What Is Hip Bursitis? Causes, Symptoms & Treatment

Pain on the outside of your hip when you walk, climb stairs or lie on your side at night? You may have hip bursitis. Many people try rest, ice, pills or an injection, only to have the ache come right back the next time they walk the dog or roll over in bed.

Here’s what hip bursitis is, what causes it, the warning signs to take seriously, and how to treat it without drugs, injections or surgery.

What Is Hip Bursitis?

A bursa is a small, fluid-filled sac that reduces friction where tendons and muscles glide over bone. When a bursa gets irritated or inflamed, it’s called bursitis.

The hip has two main bursae that cause trouble:

• Trochanteric bursa: sits over the bony point on the outside of your upper thigh (the greater trochanter). If you stand with your arms at your sides, it’s roughly under the middle of your palm. This is the most common type of hip bursitis.
• Ischial bursa: sits under the sit bone at the bottom of your pelvis. It causes a dull ache in the upper buttock, especially when sitting on hard surfaces.

Outer hip pain is often more than just the bursa. Research now recognizes irritation of the gluteal tendons, the tendons of the muscles on the side of your hip, as a main source of this pain. It’s most common in mid-life and affects women more than men. That’s why we look at the tendons and muscles around the hip, not just the bursa. Our article on gluteal tendinopathy explains that side of the picture.

What Causes Hip Bursitis?

• Injury: a fall onto the hip, a car accident or bumping into something hard, or long periods of pressure on one side.
• Overuse: lots of stairs, climbing, running or standing for long periods. Runners, other athletes and dancers are often affected.
• Posture and spine problems: conditions like scoliosis or lower back arthritis change how load passes through the hip.
• Weak hip muscles: weak glutes let the thigh drift inward when you walk or stand, which squeezes the tissues on the outside of the hip.
• Sitting too long: muscles stiffen and shorten, then pull across the hip when you stand up.
• Other conditions: rheumatoid arthritis, gout, bone spurs or previous hip surgery can all irritate the bursa.
• Infection (rare): a bacterial infection of the bursa, called septic bursitis, needs prompt medical care.

Signs and Symptoms of Hip Bursitis

People describe hip bursitis as anything from a dull ache to a sharp, burning pain, usually on the outer hip or thigh. It often gets worse with:

• Lying on the painful side: many people say it’s worst at night for this reason.
• Climbing stairs or hills: and walking, especially longer distances.
• Getting up after sitting: the first steps can be the worst.
• Pressing on the outer hip: the spot is often tender to touch.

Ischial bursitis feels different: a dull pain in the upper buttock that’s most noticeable when sitting on a hard surface or climbing.

Red Flags: When to Get Checked Right Away

Most hip pain responds well to the right plan, but get medical care promptly if you notice:

• Fever or a hot, red, swollen hip: this can be a sign of infection.
• Pain after a fall: or a hip that won’t take your weight.
• Groin pain or a locking, catching hip: these point to a problem inside the joint.
• Numbness, tingling or weakness: down the leg, or bladder or bowel changes.
• Night pain with weight loss or feeling unwell: pain that doesn’t change with position.

How Hip Bursitis Is Diagnosed

Outer hip pain can come from the bursa, the gluteal tendons, the hip joint or the lower back, and each needs a different plan. At Back In Motion, we start with a detailed conversation about your pain and a hands-on exam.

When it helps, we use musculoskeletal (MSK) ultrasound to see the bursa and tendons in real time, without radiation or a long wait for an MRI.

How Physical Therapy Treats Hip Bursitis

The usual approach is rest, ice or heat, anti-inflammatory pills and sometimes a cortisone injection. Those can calm symptoms, but they don’t change why the hip got irritated. That’s why the pain so often comes back.

The Gray Method™ looks for the cause in three steps:

1. Your history: when it started, what makes it better or worse, and what you’ve tried.
2. A full exam: we test the strength and flexibility of your hip and leg muscles and check for joints that are too stiff or too loose. We also look at your posture, your spine and how you move, because the feet, hips and upper back are often where the problem starts.
3. A clear diagnosis and plan: you’ll know what’s going on, how severe it is and what it will take to fix it.

Treatment is built around what we find. It often includes:

• Load management: simple changes that take pressure off the outer hip, like not crossing your legs, not standing with your weight hanging on one hip, and sleeping with a pillow between your knees.
• Progressive hip strengthening: exercises that build the glutes and hip muscles so they control the thigh and protect the tissues.
• Hands-on treatment: joint and soft tissue work to ease pain and restore movement.
• Targeted stretching: for tight muscles in the legs, hips and lower back.
• Low-impact exercise: swimming or a stationary bike keeps you moving while the hip settles.
• Ice and heat: for short-term relief while the real fix takes hold.

The research supports this approach. In a clinical trial of people with painful outer hips from gluteal tendon problems, education plus exercise led to better results than a cortisone injection at 8 weeks, and better overall improvement at one year.

What You Can Do at Home

1. Sleep smart: lie on your back or the other side with a pillow between your knees.
2. Stand evenly: keep your weight on both feet instead of hanging on one hip.
3. Uncross your legs: when sitting, keep your knees in line with your hips.
4. Break up long sitting: stand and move every 30 to 45 minutes.
5. Stay active, gently: walk on flat ground, swim or bike, and back off if pain builds.

For exercises to start with, see our guides to hip stability exercises and hip physical therapy exercises.

Hip Bursitis FAQ

How long does hip bursitis take to heal?

It depends on how long you’ve had it and what’s driving it. Many people feel better within a few weeks once the cause is addressed, but long-standing cases can take longer.

Is walking good for hip bursitis?

Usually, yes, in amounts that don’t flare it up. Walking on flat ground is often fine. Hills, stairs and long distances may need to be built back up gradually.

Should I get a cortisone shot?

An injection can ease pain in the short term, but it doesn’t fix the cause. In research, exercise and education did better than an injection over time. Talk it through with your doctor and physical therapist.

Do I need an MRI?

Most people don’t. A good exam, plus MSK ultrasound when needed, usually gives a clear answer.

Research

• Grimaldi A, Mellor R, Hodges P, et al. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Med. 2015;45(8):1107-1119. PubMed
• 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

Get Back to Walking and Sleeping Without Hip Pain

At Back In Motion Physical Therapy & Performance, every visit is one-on-one with a Doctor of Physical Therapy. Using The Gray Method™, we find what is irritating your hip and fix it, at our clinics in Fort Myers, Cape Coral and Estero. Learn more about our hip pain treatment.

Start with our Fixing the Cause & Not Just the Symptoms Assessment, or Inquire About an Appointment →

Call our office at (239) 223-0484 to schedule your appointment.