Ask someone with a sore hip to show you where it hurts, and watch the hand. Some people press their fingers into the crease at the front of the hip, where the leg meets the body.
Others lay a palm flat on the outside of the hip, right about where a pants pocket sits.
Both groups often call it “my arthritis.” The second group is frequently describing something else, a painful problem on the outside of the bony point of the hip with its own causes and its own list of things that make it worse.
If you are a senior who wakes up every time you roll onto one side, that night pain is an important clue.
If you are a caregiver, notice how your parent sleeps and how they stand at the kitchen counter. Several of the habits that keep this condition going are visible from across the room.
Quick Answer: What Is Trochanteric Bursitis?
Trochanteric bursitis is the traditional name for pain over the greater trochanter, the bony bump on the outside of the upper thigh bone. Imaging studies now show that most of this pain comes from irritated gluteal tendons rather than an inflamed bursa, so many clinicians call it greater trochanteric pain syndrome or gluteal tendinopathy.
It is not the same as hip arthritis.
Arthritis pain usually sits in the groin and the front of the thigh, while this pain sits on the side of the hip and is classically worse lying on that side at night. The tendons are aggravated by being squeezed, so the most useful early treatment is changing everyday positions, especially how you sleep and sit, followed by a gradual strengthening program.
The Name Is Older Than the Evidence
A bursa is a small, fluid-filled cushion that lets tissues glide over bone. For decades, pain over the outer hip was blamed on the bursa sitting on top of the greater trochanter, and the name stuck.
Then people started looking with scanners.
In a 2001 MRI study in Arthritis and Rheumatism, Bird and colleagues examined 24 women with this pain, aged 36 to 75. Fifteen showed gluteus medius tendinitis and 11 had a tear in that tendon, while only 2 had a swollen bursa.
A much larger ultrasound study followed in 2013. Long and colleagues reviewed 877 patients with outer hip pain and found gluteal tendon changes in about half of them, while only about 1 in 5 showed any bursitis at all, a finding the authors put right in the title as “the rarity of primary bursitis.”
The gluteus medius and gluteus minimus are the muscles that hold your pelvis level each time you stand on one leg, which you do with every step. Their tendons wrap over the greater trochanter to attach there.
This is more than a vocabulary update. A bursa that is “inflamed” sounds like something to rest and calm down, while a tendon that is irritated by being squeezed against bone points toward a very different plan, one built around how the hip is positioned all day long.
This article uses “hip bursitis” because that is what most doctors’ notes and most searches still say. The advice below is written for the tendon problem underneath it.
Side of the Hip or the Groin? Telling Bursitis From Hip Arthritis
The two are easy to confuse because both get called hip pain and both are common after 50. They behave differently once you know what to look for.
| Feature | Trochanteric bursitis / gluteal tendinopathy | Hip osteoarthritis |
|---|---|---|
| Where you point | The outside of the hip, over the bony point, sometimes spreading down the outer thigh | The groin most often, or the thigh, sometimes spreading to the buttock or knee |
| Worst times | Lying on the sore side at night, and sometimes on the other side too | Mornings, or after sitting or resting for a while |
| What sets it off | Standing on one leg, stairs, getting up after sitting, crossing the legs | Vigorous activity and high-impact exercise |
| Other signs | Pain within 30 seconds of standing on the affected leg | Locking, sticking, or grinding, plus reduced range of motion and sometimes a limp |
| X-ray | Often used mainly to rule other problems out | May show joint space narrowing and bone spurs |
| Who tends to get it | Most often adults over 40, with women outnumbering men | Most often adults 50 and older |
The location row does most of the work. Groin pain that makes putting on socks or getting out of a car difficult is the classic arthritis picture, and our guide to hip and knee osteoarthritis exercises covers that side of the fork.
The lower back is the third suspect.
Nerve pain from the spine can land in the buttock and outer thigh, and the two problems often travel together. In the Multicenter Osteoarthritis Study of 3,026 adults aged 50 to 79, people with low back pain were nearly three times as likely to have this outer hip pain (odds ratio 2.79).
Pain that runs below the knee with tingling or numbness points more toward a nerve, which our article on sciatica in older adults explains in detail.
Why Lying on Your Side Hurts, Even on the Good Side
Tendons near bone are sensitive to compression, the squeezing that happens when the tendon is pressed or pulled tight against the bony point beneath it. Physical therapy researchers Grimaldi and Fearon point to one position in particular: the thigh drawn in across the body’s midline, known as hip adduction.
Lying on your side manages to do it to both hips at once.
The bottom hip is pressed into the mattress. The top leg drops forward and down across the body, which pulls the tendons on that side tight over the bone, so people who switch to the “good” side are sometimes surprised that the sore hip still aches.
The same squeeze happens during the day, in positions most people never think about. Crossing the knees or standing with your weight sunk into one hip puts the outer hip in that drawn-in position, often for minutes at a time.
That is why the list of things to change is longer than the list of exercises.
Hip Bursitis Exercises to Avoid, and the Everyday Positions That Make It Worse
The items below come from the education given to participants in the LEAP trial, a 204-person treatment study described further down, along with patient guidance from NHS hospital physical therapy departments.
- IT band stretches and cross-body hip stretches. Pulling the leg across the body to stretch the outer thigh adds tension and compression at the same spot, and Grimaldi and Fearon say these stretches “should be avoided.”
- Piriformis or “figure four” style stretches that draw the knee across toward the opposite shoulder. The LEAP protocol lists piriformis and IT band stretches together as stretches that place compressive load on these tendons.
- Side-lying leg lifts, a staple of many hip handouts, when the top leg starts from a dropped position across the body. If a therapist uses side-lying work early, it is typically done with pillows keeping the top hip level.
- Crossing your legs, whether at the knees or the ankles, and sitting with your knees pressed together
- Standing “hanging on one hip,” the relaxed lean many people use at a counter or in a line, with the pelvis pushed out to one side.
- Low chairs, which both East Sussex and King’s College Hospital NHS leaflets tell patients to avoid
- Lots of stairs during a flare, while keeping ordinary walking going at a comfortable pace and distance
Readers should know that published advice is not unanimous on stretching. The American Academy of Orthopaedic Surgeons’ patient site still says a doctor may prescribe exercises “to stretch out the IT band,” while the newer tendon research advises against it.
The difference comes from how the problem is understood. If the cause is a squeezed tendon rather than a tight band, stretching into that squeeze works against you.
Sleeping With Hip Bursitis
Night pain is often the symptom that finally sends people to a doctor, and it is also one of the easiest to change.
Put a pillow between your knees and shins when you lie on your side. The East Sussex NHS leaflet suggests two pillows in one pillowcase, which keeps the knees far enough apart that the top hip does not drop.
Grimaldi and Fearon also suggest a soft foam overlay on the mattress to ease pressure on the bottom hip, since side-lying is hard to give up completely.
Caregivers can help here without a single conversation about pain. A long body pillow or a doubled pillowcase left on the bed tends to get used, while a reminder at bedtime tends to get forgotten.
What Actually Helps: A Gentle Starting Program
The goal is to make the hip muscles stronger without squeezing the tendons while they settle. Programs usually start with holds where the muscle works without the leg moving, then build toward standing strength over several weeks.
The dosing below follows East Sussex and King’s College Hospital NHS patient leaflets for this condition. Check with your doctor or physical therapist before starting, particularly after a recent fall or a hip replacement.
- Standing push-apart hold. Stand holding a counter with your feet slightly wider than your hips. Without letting your feet move, gently press them outward as if trying to slide them apart, hold 5 to 10 seconds, and repeat 5 to 10 times, twice a day.
- Lying belt press (weeks 1 to 3). Lie on your back with a pillow under your knees and a belt fastened just above them, then gently press your knees outward into the belt. Hold 5 seconds, 5 to 10 times, two or three times a day.
- Double-leg bridge (from week 2): lie on your back with knees bent, squeeze your buttocks and lift your hips without arching your back, hold 3 to 5 seconds, 5 to 10 times, twice a day
- Mini squat with a band (weeks 4 to 6). With a resistance band around your knees and feet shoulder-width apart, squat a short way while keeping your knees from dropping inward. Hold 5 seconds and repeat 10 times, every other day.
- Side-stepping with a band (weeks 7 to 8): 2 sets of 10 steps each way, every other day, holding a counter if balance is a concern
Use a simple pain rule. The East Sussex leaflet says some discomfort during exercise is acceptable if it eases afterward and does not leave you with more pain that night or the next morning.
Night pain makes a good gauge. The LEAP program used it the same way, allowing harder strengthening only when it did not increase pain at night.
Eight weeks is a long time to keep up a home routine. Our piece on sticking with a home exercise program has practical ways to keep it going.
What the Research Says About Exercise, Injections and Waiting
The best evidence comes from the LEAP trial, published in the BMJ in 2018. Mellor and colleagues randomly assigned 204 people with this condition to one of three approaches: 14 physical therapy sessions of education plus exercise over eight weeks, a single corticosteroid injection, or waiting to see.
At eight weeks, 51 of 66 people in the education and exercise group reported success, compared with 38 of 65 after an injection and 20 of 68 who waited.
At one year, the gap had changed shape. The exercise group held steady at 51 of 65, while the injection group, at 36 of 63, was now close to the waiting group at 31 of 60.
An earlier trial by Brinks and colleagues in the Annals of Family Medicine told a similar story about injections. Recovery at three months was 55 percent with an injection versus 34 percent with usual care, but by twelve months the two groups were level at 61 and 60 percent.
So an injection can buy real short-term relief. On its own, it does not seem to change where you end up a year later.
There is an honest limit worth stating plainly. LEAP enrolled adults aged 35 to 70 with an average age of about 55, so people in their 70s and 80s were not part of the evidence, and the advice for them is carried over from a younger group.
A second trial raises a more interesting question.
Ganderton and colleagues gave 94 postmenopausal women the same education about avoiding tendon compression, then assigned half to targeted hip strengthening and half to sham exercises. Both groups improved over a year, and the overall results showed no difference between them.
Strengthening still matters, and LEAP’s program included both.
What Ganderton’s result suggests is that the position changes in the section above may be doing more of the work than most people assume.
When It Is Both
Outer hip pain and hip arthritis are not always either-or.
In a small Australian study, Bicket and colleagues followed people with this outer hip pain for 11 years. Among the 24 who were reassessed, 35 percent had been clinically diagnosed with hip arthritis, compared with none of a comparison group, though the authors note the sample was small and the arthritis diagnoses were not confirmed by X-ray.
The same study found that 45 percent still had the outer hip pain after 11 years. For something often described as a short-lived flare, that is a reason to treat it properly rather than wait it out.
What a Doctor or Physical Therapist Will Typically Check
Most of the diagnosis happens with hands and a few movements rather than a scan.
- Exactly where you point when asked where it hurts, and whether it spreads down the outer thigh or into the groin
- Pressing on the greater trochanter. In a 2017 study in the British Journal of Sports Medicine, Grimaldi and colleagues found that no tenderness there makes gluteal tendinopathy unlikely.
- A 30-second single-leg stand, with support nearby. In the same study, outer hip pain within 30 seconds of standing on the affected leg made tendon changes on MRI very likely.
- Hip movement tests that draw the leg across the body, sometimes against resistance, to see whether they reproduce the familiar pain
- Hip range of motion, to screen for arthritis inside the joint
- A back and nerve screen, given how often low back pain travels with this condition
- How you walk. A pelvis that drops on one side with each step can point toward a weak or torn gluteal tendon, a sign Bird and colleagues found useful for spotting tears.
- An X-ray to rule out other problems, with ultrasound or MRI if the picture is unclear or not improving
Caregivers can bring useful observations to that visit.
Note which side your parent sleeps on and which chair claims their evenings. If they lean into one hip while washing dishes, mention that too.
What NOT to Do
- Do not assume side-of-the-hip pain is arthritis and follow an arthritis exercise sheet without checking. Some of the most common hip handout exercises are the ones to modify here.
- Do not stretch into the pain, especially by pulling the leg across your body.
- Do not stop walking altogether. Shorter, flatter walks at a comfortable pace keep the hip muscles working while the tendons settle.
- Do not count on an injection alone to fix it. In both trials described above, the injection advantage had faded by one year.
- Do not ignore a hip that is red, warm or swollen, or pain that comes with fever or chills. Cleveland Clinic lists these as signs of a possible infection that needs prompt medical care.
- Do not take over-the-counter pain relievers every day for weeks without asking your doctor or pharmacist, especially if you take other regular medications.
Frequently Asked Questions
Can I still walk with trochanteric bursitis?
Yes, and the NHS guidance cited above encourages it. Shorten the distance and choose flatter routes so the pain stays mild.
OrthoInfo notes that a cane or crutches for a week or more can help when walking is painful, and our guide to choosing between a cane and a walker covers fit and which hand to use.
How long does hip bursitis take to get better?
Expect months rather than weeks. King’s College Hospital’s leaflet says this kind of hip pain can take roughly 3 to 6 months to settle, and in LEAP, most of the improvement in the exercise group showed up within the eight-week program.
My mother keeps calling it her arthritis and spends every evening in a low recliner. What can I change without a fight?
Change the environment rather than the conversation. A firm cushion that raises the seat of that recliner and a body pillow left on the bed both reduce the squeeze on the tendons without asking her to remember anything.
If she points to the outside of her hip when it hurts, that is a reasonable thing to mention at her next appointment. A doctor or physical therapist can usually tell the two apart with a short exam.
Should I get a cortisone shot?
That is a decision for you and your doctor. The trials suggest a shot can ease pain over the first few months, while education and exercise produced better results at one year.
Some people use an injection to calm things down enough to start the exercise program, which is a reasonable thing to ask about.
Final Thoughts for Adults Over 50
Pain on the outside of the hip has spent decades under the wrong name, and it is easy to spend months treating the wrong joint because of it.
If you are a senior, start with the pillow between your knees and uncrossed legs tonight. Those two changes cost nothing, and the research suggests they carry more weight than they appear to.
If you are a caregiver, look at the chair your parent sits in every evening and at the bed. The fixes for this condition are mostly furniture and habits, which makes them unusually easy for a family to help with.
Then get the hip checked, so the exercise plan matches the problem you actually have.
Medical Disclaimer
This article is for general education and does not replace personalized medical advice. Hip pain should be evaluated by a doctor or physical therapist before starting an exercise program, especially after a fall or a hip replacement.
Seek prompt medical care for a hip that is red, warm or swollen, or for hip pain with fever or chills. Never start, stop or change a prescribed medication on your own.
You Might Also Be Wondering
- Practical sleep tips for older adults, useful when hip pain has already broken your sleep habits.
- What causes lower back pain after 50, since back and outer hip pain so often show up together.
- How to tell whether physical therapy is the right next step.
Medical References
- 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.
- Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44(9):2138-2145.
- Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88(8):988-992.
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910-922.
- Grimaldi A, Mellor R, Nicolson P, Hodges P, Bennell K, Vicenzino B. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. Br J Sports Med. 2017;51(6):519-524.
- 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.
- Mellor R, Grimaldi A, Wajswelner H, et al. Exercise and load modification versus corticosteroid injection versus ‘wait and see’ for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskelet Disord. 2016;17:196.
- 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.
- Brinks A, van Rijn RM, Willemsen SP, et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med. 2011;9(3):226-234.
- Bicket L, Cooke J, Knott I, Fearon A. The natural history of greater trochanteric pain syndrome: an 11-year follow-up study. BMC Musculoskelet Disord. 2021;22:1048.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Hip Bursitis.
- American Academy of Orthopaedic Surgeons, OrthoInfo. Osteoarthritis of the Hip.
- Cleveland Clinic. Trochanteric Bursitis.
- Cleveland Clinic. Gluteal Tendinopathy.
- East Sussex Healthcare NHS Trust. Gluteal Tendinopathy (patient information leaflet).
- King’s College Hospital NHS Foundation Trust. Hip Soft Tissue Injury (patient information leaflet PL942.1).
