Hip bursitis is inflammation of a fluid-filled sac (called a bursa) near your hip joint, and it’s far more common than most people realize. In a study of nearly 3,000 adults over age 50, about 17.6% had the condition in at least one hip. The most common type involves the bursa on the outer point of your hip bone, where it acts as a cushion between bone and the thick band of tissue running down your outer thigh. When that bursa gets irritated, it produces a distinctive aching pain on the outside of your hip that can make sleeping, walking, and climbing stairs miserable.
Where the Pain Comes From
Your hip has several bursae, but the one that causes the most trouble sits over the greater trochanter, the bony bump you can feel on the outer side of your upper thigh. This bursa reduces friction between the bone and the iliotibial band, a strip of connective tissue running from your pelvis to your knee. When repetitive motion, pressure, or injury inflames this bursa, the result is what doctors now increasingly call “greater trochanteric pain syndrome” rather than simply bursitis, since imaging studies often reveal tendon damage and tissue irritation alongside or instead of true bursa inflammation.
A less common form, ischial bursitis, affects the bursa under your “sit bones” at the base of your pelvis. This type tends to bother people who sit on hard surfaces for long periods. But when most people say “hip bursitis,” they’re talking about the trochanteric type, and that’s where most of the research and treatment guidance is focused.
Who Gets It
Women are significantly more affected than men. In the same large community study, 23.5% of women had the condition in one or both hips compared to 8.5% of men. Women were more than three times as likely to develop it, likely due to differences in pelvic width and the angle at which the iliotibial band crosses the hip. Interestingly, age and race were not found to be significant risk factors once other variables were accounted for.
Common Causes and Risk Factors
Repetitive stress is the primary trigger. Activities that load the outer hip over and over, like running, cycling, climbing stairs frequently, or standing for long stretches at work, can irritate the bursa. A single fall or direct impact to the hip can also set it off.
Biomechanical issues play a major role. If one leg is slightly longer than the other, or if you have scoliosis, hip bone spurs, or weak muscles around the pelvis, the stress on your outer hip shifts in ways the bursa isn’t designed to handle. Calcium deposits in the tendons near the hip can create similar problems. Underlying conditions like diabetes, gout, psoriatic arthritis, and other inflammatory types of arthritis can also increase your risk by promoting systemic inflammation that makes the tissues around the hip more vulnerable.
What It Feels Like
The hallmark symptom is a sharp or burning pain on the outside of your hip. Early on, the pain tends to be intense and localized to that bony point. Over time, it often becomes a broader, duller ache that can radiate down the outer thigh toward the knee. Pain is typically worst when you press directly on the area, lie on the affected side (making sleep particularly frustrating), get up from a chair after sitting for a while, or climb stairs. Walking on flat ground is usually tolerable, but longer walks or uneven terrain can flare it up.
One thing that distinguishes hip bursitis from problems inside the hip joint itself: the pain is on the outer side, not deep in the groin. Groin pain with hip movement points more toward arthritis or a labral tear inside the joint. Outer hip pain that’s tender to touch is the classic bursitis pattern.
How It’s Diagnosed
Diagnosis is usually straightforward and based on a physical exam. Your doctor will have you lie on your side with the painful hip facing up and press on the bony point of the greater trochanter. Tenderness there is the key finding. They may also flex and extend your leg while feeling for snapping of the iliotibial band over the bone, which can be part of the same pain syndrome. Imaging like X-rays or MRI is typically reserved for cases that don’t respond to initial treatment, mainly to check for tendon tears or problems inside the joint that might be contributing.
Treatment That Works for Most People
The reassuring news is that conservative treatment resolves more than 90% of cases. The typical approach combines several strategies: reducing or modifying the activities that aggravate the hip, anti-inflammatory medication, ice, and physical therapy focused on strengthening the muscles around the hip and stretching the iliotibial band.
A structured home exercise program is a cornerstone of recovery. The key muscles to target are the gluteal muscles (both the larger ones that power your stride and the smaller ones that stabilize your pelvis), the outer thigh, and the piriformis deep in the buttock. Specific exercises include standing iliotibial band stretches, clamshells and reverse clamshells, straight leg raises, and assisted squats. The American Academy of Orthopaedic Surgeons recommends following a hip conditioning program for four to six weeks. In one study, a six-week home training program of stretching and strengthening led to significant improvement in about 41% of patients, with an additional portion seeing partial relief.
Combining multiple conservative approaches works better than any single treatment. One study found that a course of rest, physical therapy, ultrasound, ice, heat, and steroid injections together allowed 66% of patients to return to sports and 83% to return to physically demanding jobs within about three months.
Steroid Injections
When pain is severe or not responding well to exercises and activity changes alone, a corticosteroid injection into the bursa can provide significant relief. These injections typically ease pain for three to six months, though individual responses vary widely. In studies, the rate of subjective improvement ranged from 49% to 100%. Most people need only one injection, but up to a third require a second round. Injections are generally limited to three or four per year to avoid side effects from cumulative steroid exposure.
Shock wave therapy is another option that has shown some promise, allowing 64% to 76% of patients to return to normal activity in clinical trials. However, when compared directly to a home exercise program over 15 months, the difference in pain and recovery wasn’t statistically significant, suggesting that consistent exercise may achieve similar long-term results.
When Surgery Becomes an Option
Surgery is reserved for the small percentage of cases that don’t improve after months of conservative treatment, including physical therapy, activity changes, anti-inflammatory medication, and at least one steroid injection. These refractory cases may involve surgical removal of the bursa, lengthening of the iliotibial band, or repair of damaged gluteal tendons.
For those who do need surgery, outcomes are encouraging. A systematic review found that 95% of patients were satisfied or very satisfied with their results, and 82% said they would have the same surgery again. Failure to improve pain was reported in only 0% to 8% of surgical patients. The specific criteria for when to proceed with surgery aren’t firmly established in clinical guidelines, so the decision is typically made case by case when all other options have been exhausted.
Keeping It From Coming Back
Because hip bursitis is driven by repetitive stress and muscle imbalances, prevention and long-term management are really about the same thing: keeping the muscles around your hip strong and the iliotibial band flexible. Continuing a maintenance version of your hip conditioning exercises after the acute pain resolves is the most effective strategy. If you have a leg length discrepancy, a shoe insert can help equalize the stress on your hips. Runners and cyclists should pay attention to gradual increases in training volume rather than sudden jumps, and anyone who stands for long periods at work benefits from shifting weight frequently and wearing supportive footwear.
Maintaining a healthy weight also reduces the load on the bursa with every step. For people with inflammatory conditions like gout or psoriatic arthritis, keeping those conditions well managed lowers the overall inflammatory burden on the hip tissues.