Mr Oni explaining hip bursitis to an older looking female patient at his desk.

conditions

Hip Bursitis

Pain on the outside of the hip, often worse on stairs or when lying on that side at night. Hip bursitis is common and treatable under correct guidance, intervention and physiotherapy, and rarely needs surgery.

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What is hip bursitis?

Trochanteric bursitis and greater trochanteric pain syndrome: pain on the outside of the hip

Hip bursitis is a common cause of pain on the outside of the hip. A bursa is a small fluid-filled sac that cushions the tendons as they pass over the bony point on the outer hip, known as the greater trochanter, and bursitis means this area has become irritated and painful.

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In practice, specialists now understand that most cases are not simply an inflamed bursa. More often the nearby gluteal tendons are irritated or worn, usually with some inflammation alongside, which is why the condition is now more accurately called greater trochanteric pain syndrome, or GTPS.

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It usually comes on gradually rather than from a single injury, and it is far more common in women than men, particularly between the ages of 40 and 60. It is often linked to weakness or imbalance in the muscles around the hip, a change in walking pattern, or extra load on the tendons, and it can also follow a hip replacement or problems in the lower back and pelvis.

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The reassuring part is that hip bursitis is treatable with the correct guidance, intervention and physiotherapy. The vast majority of patients improve with the right rehabilitation and, where needed, a targeted injection, and surgery is only very rarely required.

knee with sports tape across the kneecap

Recognising the condition

Common symptoms of hip bursitis

Hip bursitis pain is felt on the outside of the hip, over the bony point, and it is often tender to touch. It tends to be worse going up stairs, standing for a while, getting up from a chair, and classically when lying on that side in bed, which is why it so often disturbs sleep. The pain can spread down the outside of the thigh, and it is one of the most common causes of hip pain in women. These are the signs and symptoms patients most commonly notice.

Pain on the outside of the hip

A sharp or aching pain over the bony point on the outer hip, often tender to touch and worse with activity.

Pain lying on that side

Discomfort when lying on the affected hip in bed, which commonly disturbs sleep and makes it hard to get comfortable.

Pain on stairs and standing

Aching that builds when climbing stairs, walking, or standing for long periods.

Pain getting up from sitting

A flare of pain when rising from a chair or getting out of the car, especially after sitting still for a while.

Pain down the outer thigh

A sharp or burning pain that spreads from the hip down the outside of the thigh, sometimes towards the knee.

Tenderness to touch

The outer hip feels sore when pressed or leaned on, even against a firm chair or mattress.

A limp or altered walk

Favouring the leg or walking differently as the hip becomes more painful to load.

Reduced confidence in movement

Hesitation with walking, exercise or everyday activities as the pain becomes more persistent.

Pain on the outside of the hip can have several causes, and it is not always bursitis. It can be confused with hip arthritis, pain referred from the lower back or a trapped nerve, or a tear in the gluteal tendons. The right treatment is different for each, so an accurate diagnosis matters, and Mr Oni will identify the cause at your first appointment.

Hip bursitis rarely comes from a single injury. More often the tendons and the bursa over the outer hip are put under repeated strain, and over time they become irritated and inflamed. Because the gluteal tendons are usually involved, it tends to build up gradually rather than appear overnight.

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It is far more common in women, partly because the wider female pelvis changes the angle at which the tendons pull across the hip, placing more load on them. Weakness or imbalance in the hip and buttock muscles, a change in walking pattern, carrying extra weight, or a tight band of tissue down the outside of the thigh, known as the IT band, all add to the strain.

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Sometimes there is a clear trigger, such as a fall onto the side of the hip, a sudden increase in walking or running, or a recent hip replacement that has changed how the hip is loaded. In many patients it is a combination of these factors rather than one single cause.

Overuse and repetitive strain

Often the trigger in active people. Running, cycling, long walks or a sudden increase in activity can overload the tendons over the outer hip.

Muscle weakness and biomechanics

The most common underlying factor. Weakness or imbalance in the hip and buttock muscles, a leg-length difference, or an altered walking pattern strains the tendons, part of why it is so common in women.

After injury or surgery

Less common. It can follow a fall onto the hip, or develop after a hip replacement or lower back and pelvis problems change how the hip is loaded.

causes and types

What causes hip bursitis?

Mr Oni with his back to the camera showing a female patient a model of a hip joint while she is smiling and looking back at him.

how mr oni Helps

diagnosis & Next Steps

Getting the diagnosis right comes first. Hip bursitis can usually be identified from your symptoms and a careful examination, Mr Oni checks for tenderness over the outer hip, assesses the tendons, your movement and your walking pattern, and rules out other causes such as arthritis or a problem in the lower back. Where it helps, an ultrasound or MRI scan can confirm the state of the tendons, rather than the X-ray used for arthritis. That way your treatment is built on a clear picture, not assumptions.

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consultation

A thorough consultation reviewing your symptoms, movement, and any existing imaging. No assumptions, no rushed conclusions.

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clinical examination

A hands-on assessment of the joint - checking movement, strength and what triggers your pain - to understand exactly what's going on.

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imaging

Where needed, an X-ray or scan to confirm the diagnosis and see the joint clearly, so nothing is left to guesswork.

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treatment plan

Every option considered. From load management and physiotherapy to further investigations and surgical options. A plan built around your lifestyle and goals, not a one-size-fits-all protocol.

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with the right treatment

life after treatment

Sleeping on that side again

With the outer-hip pain settled, most patients can lie on the affected side again and finally sleep properly again.

Walking and stairs without pain

Stairs, longer walks and standing for a while become comfortable again as the strain on the tendons eases.

Back to the activities you enjoy

Walking, golf, cycling and exercise become possible again, without the outer-hip pain holding you back.

Less reliance on pain relief

As the hip settles, most patients lean far less on painkillers and anti-inflammatories

Recognising the condition

How hip bursitis is treated

Most cases of hip bursitis settle with non-surgical treatment, and surgery is rarely needed. Mr Oni's approach starts with an accurate diagnosis, then focuses on the measures that give the best chance of lasting relief: activity modification, targeted physiotherapy to strengthen the gluteal muscles, and anti-inflammatory measures to calm the inflammation. Where a guided injection is appropriate, Mr Oni works alongside trusted specialist colleagues to arrange it as part of a coordinated plan of care. In the small number of cases that do not respond, surgery to remove the inflamed bursa or address the surrounding tendons may be considered.

Patient Stories

Hear from patients who have undergone investigations and treatments for their hip and knee problems with Mr Oni.

★ ★ ★ ★ ★

Mr Richard M.

Mr Oni explained everything clearly and the whole process was faultless. I was walking the corridors within two days and driving again in a fortnight. The scar is so neat you can hardly see it.

Treatment

Hip Replacement

★ ★ ★ ★ ★

Mr Robert F.

Mr Oni and the team were very professional throughout. The recovery was tough, but I stuck to the exercises and only needed over-the-counter painkillers. Two months on, I completed a nine-mile bike ride.

Treatment

Robotic Knee Replacement

★ ★ ★ ★ ★

Ms Liz.

Mr Oni and Libby are a really good team and made me feel completely comfortable. I'd been limping for a year, but almost marched into my follow-up. I've got my life back.

Treatment

Arthrosamid Injection

★ ★ ★ ★ ★

Mr Tony G.

Mr Oni gave me real confidence going into surgery, and I cannot fault my experience. I'm back to walking the dogs, gardening and farm work. The steep hills that once bothered me, now I don't even notice.

Treatment

Robotic Knee Replacement

★ ★ ★ ★ ★

Ms Zoe G.

Mr Oni and the team were incredibly supportive, kind and patient. I was walking with a frame the same day and dressing myself the next morning. Within two weeks I could pick my daughter up from school.

Treatment

Hip Replacement

★ ★ ★ ★ ★

Mr Ian F.

Mr Oni recommended the Arthrosamid injection and everything has been brilliant. Two weeks later I was rotovating the garden for two hours. It felt like some sort of miracle, I didn't notice I'd had bad knees.

Treatment

Arthrosamid Injection

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Take the next step

Book a consultation about your outer hip pain

Outer hip pain is often misdiagnosed, so getting it right matters. Mr Oni will examine the hip, pinpoint exactly what is causing your pain, and talk you through a clear plan, usually physiotherapy and, if needed, an injection, with surgery rarely part of the picture. No pressure, no assumptions.

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locations

Mr Oni consults and operates at several leading private hospitals across the region, so you can choose the location most convenient for you.

Exterior Image of The Horder Centre Crowborough East Sussex

The Horder Centre

St John's Road
Crowborough
East Sussex
TN6 1XP

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Exterior Image of the Nuffield Health Private Hospital in Tunbridge Wells

Nuffield Health

Kingswood Road
Tunbridge Wells
Kent
TN2 4UL

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Exterior Image of the Vale Health Clinic in Tunbridge Wells, Kent

Vale Health Clinic

31-33 Vale Road
Tunbridge Wells
Kent
TN1 1BS

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Frequently asked questions

There is no overnight fix, but most cases settle steadily over a few weeks to a few months. The fastest progress usually comes from easing the activities that overload the hip, starting targeted physiotherapy to build strength, and using ice and anti-inflammatories to calm a flare. If the pain is severe or slow to settle, Mr Oni can add an injection to speed things along.

Exercises that strengthen the buttock and hip muscles take load off the irritated tendons and are one of the most effective treatments, ideally guided by a physiotherapist so they are tailored to you. It is best to avoid the things that compress the outer hip, such as sitting with your legs crossed, sleeping on the painful side, and aggressive stretches of the band down the outside of the thigh.

Mr Oni can usually diagnose it from your symptoms and an examination, the outer hip is typically tender over the bony point, and he will check your movement, walking pattern and the surrounding tendons. Where it helps, an ultrasound or MRI scan can confirm the state of the tendons and rule out other causes such as arthritis.

They can. A targeted injection, often given under ultrasound guidance for accuracy, reduces inflammation and can settle the pain enough to get the most out of physiotherapy. It works best alongside a strengthening programme rather than on its own, and Mr Oni will advise whether an injection is right for your case.

It varies. Many people improve within a few weeks of starting the right treatment, though tendon problems can take a few months to fully settle, especially if they have been there a while. Sticking with a strengthening programme is the single biggest factor in a lasting recovery.

Very rarely. The great majority of patients get better with physiotherapy, activity changes and, where needed, an injection or shockwave therapy. Surgery is only considered when months of these measures have not worked, and Mr Oni would always exhaust the non-surgical options first.

Answers written by Mr Tofunmi Oni, Consultant Orthopaedic Surgeon (MBChB BSc PGDip FRCS (Tr & Orth), GMC 7074916). Figures come from the NHS, NICE and the trials listed in the sources at the end. Last reviewed October 2026.

What are the symptoms of hip bursitis, and what triggers it?

Hip bursitis, now usually called greater trochanteric pain syndrome because the gluteal tendons rather than the bursa are the main problem, causes pain over the bony point on the outside of the hip and down the outer thigh, with tenderness when you press on it. It is typically worse lying on that side at night, going upstairs or uphill, crossing your legs, standing on one leg and getting up from a chair. There is often no single trigger; a change in activity, weight gain, prolonged standing and weak hip muscles all contribute. It is commoner in women and often sits alongside low back pain or knee arthritis.

What gets mistaken for hip bursitis?

Hip arthritis is the main one, and the two often coexist. Arthritis pain is deep in the groin, limits rotation and makes shoes and socks difficult; bursitis pain is on the outside, tender to touch and worst lying on it. Pain referred from the lower back can mimic either. A study comparing the two found difficulty with shoes and socks points to arthritis, while tenderness over the outer hip with outer hip pain on the figure of four test points to bursitis.

How long does hip bursitis last, and is it painful all the time?

NHS leaflets say symptoms usually improve within three to six months and the condition is usually self limiting, but a primary care study found at least 36% of people still had pain at one year and 29% at five years, so for a substantial minority it is a long term problem. The pain is position related rather than constant: worst lying on the side, on stairs and on the first steps after rest.

What is the fastest way to settle hip bursitis?

The best evidence is for education plus a progressive strengthening programme. In the LEAP trial, 77% of people reported improvement at eight weeks with education and exercise, compared with 58% with a steroid injection and 29% with wait and see, and the exercise group was still ahead at one year. A steroid injection gives the quickest short term relief, with about 75% improved at one month in one study but under half at 15 months. Ice for 10 to 20 minutes several times a day and a simple painkiller or anti inflammatory can help in the early weeks.

What makes hip bursitis worse, and what should I not do?

Lying on the painful side, sitting with crossed legs, low chairs, standing with your weight hung on one hip, and repetitive hip movements such as long uphill walks or stairs. Stretching the outer hip hard, which many people do instinctively, compresses the tendons against the bone and usually makes things worse.

Is walking good for hip bursitis?

Keep active in moderation and break up long periods of sitting or standing. Walking on the flat is fine, but the condition worsens with sudden increases in load, so build up gradually rather than stopping altogether or pushing through a flare.

What is the best sleeping position for hip bursitis?

Sleep on your back, or on the non painful side with a pillow between your knees so the top hip and knee are level. Lying on the painful side compresses the tendons and bursa and is the commonest reason people wake at night.

Do injections help hip bursitis?

In the short term, yes. A randomised trial found 55% recovered at three months with a steroid injection compared with 34% with usual care, but by twelve months the difference had gone. Another trial found injection did worse than home exercises or shockwave at 15 months. So an injection is a reasonable way to break a painful cycle so you can do the strengthening, not a cure on its own. Some NHS areas do not recommend injections for this condition at all, which reflects that short term only benefit.

Does shockwave therapy work for hip bursitis?

NICE says the evidence for extracorporeal shockwave therapy in persistent greater trochanteric pain is limited and that it should only be used with special arrangements for consent and audit. One trial found 68% success at four months and 74% at 15 months, better than injection in the longer term. It is an option for stubborn cases that have not responded to a proper exercise programme.

Does hip bursitis ever need surgery?

Rarely. NHS guidance is that in most cases it does not require surgery. Surgery, usually to repair a torn gluteal tendon or release the band of tissue that rubs over the bone, is reserved for people whose symptoms persist despite a full course of exercise and injection and whose scans show a tendon tear. If you have hip bursitis after a hip replacement, surgery for it has a poor track record and is approached with particular caution.

Sources

Mellor R et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy (LEAP trial). BMJ 2018;361:k1662. https://doi.org/10.1136/bmj.k1662

Brinks A et al. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med 2011;9:226-34.

Rompe JD et al. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med 2009;37:1981-90.

Lievense A et al. Prognosis of trochanteric pain in primary care. Br J Gen Pract 2005;55:199-204.

Fearon AM et al. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med 2013;47:649-53.

Segal NA et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 2007;88:988-92.

NICE IPG376, Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome (2011). https://www.nice.org.uk/guidance/ipg376

NHS.uk, Hip pain in adults (reviewed November 2025). https://www.nhs.uk/conditions/hip-pain-adults/

Kingston and Richmond NHS Foundation Trust and Royal Berkshire NHS Foundation Trust, Greater trochanteric pain syndrome patient leaflets (2024).

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