Hip bursitis is inflammation of one or more fluid-filled sacs (bursae) that cushion the bones, tendons, and muscles around your hip joint. It most commonly affects the outer hip, causing pain that can disrupt sleep, walking, and everyday movement. The condition peaks between ages 40 and 60, affecting roughly 1.8 per 1,000 people each year, and is significantly more common in women than men.
Where It Happens in the Hip
Bursae are small, jelly-like sacs positioned between bones and soft tissues throughout your body. They contain a thin layer of fluid and act as cushions that reduce friction when you move. Your hip has two bursae that commonly become inflamed.
The first covers the bony point on the outside of your hip called the greater trochanter. Inflammation here is called trochanteric bursitis, and it’s by far the more common type. It causes pain on the outer hip and thigh. The second, the iliopsoas bursa, sits on the inner (groin) side of the hip. When this one flares up, the pain centers in the groin rather than the outer hip. Both conditions fall under the umbrella of “hip bursitis,” but they feel quite different because of where the irritated tissue sits.
Doctors now often use the term “greater trochanteric pain syndrome” (GTPS) instead of trochanteric bursitis, because the problem frequently involves not just the bursa but also the tendons and muscles that attach to the outer hip bone. When these soft tissues become overloaded, they’re the primary drivers of pain.
What It Feels Like
The hallmark symptom is a sharp or burning pain on the outside of the hip that may spread down the outer thigh. Early on, the pain tends to be intense and localized to a specific point you can press on. Over time it can become more of a widespread ache. Many people first notice it after prolonged walking, climbing stairs, or getting up from a deep chair.
Night pain is one of the most disruptive symptoms. Lying on the affected side puts direct pressure on the inflamed bursa, which can wake you repeatedly. Even lying on the opposite side sometimes aggravates it if the top leg drops across the body and stretches the outer hip. Pain often worsens after sitting for long periods, especially with crossed legs, and during repetitive activities like running or cycling.
Common Causes and Risk Factors
Hip bursitis develops when the soft tissues around the greater trochanter are overloaded or repeatedly irritated. Several factors raise your risk:
- Repetitive stress: Running, cycling, standing for hours, or regularly climbing stairs can strain the outer hip over time.
- Biomechanical imbalances: A leg length difference of 10 millimeters or more creates an asymmetry in posture and gait that places chronic stress on the hip. This imbalance can also contribute to functional scoliosis, compounding the problem.
- Weak hip muscles: When the gluteal muscles on the side of your hip are weak, the tendons and bursa absorb forces they aren’t designed to handle.
- Obesity: Extra body weight increases the mechanical load on your hip joints with every step.
- Coexisting conditions: People with low back pain, knee osteoarthritis, or tightness along the iliotibial band (the thick tissue running from hip to knee on the outer thigh) have a higher prevalence of GTPS. The altered movement patterns from these conditions shift extra stress onto the outer hip.
- Gender: About 15% of women experience one-sided GTPS at some point, compared to roughly 6.6% of men. The wider female pelvis changes the angle of pull on the hip tendons, which likely explains the difference.
A fall onto the hip, prior hip surgery, or bone spurs on the greater trochanter can also trigger inflammation.
How It’s Diagnosed
Most of the time, a doctor can diagnose hip bursitis through a physical exam and your description of symptoms. Pressing on the outer hip and reproducing that sharp, recognizable pain is often enough. X-rays can’t confirm bursitis, but they’re sometimes ordered to rule out other causes of hip pain like a stress fracture or arthritis. Ultrasound or MRI may be used when the diagnosis isn’t clear from the exam alone, or when a doctor suspects tendon damage alongside the bursitis.
Treatment Without Surgery
The good news: most cases resolve with conservative care. With proper management, symptoms typically improve within 6 to 10 weeks.
Activity Modification and Rest
The first step is reducing whatever is overloading the hip. If running triggered it, switch to swimming or upper-body exercise temporarily. Avoid lying on the painful side at night. Placing a pillow between your knees when sleeping on the opposite side keeps the top leg from dropping and stretching the irritated tissue.
Physical Therapy and Stretching
A structured exercise program targets the muscles that stabilize the hip. Key areas include the gluteal muscles (both the larger muscles in the buttocks and the smaller ones on the side of the hip), the outer thigh, and the hamstrings. Strengthening these muscles reduces the load on the bursa and tendons.
Stretching the iliotibial band is a staple of recovery. A simple standing stretch involves crossing the leg closest to a wall behind your other leg and leaning your hip toward the wall until you feel a stretch on the outer hip. Holding for 30 seconds and repeating four times on each side, done daily, gradually reduces tightness. Knee-to-chest stretches while lying on your back target the gluteal muscles and help relieve compression around the bursa.
Steroid Injections
When rest and therapy aren’t enough, a corticosteroid injection into the bursa can provide meaningful relief. In clinical data, about 61% of patients experienced more than 50% pain reduction at one month, and 44% maintained that relief at three months. Injections work best as a bridge, buying time for physical therapy to address the underlying weakness or imbalance. Current guidelines suggest spacing injections at least 2 to 3 weeks apart and stopping once relief plateaus, though there are no firm yearly or lifetime limits. Postmenopausal women may be advised to keep cumulative steroid doses lower due to effects on bone density.
When Surgery Becomes an Option
Surgery is reserved for cases that don’t respond to months of conservative treatment, typically after at least two steroid injections have failed to provide lasting relief. The procedure, called a bursectomy, removes the inflamed bursa and can be done arthroscopically through small incisions. In one study of patients with recalcitrant symptoms, 23 out of 27 had good or excellent results immediately after surgery, and all but one were satisfied with the outcome long-term.
Recovery from arthroscopic bursectomy generally allows a return to sports and physical activities within 6 to 8 weeks. If your job involves prolonged standing, walking, or heavy lifting, plan for more than a month before returning to full duties.
Preventing Recurrence
Hip bursitis tends to come back if the factors that caused it aren’t addressed. Maintaining a healthy weight is one of the most effective prevention strategies, since even modest weight loss reduces the repetitive stress on your hips with every step. Supportive footwear matters more than most people realize. Unsupportive shoes, high heels, and flat flip-flops can alter your gait enough to shift excess strain onto the hip. If you have a leg length difference, a simple shoe insert can even out your stride and take chronic pressure off the hip.
Continuing a hip-strengthening routine two to three times per week after symptoms resolve builds the muscular support that protects the bursa from future irritation. Gradually increasing exercise intensity rather than jumping back into high-mileage running or heavy training gives the tissues time to adapt without becoming overloaded again.