Lateral Hip Pain (\"Hip Bursitis\"): A Patient Guide to Greater Trochanteric Pain Syndrome

If you have a deep, nagging ache on the bony outer part of your hip — the spot you land on when you lie on your side — you already know how much it can wear you down. Maybe it flares when you climb stairs, get up from a low chair, or walk further than usual. Maybe the worst part is at night: you roll onto that side, the ache wakes you, and you spend the small hours hunting for a position that does not hurt. Many people are told they have "hip bursitis," picture a small inflamed sac, and expect it to settle in a week or two. When it does not, the frustration is real.

This guide explains what that outer-hip pain usually turns out to be, why the old "bursitis" label is only part of the story, and how different health professions tend to approach it. The aim is to help you understand your options and ask good questions — not to tell you what will work for you. That part is a conversation for you and a qualified clinician who can examine you in person.

What this pain usually is

The bony bump you can feel on the side of your hip is the greater trochanter, the top of your thigh bone. Several tendons from your buttock muscles (the gluteus medius and gluteus minimus) attach there, and small fluid-filled cushions called bursae sit nearby to reduce friction. When this whole area becomes painful, clinicians increasingly use the umbrella term greater trochanteric pain syndrome, or GTPS, rather than "trochanteric bursitis."

That change in wording matters, and it is worth understanding. For a long time the pain was blamed mainly on an inflamed bursa — hence "bursitis," where "-itis" means inflammation. But when researchers looked closely with imaging, the bursa often was not the main problem. In one review of ultrasound findings from 877 people with this kind of hip pain, gluteal tendinopathy (a problem with the tendons) was the most common finding at about half of cases, while isolated bursitis with no tendon involvement showed up in only around 8 percent [1]. In other words, most lateral hip pain is now understood to be driven by the gluteal tendons — irritated and struggling to cope with the load being put through them — rather than a bursa on its own [1].

Why does this matter to you? Because it changes what tends to help. A problem centred on tendons that are overloaded usually responds better to gradually rebuilding the tendons' capacity to handle load than to treatments aimed only at calming inflammation. The word tendinopathy simply means "a problem with the tendon" without claiming to know the exact cause — and it points care in a more useful direction than the older "bursitis" picture. Contemporary reviews describe GTPS as primarily a load-related tendon condition and treat the pure-inflammation model as dated [2].

GTPS is common, and it is most often seen in women in their 40s to 60s, though anyone can develop it [1]. It frequently comes on gradually, without a single injury, which is one reason it can be confusing to make sense of.

What tends to make it worse

One of the most useful things to understand about GTPS is that certain positions compress the sore tendons against the bone, and these are often the very positions that flare the pain. Recognising them helps explain your symptoms and points toward gentler habits:

• Lying on the painful side squeezes the tendons directly, which is why night pain and disturbed sleep are such classic features.
• Crossing your legs, or standing with your weight slumped onto one hip ("hanging" on the hip) pulls the thigh across the midline and compresses the area.
• Sitting with knees together and feet apart, or in very low, soft chairs can do the same.
• Deep stretching of the outer hip — a natural instinct when something aches — can actually provoke these tendons rather than soothe them, because the stretch adds compression [3].

None of this means the hip is fragile. It means the tendons are sensitive to being squeezed, and easing that compression is often part of settling things down.

When to get checked sooner rather than later

Most GTPS builds up gradually and is not an emergency. But arrange a prompt assessment, rather than self-managing, if you have:

• Pain that began suddenly and severely, or right after a fall or specific injury.
• A hip that looks deformed, or a leg that seems shorter or turned out — especially after a fall.
• Fever, marked redness, warmth, or the area feeling hot, which can suggest infection.
• Night pain that is severe and unrelenting, unexplained weight loss, or a history of cancer.
• Numbness, pins and needles, weakness, or the leg giving way.
• Pain that is deep in the groin rather than on the outer hip, which can point toward the hip joint itself (such as hip osteoarthritis) rather than GTPS.

If any of these apply, let a clinician guide you rather than relying on a general guide.

How different disciplines approach it

Several kinds of practitioner see lateral hip pain, and their methods overlap. Below is a plain description of how each tends to approach it, along with what the research does and does not show. Notice the honest hedges — the evidence here is real but often modest, and no single approach is proven "best" for everyone. Which path suits you depends on your examination, your goals, and your preferences, worked out with a professional.

Physiotherapy

Physiotherapists (physical therapists) usually build their plan around two things: education about load and progressive strengthening exercise. The education part means learning which positions compress the tendons (the ones listed above) and adjusting daily habits to give them a break. The exercise part means carefully graded strengthening for the gluteal muscles, starting gentle and building up over time so the tendons gradually rebuild their tolerance for load.

This combination is the most consistently recommended first-line approach, and it is backed by one of the better trials in this area. The LEAP trial, published in the BMJ in 2018, randomly assigned 204 people with gluteal tendinopathy to one of three approaches: education plus exercise, a single corticosteroid (cortisone) injection, or a "wait and see" approach. At 8 weeks, 77 percent of the education-plus-exercise group reported feeling much better or very much better, compared with 58 percent of the injection group and 29 percent of the wait-and-see group. At one year, the education-plus-exercise group was still ahead — 78 percent reported meaningful improvement, versus 57 percent for the injection and 52 percent for wait-and-see [4]. In plain terms: an active, education-and-exercise plan outperformed both a cortisone shot and simply waiting, and the advantage held up over the longer run [4].

It is worth being clear-eyed about the strength of the wider evidence, though. A 2025 systematic review that pooled the available studies rated exercise and education as having moderate-strength evidence of a medium effect on pain and function in the short term, with the effects becoming smaller over the medium and longer term [2]. A separate 2024 systematic review with meta-analysis similarly found that exercise-based programmes helped function and symptoms more than minimal intervention, while noting real limitations in how many high-quality trials exist [5]. The honest takeaway: education plus exercise is the best-supported starting point and helps many people, but it is not a guarantee, the effects are meaningful rather than dramatic, and consistency over months tends to matter more than any single exercise recipe.

One practical note from the research: some traditional advice may not help. Aggressive stretching of the outer hip, in particular, is more likely to provoke these tendons than to calm them, because it adds compression at the very spot that is already irritated [3]. A physiotherapist can steer you toward strengthening that loads the tendons without squashing them.

Massage therapy and manual therapy

Massage therapists, and physiotherapists or other clinicians using hands-on ("manual") techniques, may work on the muscles around the hip and buttock — with soft-tissue massage or gentle mobilisation. People often find these approaches comfortable, and easing muscle tension or feeling less guarded can be a welcome part of getting back to normal activity.

It is fair to be transparent that the direct research evidence for hands-on therapy as a stand-alone treatment for GTPS is limited, and the studies that exist generally position manual techniques as an addition to the core work of education and loading rather than a replacement for it [2]. So the most reasonable way to think about massage and manual therapy is as a supportive adjunct — something that may help you feel better and stay active while the tendons do the slower work of adapting to load. It is also worth mentioning that deep, direct pressure or firm stretching over the sore outer hip can sometimes aggravate irritated tendons, so it is reasonable to tell your therapist where it hurts and how it responds. A good therapist should be able to explain how a hands-on session fits alongside, not instead of, a strengthening plan.

The injection question

Many people are offered — or ask about — a corticosteroid (cortisone) injection into the sore area, and it is a genuinely reasonable thing to discuss. The evidence gives a nuanced answer worth understanding.

Cortisone injections can provide real relief in the short term. The 2025 systematic review found moderate-strength evidence of a small pain-reducing effect from corticosteroid injection in the short term — but noted that this effect fades over the longer term [2]. That fits what the LEAP trial found: the injection group did better than waiting at first, but by one year they had fallen well behind the education-and-exercise group, and were only marginally ahead of doing nothing [4].

So the practical picture many clinicians describe is this: a cortisone injection may take the edge off a bad flare and buy some comfort, but it does not appear to fix the underlying tendon problem, and the benefit tends not to last. Some people use an injection specifically to reduce pain enough to get started on an exercise programme, rather than as a treatment on its own. Other options such as shockwave therapy or platelet-rich plasma (PRP) injections are sometimes raised for stubborn cases; the same 2025 review found the evidence for these to be limited and called for better trials before firm recommendations can be made [2]. If any injection is offered to you, it is worth asking directly about how long the benefit is likely to last and how it fits with the rest of your plan.

Self-management and a realistic timeline

Alongside professional care, several everyday habits are commonly encouraged. None of these is a promise, but they reflect the general direction of load-based rehabilitation and the advice found in patient information from health services:

• Ease the compression. Try not to sleep on the painful side; lying on your back, or on the good side with a pillow between your knees to keep the top leg from dropping across your body, can reduce night pain [6].
• Watch your standing and sitting habits. Avoid "hanging" your weight onto one hip when you stand, crossing your legs, and very low chairs [6].
• Manage the load rather than fully stopping. Complete rest is usually not the goal. The idea is to dial back the activities that clearly flare it up while keeping moving in ways the hip tolerates. A common rule of thumb is that some discomfort during activity can be acceptable if it settles fairly quickly and does not build day to day; pain that climbs high or lingers well beyond 24 hours is a signal to ease back [6].
• Pace yourself. Breaking bigger tasks and longer walks into chunks, with breaks, helps you stay active without repeated flares [6].
• Be patient with the strengthening. Tendons adapt slowly. Exercises usually need to be done regularly for months to build capacity; doing them for a week or two then stopping rarely gives the tendon what it needs.

On timing: this is not a quick fix, and setting realistic expectations helps. Patient information from health services notes that GTPS often takes on the order of 6 to 9 months, and sometimes longer, to settle with the right approach [6]. Progress is usually uneven — good weeks and setback weeks — which is normal and not a sign you are failing. What tends to matter is staying consistent and adjusting the load rather than abandoning the plan at the first flare.

When to seek an assessment

Self-management suits many milder cases. But it is worth getting a professional assessment if:

• Your pain has lasted more than about six weeks without improving, or it keeps coming back.
• The pain is disturbing your sleep, or limiting your walking, work, or daily activities.
• You are unsure whether you are doing the right exercises, or at the right level.
• The pain is felt deep in the groin rather than on the outer hip, or you have any of the warning signs listed earlier.

An in-person examination lets a clinician confirm whether it really is GTPS (versus hip joint problems like osteoarthritis, low-back-related pain, or something else), gauge how irritable the tendons are, and tailor a loading plan to you. That tailoring is exactly the part a general article cannot do.

The bottom line

Lateral hip pain that has long been called "bursitis" is, for most people, better understood as greater trochanteric pain syndrome — a load-related problem with the gluteal tendons rather than a simple inflamed sac. The best-supported first step is an active plan of education about load and progressive strengthening, which in the strongest available trial outperformed both a cortisone injection and waiting, and held that lead at a year. Cortisone can help in the short term but tends not to last, and hands-on therapies are best seen as supportive add-ons rather than proven cures. Where the research is modest or uncertain, we have tried to say so.

This guide is general education, not medical advice, and it cannot account for your specific situation. Please use it to understand your condition and to ask better questions — then let a qualified healthcare professional examine you, confirm what is going on, and guide your care.

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