessment for hip bursitis
When to see a doctor first
Get seen today
A hot, red or swollen hip, spreading redness, a fever, or feeling unwell
Possible infected bursa (septic bursitis). Get medical assessment today, or go to emergency if you feel unwell. Infection is possible even without a fever
Sudden pain after a fall, or you cannot put weight on the leg
Possible fracture or tendon tear. Same-day medical assessment, or go to emergency
Check with your doctor
Severe swelling, or hip movement that is very restricted or painful in every direction
Not typical of bursitis. See your family doctor promptly to look for a joint problem or other cause
Numbness, tingling or weakness spreading down the leg
See your family doctor before starting physiotherapy to check the lower back and nerves
Treatment
How it is treated
Main approach. Reducing the squeeze on the outer hip and gradually strengthening the buttock muscles (glutes) can help most people with outer hip pain. This pain is usually a problem of the buttock tendons, with the bursa irritated alongside them.
Alongside it. Sleep and posture changes ease the night pain early, and an injection is sometimes used to settle pain enough to start the exercise program.
Managing it over time. Building up training at a sensible pace and correcting muscle imbalances may help lower the risk of hip bursitis in active people and athletes.
A typical rehabilitation progression
Three phases, from settling symptoms to returning to full activity.
Recovery from hip bursitis is usually staged: calm the symptoms first, then rebuild the strength and capacity of the area, then return to your full activities. The phases below show how that can progress.
Phase 1Take Pressure off the Side and Calm It Down (Weeks 1 to 4)
on the outside of the hip usually comes with irritation of the buttock tendons (gluteal ), so the early job mirrors the approach in the LEAP trial (Mellor and colleagues, BMJ 2018): reduce the squeeze of the tendon and against the bony point of the hip (the ), keep the hip moving, and start holds that load the muscles without moving the joint ( exercises) and without setting off pain. Sleep and sitting positions often decide early progress more than any single exercise.
Example exercises
- Lying on your side with a pillow between the knees, so the top thigh does not drop across the body () overnight
- Standing side-on to a wall, pressing the leg outward into it and holding (isometric ), 5 sets of 30 to 45 seconds, twice daily
- Lying face down, squeezing the buttock muscles and holding, 5 sets of 10 seconds, as a gentle starting exercise
- Short walking breaks every 30 to 45 minutes, avoiding sitting with crossed legs and standing with your weight hanging on one hip
- No deep foam rolling of the (the band of tissue down the outside of the thigh) directly over the bony point of the hip while it is tender
Possible progression milestones
Sleeping through the night without rolling off the sore side, walking 10 to 15 minutes without pain, and 45-second outward holds without a flare the next day.
Phase 2Strengthen the Glutes Through Their Range (Weeks 4 to 12)
This follows the principle of matching load to what the tissue can handle: once the hip has calmed down, the muscles on the side of the hip ( and minimus) need real strength work, not stretching. The LEAP program used exercises based on everyday movements that favour moving the leg out to the side, with load and range built up gradually. Pain during exercise up to around 3 or 4 out of 10 is acceptable as long as it settles within 24 hours.
Example exercises
- Lying on your side, lifting the top leg (sidelying hip abduction) with the pelvis level, 3 sets of 8 to 12 per side, progressing to ankle weights
- Hip hitches with a band: standing on one leg on a low step, lifting and lowering the other side of the pelvis, 3 sets of 8 to 10 per side
- Bridge on both legs (lying on your back, lifting the hips), progressing to a single-leg bridge, 3 sets of 8
- Split squat and step-up variations, 3 sets of 6 to 10 per side, keeping the pelvis level
- Walking program building duration before speed or hills
Possible progression milestones
Standing on one leg for 30 seconds without pain and with the pelvis level, step-ups and split squats without pain, and everyday walking for an hour without a flare.
Phase 3Return to Running, Hiking, and Load (Months 3 to 6)
The final phase rebuilds the hip's ability to handle bigger forces and the sideways demands of running, hiking and sport. When outer hip pain comes back, it usually traces back to a drop in buttock strengthening, so the plan for finishing includes a minimum amount of maintenance work each week.
Example exercises
- Heavier lifting on both legs: trap-bar deadlift (lifting a hexagonal bar from the floor) or Romanian deadlift, 3 to 4 sets of 6 to 8
- Single-leg Romanian deadlift and split squat with the back foot raised, both with weights
- Gradual walk-run return, flat ground before hills, with a cautious increase of 10 percent a week
- Sideways step-downs and controlled sideways bounds for runners and field-sport athletes
- Hip maintenance twice a week that you will actually keep doing
Possible progression milestones
Back to the running, hiking or sport amounts you want without overnight flares, confident sleeping on your side, and a written weekly maintenance plan.
What you can do now
- Change how you lie at night. Lying on the sore side squeezes the tendon and bursa against the bony point of the hip, and lying on the other side lets the top leg drop across the body. A pillow between the knees, a softer mattress topper on the sore side, or sleeping partly on your back usually makes a difference within a week or two.
- Uncross your legs and stand evenly. Sitting with crossed legs and standing with your weight hanging on one hip both squeeze the buttock tendons and bursa. Keep your legs uncrossed when you sit, stand with your weight on both legs, and take a short walking break every 30 to 45 minutes.
- Leave the IT band alone for now. Hard IT band stretching and foam rolling over the bony point of the hip squeeze the structures that are already being squeezed. Gentle movement through the hip and trunk is a better choice while it is irritable.
- Walk on the flat, ease off hills. Flat walking is generally fine, and recreational runners can often keep running if there is no overnight flare. Hill running, long runs and running on sloped roads are the usual early triggers, so cut those back first.Judge the amount by how the hip feels the next morning rather than pushing through.
- Start gentle holds against a wall. Standing side-on to a wall and pressing the leg outward into it, without moving, is a gentle way to start loading the muscles on the side of the hip. Hold for 30 to 45 seconds, 5 times, twice a day.Keep any pain during the hold to about 3 or 4 out of 10, and make sure it settles within 24 hours.
What I use in clinic
- Progressive Loading. In the LEAP trial, education plus progressive exercise for the buttock muscles (glutes) gave better overall improvement than an injection or waiting.
- Address Contributing Factors. Sudden jumps in training, hip weakness, and sleeping and standing habits are adjusted to lower the chance of a flare coming back.
Recovery
How long it takes
Meaningful change usually takes 6 to 12 weeks, and building lasting strength and tolerance in the tendon takes 3 to 6 months.
The outlook is generally good with non-surgical care. Long-standing cases may need more intensive treatment.
What changes the timeline
- What is causing it
- How inflamed it is
- Keeping up with treatment
- Whether there is an infection
- Other conditions at the same time
How I track it. I track how much the pain gets in the way of the tasks that matter to you, how well you move when I test those tasks in clinic, and how confident you feel in daily activities
Similar conditions
Conditions that can feel similar
- Gluteal Tendinopathy
- A more common cause of pain on the outer hip than true bursitis
- Hip Osteoarthritis
- Symptoms from the joint itself, morning stiffness, and less hip movement (limited range of motion)
- Stress Fracture
- Pain in the bone, often after an increase in activity
Questions
What patients ask me most
Is my hip bursitis actually bursitis?
Usually not as a problem on its own. The term stuck around for decades, but imaging and surgical studies showed that most outer hip pain labelled trochanteric bursitis is really a problem of the buttock tendons (gluteal tendinopathy), sometimes with the bursa irritated as well. The practical point: treatment that targets the tendon (progressive loading, reducing compression) works. Treatment that targets only the bursa (rest, repeated steroid injections) usually does not hold.
Will a cortisone injection fix it?
It can ease pain in the short term, but it does not rebuild the tendon. The LEAP trial (Mellor et al., BMJ 2018) compared education and exercise against corticosteroid injection and a wait-and-see approach. At 8 weeks, steroid injection beat waiting. Education plus exercise did better than injection on overall improvement at 8 weeks and at 12 months, though by 12 months pain levels were similar. Injection is worth considering selectively when pain is stopping someone from engaging with rehab, not as the plan itself. Injection is not something I do myself. When that route makes sense, I coordinate with a sports medicine physician who handles the procedure, and I plan the rehab work around it.
Why does it hurt most at night?
Because lying on the sore side squeezes the tendon and bursa against the bony point of the hip (the greater trochanter) for hours, and lying on the other side lets the top leg drop across the body (adduction), which also squeezes them. A pillow between the knees, a softer mattress topper on the sore side, or sleeping partly on your back usually changes things within a week or two.
Should I stretch my IT band or foam roll it?
No, not while it is irritable. Hard IT band stretching and foam rolling directly over the bony point of the hip squeeze the exact structures that are already being squeezed. I swap those for gentle mobility work through the hip and trunk, and targeted loading of the buttock muscles (glutes).
How long does this take to settle?
A typical time frame is 6 to 12 weeks for meaningful symptom change and 3 to 6 months to build durable capacity. Longer in people who have had it for years or who keep returning to the sleeping and sitting positions that loaded it. The LEAP program ran 14 sessions over 8 weeks, which is a reasonable yardstick for the active phase.
Can I still run or walk?
Usually yes, at a reduced and adjusted dose. Flat walking is generally fine. Running often stays in for recreational runners if there is no overnight flare. Hill running, long runs and running on sloped roads (camber) are the usual early triggers. I set the dose by how it feels the next morning rather than by pushing through.
Do I need an MRI or ultrasound?
Not routinely. Imaging finds tendon changes and fluid in the bursa in many people without outer hip pain, so the result rarely changes the plan. I cannot order imaging myself, so I flag it to your family doctor or a sports medicine physician and refer you when imaging would change the plan: when the history is unusual, when symptoms do not progress after a fair trial of loading, or when an injection guided by imaging is being considered.
The science
The Science of Hip Bursitis
Hip involves inflammation of the fluid-filled sacs () that cushion the hip joint. The most commonly affected bursae are the bursa (lateral hip) and iliopsoas bursa (anterior hip). However, true isolated bursitis is actually less common than previously thought.
What was traditionally called "trochanteric bursitis" is now understood to be primarily Greater Trochanteric Pain Syndrome (GTPS), a gluteal affecting the and minimus tendons. For years, lateral hip pain was attributed to an inflamed bursa, and the presumed treatment was rest, ice, and anti-inflammatory injections. Research has shown that the primary issue is frequently not an inflamed bursa, but a distressed gluteus medius or minimus tendon. The bursa can become secondarily irritated, but it's rarely the main driver.
This distinction is crucial because treating a tendinopathy is not about rest and inflammation control; it's about managing load and progressively strengthening the tendon. True isolated bursitis typically occurs secondary to other conditions, direct trauma, or in rare cases, infection or inflammatory conditions. The bursa becomes inflamed due to mechanical irritation or repetitive friction, but this is usually part of a broader mechanical problem rather than an isolated inflammatory condition.
Contributing factors
exist at locations where friction occurs between moving tissues, serving as fluid-filled cushions that reduce mechanical irritation. The bursa sits between the (IT) band and the greater trochanter bone, while the iliopsoas bursa sits between the iliopsoas tendon and the hip joint capsule or bony pelvis. Under normal circumstances, these bursae allow smooth gliding of these structures during hip movement. Inflammation develops when repetitive or excessive friction overwhelms the bursa's protective capacity.
For trochanteric , the mechanical problem involves the same compression forces discussed in Greater Trochanteric Pain Syndrome (GTPS). When your hip moves into adduction, bringing your thigh across your body's midline, the IT band tightens and compresses the trochanteric bursa against the greater trochanter. Positions that commonly create this compression include standing with weight shifted to one side, crossing your legs, and side-lying sleep postures where the top leg falls forward. substantially increases compressive load on the trochanteric bursa compared to neutral hip alignment.
Repetitive activities that involve and adduction cycles create a "bow-stringing" effect where the IT band repeatedly slides over the greater trochanter, generating friction forces on the underlying bursa. Running, particularly on banked surfaces where one hip drops into more adduction than the other, repeats this compression with every stride. Repeated stance-phase loading generates shear and friction forces over the greater trochanter that can accumulate over time to irritate the underlying bursa.
The iliopsoas bursa experiences different mechanical stresses. This bursa sits at the front of the hip where the iliopsoas tendon crosses the brim of the pelvis and hip joint capsule. During hip flexion and extension movements, such as running, climbing stairs, or performing sit-ups, the iliopsoas tendon slides back and forth across the bursa. In individuals with tight hip flexors or those performing high volumes of hip flexion activities, this repetitive motion can irritate the bursa.
Sleep position matters too. Lying on the painful side presses on the outer hip for hours at a time, and sustained side-lying pressure is a recognised aggravating factor that can disturb sleep and keep symptoms going.
This page uses "hip bursitis" because it is the familiar term, but the rehabilitation outline here is mainly for pain over the outside of the hip, which often involves the gluteal tendons as well as the bursa. Pain at the front of the hip (around the iliopsoas bursa), a new injury, or signs of infection need their own assessment.
Muscle weakness, particularly of the hip abductors, creates abnormal loading patterns that increase friction forces on the bursae. When your is weak, the IT band and tensor fasciae latae must work harder to stabilize the pelvis during single-leg stance. This increased muscle tension translates to greater compression and friction forces on the trochanteric bursa. Hip abductor weakness is associated with increased IT band tension during walking compared to normal strength, contributing to greater bursal compression.
Research
What the studies show
Buttock tendon problems on the side of the hip: a review (Grimaldi et al., Sports Medicine)
Tendon problems (tendinopathy) of the gluteus medius and minimus, the buttock tendons on the side of the hip, are now recognised as a main local source of outer hip pain. What was long labelled trochanteric bursitis most often reflects this tendon problem rather than inflammation of the bursa alone.
Shapes how the problem is assessed and which treatment is chosen.
Grimaldi A, Mellor R, Hodges P, et al. (2015). Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Med. PMID: 25969366.
Related Conditions
Conditions I commonly see alongside, or confused with, this one.
Getting back to it
Physiotherapy for hip bursitis, built around the activity you want back.
