Do you feel a sharp or aching pain on the outside of your hip when walking, lying on your side, climbing stairs, or after longer periods of activity? You may be experiencing Hip Bursitis, also known as Greater Trochanteric Pain Syndrome (GTPS) — a common condition that affects active adults, runners, and individuals with hip or pelvic weakness. While it can be frustrating and persistent, the good news is that with the right assessment and a structured rehab plan, hip bursitis typically responds very well to physiotherapy.
What Exactly Is Hip Bursitis?
Hip bursitis occurs when the bursa — a small fluid-filled sac on the outside of the hip — becomes irritated or inflamed. Traditionally, this was thought to be purely an inflammation issue, but newer research shows that GTPS is more often caused by overload of the gluteal tendons that attach near the bursa¹.
This tendon overload can lead to:
- Thickening or irritation of the bursa
- Pain when pressure is applied (e.g., lying on the side)
- Reduced ability of the hip muscles to stabilise the pelvis
- Pain during walking, running, or single-leg activities
Symptoms often build gradually and may worsen with increased training, long walks, hill climbs, or sitting cross-legged.
Why Does It Happen?
GTPS is very common — affecting up to 25% of women and 8% of men aged 40–60² — but it can occur in all active populations, especially runners. Key contributors include:
- Weakness of the gluteus medius and minimus, leading to increased compression on the bursa during movement³.
- Sudden increases in activity, including walking volume, running, hill work, or returning to training too quickly⁴.
- Tight or overloaded ITB, which increases friction/compression around the bursa.
- Biomechanical issues, such as pelvic drop, hip adduction, or uneven leg strength.
- Extended pressure, such as lying on one side at night.
A precise diagnosis is essential, as hip bursitis can mimic gluteal tendinopathy, lumbar issues, or referred pain – all of which require different rehabilitation strategies.
Evidence-Based Approach to Recovery
Current research strongly supports strengthening and load management as first-line treatment:
- A landmark 2018 RCT found that gluteal strengthening and education were more effective than corticosteroid injections at both 8 weeks and 52 weeks for GTPS⁵.
- A 2022 systematic review confirmed that exercise therapy significantly reduces pain and improves function, outperforming passive treatments alone¹.
- Movement retraining to reduce hip adduction (the leg dropping inward) is associated with improved tendon loading and long-term symptom reduction⁶.
The takeaway?
Strengthening, control, and smart load management form the backbone of effective long-term recovery.
How We Help at Physio on the Green
1. Functional & Biomechanical Assessment
Pain on the outside of the hip often reflects how the hip, pelvis, and even the foot and knee move together.
Using gait and functional movement analysis, we assess:
- Pelvic control during walking and standing
- Hip adduction and rotation patterns
- Single-leg mechanics
- Aggravating positions (e.g., stairs, lying on the side)
Identifying these patterns allows us to personalise your treatment so you can move more efficiently and comfortably.
2. Strength Testing & Force Decks Analysis
Force decks provide objective insights into:
- Hip and gluteal strength
- Landing and push-off asymmetries
- Pelvic control
- Single-leg stability
This data helps target your rehab precisely and track improvement over time.
3. Ultrasound Imaging
Ultrasound allows us to directly visualise:
- The gluteal tendons
- The trochanteric bursa
- Signs of inflammation, tendon thickening, or fluid
This helps confirm whether symptoms are bursitis, tendinopathy, or a combination – guiding a clearer and more effective treatment plan.
- If appropriate, we can also refer inhouse guided steroid injections
4. Extracorporeal Shockwave Therapy (ESWT)
For persistent or chronic hip bursitis or gluteal tendinopathy, Shockwave Therapy can be a useful adjunct to rehabilitation.
Evidence supports its use:
- Several clinical trials show Shockwave can significantly reduce pain and improve function in GTPS⁷.
- When combined with strengthening and movement retraining, improvements are often faster and longer lasting.
Shockwave works best with, not instead of, a structured rehab programme.
5. Tailored Rehabilitation
Based on your assessment outcomes, your rehab may include:
- Gluteal strengthening, especially gluteus medius and minimus (key for long-term resolution⁵)
- Load management strategies, including modifying aggravating positions
- Movement retraining, particularly reducing hip adduction during walking/running
- Pilates-based exercises for hip and pelvic control
- Manual therapy or soft-tissue release around the ITB and outer thigh
- Shockwave therapy for persistent tendon/bursal irritation
- Education on optimal sleeping and sitting postures to reduce compression
The goal is a personalised programme that supports short-term relief and long-term resilience.
Key Takeaway
Hip bursitis can be stubborn, but it is highly treatable with the right approach. A combination of targeted strengthening, movement retraining, and load management consistently yields excellent outcomes.
At Physio on the Green, we use ultrasound imaging, strength testing, force deck analysis, and tailored rehab programmes to help you reduce pain, restore function, and get back to the activities you love.
Written by Caitlin Irving | Pelvic health Physiotherapist | Physiotherapist
References
- Ganderton C., et al. Gluteal tendinopathy and GTPS: A review. Sports Med, 2022.
- Segal N., et al. Prevalence of GTPS in the general population. Arthritis Care Res, 2007.
- Bird P., et al. The role of gluteal tendons in GTPS. Clin Rheumatol, 2001.
- Fearon A., et al. Tendon load and hip pain mechanisms. Br J Sports Med, 2014.
- Mellor R., et al. Exercise + education vs corticosteroid injection in GTPS. BMJ, 2018.
- Allison K., et al. Movement retraining for hip abductor loading. J Orthop Sports Phys Ther, 2020.
- Rompe J., et al. Shockwave therapy efficacy in GTPS. Am J Sports Med, 2009.