What Is Hip Bursitis Actually?

Do you have bursitis? Or have you been told you do?

Good news — you probably don’t. Lateral hip pain (pain on the outside of the hip) has long carried the label “trochanteric bursitis,” implying inflammation of the bursa — a small fluid-filled sac that reduces friction around joints. That diagnosis tends to push treatment toward anti-inflammatories and rest. But new evidence tells a different story for most people with side-of-hip pain.

Why the old label is changing

Recent research suggests the bursa is actually responsible for only about 2% of lateral hip pain cases. In the vast majority of cases the problem lies with the tendons that attach the gluteus medius and gluteus minimus muscles to the greater trochanter (the bony prominence on the outside of your hip). When these tendons are overloaded or irritated, they produce pain very similar to what was traditionally called bursitis. That broader, more accurate term is Greater Trochanteric Pain Syndrome (GTPS).

Who is most affected

GTPS is particularly common in women, especially between the ages of 40 and 60. This likely reflects a combination of hormonal changes, age-related changes in tendon structure, and lifestyle factors — many people in this age group pick up new activities, return to exercise after a break, or suddenly change their training volume or type, which can overload previously unchallenged tendons.

How GTPS is diagnosed GTPS is primarily a clinical diagnosis. An experienced clinician will:

• Take a detailed history about onset, activity patterns, and aggravating/relieving factors.

• Perform a physical exam assessing movement, range of motion, strength (especially hip abduction), and point tenderness over the greater trochanter.

• Check for other potential sources of pain such as hip joint osteoarthritis or referred pain from the lower back.

Routine imaging such as x-ray, MRI, or ultrasound is generally not required and can sometimes complicate the picture — incidental findings are common and may not be the source of pain. Imaging should be reserved for cases where another diagnosis is suspected (for example, a fracture, infection, or tumor) or when symptoms fail to improve after appropriate conservative care.

What actually helps — evidence-based treatment The best outcomes for GTPS come from a combination of education, activity modification, targeted exercise, and overall health strategies. Key components include:

• Education first: Understanding your condition reduces fear and improves self-management. Research shows education is the single most important element — people who understand their diagnosis and why certain actions help are more likely to follow through with rehabilitation and have better outcomes.

• Activity and posture modification: Tendons at the side of the hip are put into compression when you cross your legs, sit with your hip adducted, or lie on the painful side. Temporarily avoiding these positions can reduce irritation. Simple strategies — like sleeping with a pillow between the knees, avoiding prolonged side-lying, and changing sitting habits — can make a big difference.

• Load management: Depending on your current activity level, you may need to reduce the amount or type of exercise that aggravates the hip (for example, running or repetitive stair climbing). The goal is to reduce harmful load enough for symptoms to settle, then gradually and progressively reintroduce load in a controlled, graded way.

• Specific tendon-loading exercises: Tendon rehab aims to desensitize the tendon and increase its capacity to tolerate load. Rehab programs typically include exercises that target the gluteus medius/minimus and surrounding hip and core muscles, progressing from isometric work to heavier, slower concentric/eccentric loading as tolerated. A clinician will tailor the program to your pain levels and functional goals.

• Strengthening and movement retraining: Strengthening adjacent muscles and improving movement patterns helps offload the painful tendon. This includes hip abductors, gluteal endurance work, and exercises that address pelvic control and gait mechanics.

• General health factors: Sleep, nutrition, maintaining a healthy body weight, and managing metabolic conditions (like diabetes) all influence tendon health and recovery. Smoking cessation and regular cardiovascular activity can also support recovery.

How long will recovery take? Tendon-related lateral hip pain is often slow to resolve. Improvements are typically gradual over weeks to months rather than days. Consistency with a structured rehab plan, patience with progressive loading, and adherence to activity modifications give you the best chance of full recovery.

Takeaway: if you’ve been told you have bursitis If someone has told you your lateral hip pain is “bursitis,” it’s worth asking about GTPS and tendon-related causes. A focused clinical assessment by an experienced clinician will guide the right management — often avoiding unnecessary imaging and emphasizing education, modified activity, and a tailored exercise program.

Need help? If you’re dealing with pain on the side of your hip, or if you’ve been told you have bursitis and aren’t sure what to do next, speak to one of our experienced clinicians. We’ll assess your movement, examine the hip, rule out other causes, and build a practical, evidence-based plan to get you moving comfortably again.

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