Hip Bursitis: Outer Hip Pain Explained

You roll onto your side at 2 a.m., and the outside of your hip wakes you up. By morning it's a dull ache, and the first few stairs make it sharper. If that sounds familiar, you're far from alone. Here's what's going on, and what tends to help.

What is hip bursitis?

Hip bursitis is irritation of a bursa, a small fluid-filled sac that cushions bone from the soft tissue around it. According to OrthoInfo¹, the most common type affects the bursa over the bony point of the hip. That bony point is called the greater trochanter, so doctors call this trochanteric bursitis.

A second bursa sits on the groin side of the hip. When that one is irritated, the pain is felt in the groin instead¹. This post focuses on the outer hip. For a wider look at what causes hip pain, see our guide to hip pain.

According to Cleveland Clinic², the pain is usually felt on the outside of the hip. It can also reach the side of the upper thigh or the buttock.

Is it really bursitis, or a tendon problem?

Often, the tendons are the bigger part of the story. Your gluteal tendons attach your buttock muscles to the bony point of your hip. When they're overloaded, they get sore, and the bursa beside them can join in. Clinicians call this gluteal tendinopathy.

One NHS clinical guide notes that outer hip pain was long called bursitis. Recent evidence points mainly to the gluteal tendons instead⁴. The same guide says a bursa problem on its own is uncommon. When it happens, it's usually linked to a tendon problem⁴.

You may also hear the umbrella term greater trochanteric pain syndrome. It covers bursitis, tendon pain, or both. A 2018 trial in the BMJ described gluteal tendinopathy as affecting one in four women over 50⁵.

Why does the name matter? Tendons respond to the right kind of load, not to total rest. That shapes what helps, as you'll see below.

What does hip bursitis feel like?

The main sign is pain at the bony point of the hip that often spreads down the outer thigh. According to OrthoInfo¹, it may start sharp and intense, then settle into a wider ache. Many people notice it most at night.

These everyday moments tend to bring it on:

Pain that's worst in bed has its own tricks. See our tips for hip pain when sleeping. If the ache flares after a long meeting or drive, read about hip pain after sitting.

What causes outer hip pain?

Most outer hip pain builds slowly from repeated load, not one injury. The NHS guide notes it often starts after an increase in activity⁴. A new walking goal, more stairs at work, or a longer run can all tip the balance.

According to OrthoInfo¹, these factors are linked to hip bursitis:

• Repeated activity, such as running, stair climbing, cycling, or standing for long periods
• A fall, a bump, or lying on one side for a long time
• Spine problems, such as scoliosis or arthritis in the lower back
• A tight IT band, the long band of tissue on the outer thigh
• Legs of different lengths
• Rheumatoid arthritis or past hip surgery

It's more common in women and in middle-aged and older adults¹. Extra body weight also raises the risk of hip bursitis³. Cleveland Clinic adds diabetes and thyroid disease to the list of risk factors².

Pain lower down, on the outside of the knee, usually points elsewhere. See IT band pain for that pattern.

How can you tell it from other hip pain?

Where it hurts is your best first clue. Outer hip pain that's tender when you press the bony point fits bursitis or tendon pain. Doctors check for that tenderness during the exam¹.

Other patterns usually point somewhere else:

• Groin pain often comes from the hip joint itself or the bursa on the groin side¹.
• Buttock pain near the dimples of your lower back may come from the SI joint.
• Pain with back stiffness may start in your lower back. Learn how to tell hip pain or back pain apart.
• Pain, numbness, or tingling below the knee suggests an irritated nerve rather than the outer hip.

You can have more than one of these at once. That's one reason an exam looks at your hips, lower back, and the way you walk.

When should you get outer hip pain checked?

Most outer hip pain builds slowly and isn't an emergency. A hip that's hot, red, and swollen with a fever is different. Infection is one of the causes of bursitis, and it needs medical care first³.

If a fall leaves you unable to put weight on your leg, go to the emergency room or dial 911. It can be a sign of a broken hip.

Also see a provider if the pain gets in the way of daily life. The same goes if it gets worse, or doesn't improve within a week or two of rest and home care².

What helps hip bursitis?

Exercise, smarter daily positions, and patience help most people. Total rest usually isn't the answer, because tendons need the right kind of load to recover.

Ease the strain at first

The NHS guide suggests cutting back on activity that loads the tendon, at least at first⁴. It also recommends a few position changes⁴:

• Don't cross your legs, and avoid low chairs that fold your hips up high.
• Stand with weight on both feet instead of hanging on one hip.
• Sleep on your back, or on your side with a pillow between your knees.

Build strength over time

The best evidence supports education plus a guided exercise program. In the 2018 BMJ trial, 204 people with painful gluteal tendons were split into three groups⁵. One group got education plus exercise over eight weeks. Another got a steroid shot. The third waited and watched.

At eight weeks, 77% of the exercise group reported success, compared with 58% after the shot and 29% with waiting⁵. At one year, the exercise group still did best on overall improvement⁵.

Improvement takes time. Cleveland Clinic says recovery usually takes a few weeks to a few months². The NHS guide says it generally takes three to four months of exercise to see real change⁴.

Go easy on stretching

Stretching the outer hip feels like it should help. The NHS guide cautions that stretching the buttock muscles and IT band may not help⁴.

Medical options

Your medical doctor may offer a steroid shot. Relief may last a few months, but frequent shots can damage nearby tissue¹. Surgery to remove the bursa is rarely needed¹. Cleveland Clinic says it's considered only when symptoms last more than six months despite other care².

Can a chiropractor help with hip bursitis?

A chiropractor can examine your hip, look for what's adding strain, and guide the exercise that research supports. There aren't trials of chiropractic care for hip bursitis itself. The strongest evidence is for education plus exercise⁵, so that stays at the center of care.

Your doctor starts by listening: when the pain began and what sets it off. Then your doctor checks your hips, lower back, and the way you walk. X-rays are taken only when your exam calls for them.

Care may include hip strengthening, gentle muscle work, and gentle joint movement for the hip and lower back. Adjustments are an option only if you want them. Your doctor explains what they found, and you choose your care. Some plans add physical therapy at our Menomonee Falls, Waukesha, and West Allis North clinics.

Find out what's behind your outer hip pain

You've moved your pillow, switched sides, and started taking the stairs one at a time. The ache keeps coming back anyway. You're not sure if it's the bursa, the tendon, or your back, and guessing is getting old.

We're here to help you find out. Chiropractic Company has cared for Greater Milwaukee since 1982, with 400,000+ patients, 1,400+ five-star Google reviews, and 20+ neighborhood clinics. Our doctors care for hip pain every week. We look for the cause of your pain, not just the symptoms. Your care is designed around your hip, your medical history, your daily routine, and your goals. You choose your care, and you see the same doctor as it continues.

Care is natural and drug-free. Treatment begins at your second visit, or the same day in acute cases if your doctor decides it's appropriate. Some plans add physical therapy at our Menomonee Falls, Waukesha, and West Allis North clinics, or massage therapy at Hales Corners and Oconomowoc.

We're in-network with most insurance companies and accept Medicare and auto accident claims. Eligible new patients can start with the $29 new-patient special, which includes a consultation, an exam, and X-rays if needed. *See offer terms.

Visit one of our 20+ neighborhood clinics across Greater Milwaukee: Milwaukee East, Milwaukee North, Milwaukee Third Ward, Shorewood, Glendale, Mequon, Cedarburg, Grafton, Germantown, Brookfield, Menomonee Falls, Waukesha, Oconomowoc, New Berlin, West Allis, West Allis North, Greenfield, Hales Corners, Franklin, Muskego, and Cudahy.

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