Hip Bursitis: Why Your Outer Hip Hurts and How to Fix It
The Outer Hip Pain Problem
Pain on the outside of the hip is extremely common—especially in women over 40, runners, and people who suddenly increase their activity. You lie on that side and it aches. Climb stairs and it flares. Sometimes it radiates down the outer thigh.
For decades, this was called "hip bursitis" or "trochanteric bursitis." Doctors assumed the bursa (a fluid-filled sac) over the bony prominence of the hip was inflamed.
But here's the thing: research now shows that most "hip bursitis" isn't actually bursitis at all.
Greater Trochanteric Pain Syndrome (GTPS)
The modern understanding is that outer hip pain is usually a tendon problem—specifically, the gluteal tendons that attach near the greater trochanter (that bony bump on the outside of your hip).
This condition is now called Greater Trochanteric Pain Syndrome (GTPS), which encompasses:
Why does this matter? Because treating bursitis is very different from treating tendinopathy. If you're doing the wrong thing, you won't get better.
What Causes GTPS?
Compressive Loading
The gluteal tendons wrap around the greater trochanter. Certain positions compress these tendons against the bone:
Lying on your side - Direct compression of tendons against the bone
Standing with hip hitched - Shifting weight to one side compresses that hip
Crossing legs - Compresses the outer hip structures
Sitting with knees together - Creates sustained compression
Tensile Overload
The gluteal muscles and tendons can also be overloaded by:
Risk Factors
Symptoms
Classic GTPS presentation:
The Compression Problem
Here's the counterintuitive part: many common "treatments" actually make GTPS worse.
Stretching the IT band - Increases compression of gluteal tendons
Foam rolling the outer hip - Direct compression on irritated tendons
Pigeon pose - Compresses the tendons against the bone
Lying on the affected side - Sustained compression
If you've been stretching and foam rolling your outer hip without improvement (or with worsening symptoms), this is likely why.
Evidence-Based Treatment
Step 1: Reduce Compression
Sleep positioning
Don't lie on the affected side. If you're a side sleeper, lie on the opposite side with a pillow between your knees. Or sleep on your back with a pillow under your knees.
Sitting posture
Avoid crossing legs. Sit with knees slightly apart. Use a cushion if chairs are hard.
Standing posture
Don't hang on one hip. Keep weight even. Avoid prolonged standing when possible.
Stop stretching into compression
No IT band stretches, no pigeon pose, no foam rolling the outer hip. These feel like they should help but typically don't.
Step 2: Progressive Loading
This is the most important part. Gluteal tendinopathy responds to gradual, progressive loading—not rest, not stretching.
Isometric exercises (start here)
Isometrics involve muscle contraction without movement. For GTPS:
Isometrics often provide pain relief while building tendon tolerance.
Isotonic exercises (progress to)
Once isometrics are comfortable:
Functional exercises (final progression)
Step 3: Address Contributing Factors
Core and hip stability
Weakness in the core and hip stabilizers often contributes to gluteal tendon overload. A comprehensive program addresses the whole chain.
Load management
If you increased activity recently, you may need to temporarily reduce volume while building tendon capacity.
Weight management
Higher body weight increases load on hip structures. Even modest weight loss can help if applicable.
Timeline Expectations
Gluteal tendinopathy typically takes 3-6 months of consistent work to resolve. Some key points:
What About Injections?
Corticosteroid injections are commonly offered for "hip bursitis." The evidence is mixed:
Short-term: Injections can reduce pain for weeks to a few months
Long-term: Studies show exercise is superior to injections for lasting results
Risk: Repeated injections may weaken tendons
Injections might be appropriate for severe pain that prevents you from exercising, but they're not a standalone solution.
When Is It Something Else?
Outer hip pain isn't always GTPS. Consider other causes if:
Pain radiates past the knee - Could be referred from spine
Groin pain is prominent - Could be hip joint problem (arthritis, labral tear)
Catching or locking - Suggests mechanical hip problem
No tenderness over greater trochanter - Source may be elsewhere
Doesn't respond to GTPS treatment - Time to investigate further
An accurate diagnosis matters. Hip joint problems require different treatment than tendinopathy.
Key Exercises
Isometric Hip Abduction (Side-lying)
Lie on your back or unaffected side with pillow between knees. Press top knee into pillow without moving. Hold 30-45 seconds. This builds tendon tolerance without compression.
Standing Wall Press
Stand sideways near a wall, affected side toward wall. Press outside of knee into wall. Hold 30-45 seconds. Great for pain relief.
Side-lying Hip Abduction
Lie on unaffected side. Lift top leg toward ceiling, keeping it slightly behind you (not forward). Control the descent. Start with 10-15 reps, progress as tolerated.
Clam Shells (Modified)
Lie on unaffected side with knees bent. Lift top knee while keeping feet together. Avoid rotating pelvis. This targets gluteus medius with less compression than traditional positioning.
Single-Leg Stance
Stand on affected leg for 30-60 seconds. Keep pelvis level (don't drop opposite hip). This builds functional hip stability.
The Bottom Line
Outer hip pain labeled as "bursitis" is usually gluteal tendinopathy. The treatment that works is:
1. Reduce compression (stop stretching/rolling, fix sleep position)
2. Progressive loading (isometrics → isotonics → functional)
3. Patience (3-6 months for full recovery)
Stop doing the things that feel like they should help but don't. Start doing the exercises that actually build tendon capacity. Give it time.
Foundational Rehab's hip programs include specific protocols for gluteal tendinopathy. Our AI-guided approach progresses you safely from pain relief to full function.