Hip Bursitis: Why Your Outer Hip Hurts and 7 Proven Steps to Relief

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What is hip bursitis?

Hip bursitis is irritation of a bursa, a small fluid-filled sac that sits between bone and soft tissue so tendons can glide without friction. When that sac becomes inflamed, the outside of the hip turns sore, tender, and painful to lie on.

After more than twenty years focused on hips and knees, this is one of the most common reasons patients walk into my office pointing at the side of their hip. Many arrive convinced they need a joint replacement. Most do not.

Which bursa is usually the problem?

The trochanteric bursa causes the large majority of cases. It covers the greater trochanter, the bony bump you can feel on the outside of your hip, and inflammation there is called trochanteric bursitis.

A second sac, the iliopsoas bursa, sits on the groin side. It is involved far less often, and the pain lands in the groin rather than the side.

What does hip bursitis feel like?

It feels like a sharp or burning ache directly over the point of the hip that spreads down the outer thigh and is tender when you press on it. Early on it is sharp and intense; over weeks it flattens into a deeper ache across a wider area.

What patients describe most often:

• Pain on the outer hip and thigh, sometimes reaching toward the knee
• Soreness when pressing the bony bump on the side of the hip
• Pain standing up from a low chair or the car
• Pain climbing stairs, walking distances, or standing on one leg

Why does it hurt more at night?

Lying on the sore side presses body weight directly onto the inflamed tissue. Lying on the opposite side lets the top leg drop across the body and stretch the tendons over the same bony point.

Patients tell me they fall asleep fine and wake at two in the morning with the hip throbbing. Losing sleep is often what brings them in.

What causes hip bursitis?

Repetitive load on the outside of the hip, not a single injury, causes most cases. The tissue gets asked to do more than it is conditioned to handle, and it protests.

Common contributors include:

• A sudden jump in activity: a new walking program, hills, a return to running.
• Weak gluteal muscles: the most common finding on my exam and the most fixable one.
• A tight iliotibial band: the IT band runs down the outer thigh and presses on the bursa when tight.
• A fall onto the side of the hip, or long periods lying on one side.
• Leg length difference, which changes how you load each hip with every step.
• Back and spine problems, including lower spine arthritis and scoliosis.
• Sitting or standing in one position, especially with legs crossed.
• Rheumatoid arthritis, and previous surgery or hardware around the hip.

Hormonal change around menopause appears to contribute, which helps explain why this shows up so often in women between 40 and 60.

Is it really the bursa, or is it a tendon problem?

Often it is the tendon. Imaging of patients carrying this diagnosis often shows irritation or partial tearing of the gluteal tendons where they attach to the greater trochanter, with the sac only mildly involved. That is why many specialists now use the term greater trochanteric pain syndrome, or GTPS, which covers both.

The distinction changes treatment. An inflamed sac quiets down with rest and ice. An irritated tendon needs progressive strengthening, and pure rest lets it deteriorate further.

Here is what I tell my patients: if six weeks of rest has not fixed it, rest is not the answer.

How is hip bursitis different from hip arthritis?

Location is the fastest way to tell them apart. Bursitis hurts on the outside of the hip and is tender to touch. Arthritis hurts in the groin, the front of the thigh, or deep in the buttock, and pressing the outside of the hip does not reproduce it.

• Bursitis: painful to lie on, painful to press, often fine once you are warmed up on flat ground. X-rays are usually normal.
• Arthritis: stiff in the morning, painful with weight bearing, hard to put on socks, worse the farther you walk. X-rays show joint space narrowing and bone spurs.

Getting this right matters. A hip replacement will not fix an irritated bursa, and a few patients still have outer hip pain after a perfect replacement because the problem was never inside the joint. If your symptoms sound like the second group, my article on common hip arthritis symptoms covers that picture.

What can you do at home for outer hip pain?

Remove the load irritating the tissue, then rebuild strength around the hip. That order is the whole strategy, and most people can start both this week.

• Change the aggravating activity, do not stop everything. Swap hills and long walks for level ground, a pool, or a stationary bike for two to three weeks.
• Stop standing on one hip. Spread your weight evenly across both feet.
• Uncross your legs when sitting, and skip low, deep chairs.
• Ice the sore spot for 10 to 15 minutes a few times a day during a flare.
• Use anti-inflammatory medication for short stretches if your doctor confirms it is safe with your other medications.
• Add gluteal strengthening. Bridges, side-lying leg raises, and sit-to-stands, done daily, do more here than any pill I prescribe.
• Use a cane in the opposite hand for a week or two if walking hurts. It unloads the sore side meaningfully.

One caution: aggressive IT band stretches that pull the leg across the body compress the exact tissue that hurts.

What sleeping position helps hip bursitis?

Sleep on your back with a pillow under your knees, or on the good side with a pillow between your knees so the top leg cannot drop across your body. Avoid sleeping directly on the painful hip.

What medical treatments work best?

Formal physical therapy for hip bursitis has the best track record, and it is where I send most patients first. A therapist loads the gluteal tendons progressively, corrects the walking pattern driving the problem, and keeps you off the stretches that make it worse.

The options I consider, in order:

1. Guided strengthening and gait retraining over 8 to 12 weeks.
2. A corticosteroid injection when pain is blocking sleep or preventing therapy.
3. Shockwave therapy for stubborn tendon-dominant cases.
4. Surgical removal of the bursa for the small number who fail everything above.

An X-ray is usually the only imaging needed at the first visit, since it rules out arthritis and bone spurs. I order an MRI when I suspect a gluteal tendon tear. For more on injections, see my piece on hip injections for pain relief.

Do cortisone injections cure hip bursitis?

No. A cortisone injection relieves the pain without fixing the cause. It quiets the inflammation for weeks to months, which buys a window to do the strengthening work that actually resolves the problem.

I limit how many injections a patient receives, because repeated corticosteroid in the same area can weaken tendon and soft tissue over time.

My honest framing across the desk: the shot is the doorway, therapy is the room.

Is surgery ever needed?

Rarely. It becomes reasonable only after months of nonsurgical care have failed, and it means removing the inflamed bursa, sometimes through a quarter-inch endoscopic incision. Removing the bursa does not hurt the hip; it functions normally without it, and both versions are same-day.

I perform more than 700 knee and hip replacements a year and operate on very few bursae. That should tell you how well the nonsurgical path works.

How long does hip bursitis last?

Most patients feel meaningfully better in 6 to 12 weeks once they change the aggravating load and begin strengthening. Cases that have been building for a year, or that involve gluteal tendon damage, can take 6 to 12 months of consistent rehabilitation to settle.

Flare-ups are normal and do not mean you have failed. Back off for a few days, then resume.

The patients who recover fastest treat the exercises like medication: same time, every day, whether or not the hip hurts that morning.

When should you see an orthopedic specialist?

Get evaluated if outer hip pain has lasted more than six weeks despite activity changes, wakes you more than twice a week, or makes you limp after a short walk. Pain with fever, redness, or sudden severe intensity needs same-day evaluation, because infection has to be ruled out.

Outer hip pain gets blamed on arthritis, sciatica, and the back constantly, and the treatment for each is different. My article on side and outer hip pain maps out the possibilities.

I see patients from Franklin, Nashville, Brentwood, Spring Hill, Columbia, and across Middle Tennessee at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. No referral is needed for a first consultation.

Ready to get the hip evaluated? Schedule a consultation with Dr. Calendine or call (615) 791-2630.

Patient background reading: AAOS OrthoInfo on hip bursitis and NHS inform on greater trochanteric pain syndrome.

Medical disclaimer: This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Outcomes vary. Speak with a qualified orthopaedic specialist about your own symptoms before making treatment decisions. In a medical emergency, call 911.

References

1. Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2017;67(663):479-480. PubMed
2. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083-1086. DOI
3. 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. PubMed
4. Ganderton C, Semciw A, Cook J, Moreira E, Pizzari T. Gluteal loading versus sham exercises to improve pain and dysfunction in postmenopausal women with greater trochanteric pain syndrome: a randomized controlled trial. J Womens Health. 2018;27(6):815-829. DOI
5. American Academy of Orthopaedic Surgeons. Hip Bursitis. OrthoInfo. Contributed by Sheth NP, MD, FAAOS; peer-reviewed by Adams JE, MD, FAAOS. View source
6. NHS inform. Greater trochanteric pain syndrome. NHS 24 MSK Clinical Advisory Group. Last updated 28 July 2026. View source