What Causes Hip Bursitis and How Physio Can Help

Pain on the outside of your hip that makes it hard to lie on that side, climb stairs or get out of the car is often put down to hip bursitis. It is a common problem, particularly for women over 40, and it can affect sleep and everyday activity. This article explains what hip bursitis is, what tends to cause it, the symptoms to look out for, and how physiotherapy can help you manage it.

TLDR

Hip bursitis causes pain on the outer side of the hip, over the bony point at the top of the thigh.
It is now often described as greater trochanteric pain syndrome, because the gluteal tendons are usually involved as well as the bursa.
Common triggers include compression from side-lying or crossing your legs, a sudden increase in walking or running, and weaker hip muscles.
Typical symptoms are pain lying on the affected side, on stairs, standing on one leg and rising from a chair.
A physio assesses your hip, checks for other likely sources of the pain and explains what is loading the area.
Education about positions plus a progressive strengthening program is a well-supported first approach.
Most people can make simple changes at home, such as sleeping with a pillow between the knees, while they work on strength.

What Is Hip Bursitis?

A bursa is a small, fluid-filled sac that reduces friction between tendons and bone. On the outside of each hip there is a bursa sitting over the greater trochanter, the bony point you can feel at the top of your thigh. When this area becomes irritated and painful, it is often called hip bursitis or trochanteric bursitis.

Research over the past decade has shown that the gluteal tendons, which attach to the same bony point, are usually involved too. For this reason, many health professionals now use the broader term greater trochanteric pain syndrome, or GTPS. Gluteal tendinopathy is one of the most common causes of outer hip pain.

The name matters less than understanding what is aggravating the area. That is what guides how your hip pain is managed.

Common Hip Bursitis Symptoms

The pain is usually felt on the outer side of the hip, over the bony point, and it can spread down the outside of the thigh towards the knee. It often builds gradually rather than starting with an injury. Common signs include:

Pain when lying on the affected side, which may wake you at night
Tenderness when you press on the outer hip
Pain climbing stairs, walking uphill or standing on one leg, for example when putting on pants
Pain and stiffness when getting up from a chair or out of a car after sitting
An ache after long walks or standing for long periods

Pain felt mainly in the groin, or a hip that is stiff to turn, may point to the hip joint itself rather than the outer hip. A physio can help tell the difference.

What Causes Hip Bursitis

Outer hip pain usually develops when the tendons and bursa are compressed or overloaded more than they can handle. There is often more than one factor involved. These are the most common contributors.

Compression and Everyday Postures

Certain positions squash the tendons against the bone. Sleeping on your side with the top knee dropped across the body, sitting with your legs crossed, and standing with your weight hanging into one hip are common examples. Over time, this compression can irritate the area.

Changes in Activity or Load

A sudden increase in walking, running, hill work or stair climbing can overload the hip tendons. So can a new job that involves standing all day, or returning to exercise after a long break. The tendons need time to adapt to new demands.

Hip Muscle Weakness and Movement Patterns

The gluteal muscles help keep your pelvis level when you walk and stand on one leg. When they are weaker, the hip can drop or sway sideways, which increases compression on the outer hip. This is one reason strengthening is such an important part of care.

Age, Hormones and Other Factors

Outer hip pain is more common in women, especially from around 40 to 60, and hormonal changes around menopause may play a part. Other factors can include higher body weight, lower back problems and, less commonly, a fall onto the hip. Rarely, a bursa can become infected or inflamed by another medical condition, which needs a GP review.

How a Physio Assesses Hip Pain

Your physio will start by asking where the pain is, what makes it better or worse, how it affects your sleep and activity, and what has changed recently. They will then look at how you walk, stand on one leg, squat and move your hip, and test the strength of the muscles around it.

Specific tests help work out whether the pain is likely coming from the gluteal tendons and bursa, the hip joint or the lower back. Scans are not always needed, and your physio will let you know if your GP should arrange one. A musculoskeletal physiotherapy assessment like this gives you and your physio a starting point for talking through your options, including whether physiotherapy is suitable for you.

How Physio Can Help Hip Bursitis

Physiotherapy for outer hip pain focuses on reducing compression, gradually building the load the tendons can tolerate, and supporting you to stay active. Australian research, including the LEAP trial published in the BMJ in 2018, supports education combined with exercise as a first-line approach for gluteal tendinopathy.

Understanding Load and Positions

Knowing which positions and activities aggravate the hip is often the first step. Your physio will explain how to adjust sleeping, sitting and standing habits to reduce compression. This advice may help with day-to-day comfort while strength is being built.

Progressive Strengthening Exercises

Hip bursitis exercises usually start gently, with holds that load the gluteal muscles without compressing the tendon, then progress to standing and functional exercises such as bridges, step-ups and single-leg work. Progress is gradual, often over several weeks to a few months. Your physio adjusts the program based on how your hip responds.

Hands-On Treatment and Other Options

Soft tissue work, joint mobilisation or dry needling may be used alongside exercise, with the aim of making movement more comfortable. Your physio explains the possible side effects first, such as soreness or bruising after dry needling, and only uses a technique if you agree to it. If symptoms are slow to settle, your physio can talk with you about other options, including whether to see your GP. Treatment is always planned with your goals in mind.

Simple Changes to Ease Hip Pain

Small changes to everyday habits can reduce the load on a sore outer hip. These suggestions are general, so check with your physio which suit you.

Habit that can aggravate hip pain	Try this instead
Sleeping on your side with the top knee dropped forward	Place a pillow between your knees, or sleep on your back
Lying on the painful side	Lie on the other side, or add a soft mattress topper
Sitting with legs crossed	Sit with feet flat and knees slightly apart
Standing with weight hanging into one hip	Spread weight evenly through both feet
Low chairs and car seats	Use a cushion so your hips sit higher than your knees
A sudden jump in walking or running	Build distance gradually and avoid steep hills at first

If you are seeing a physio for the first time, it helps to know what new patients can expect before you arrive.

Get Help for Hip Pain Today

If outer hip pain is disturbing your sleep or getting in the way of walking, stairs or work, an assessment can help you understand what is going on and what to do next. Northern Physio sees people from across Melbourne's north at its physio clinic in Epping, including Lalor, Wollert, Mill Park, South Morang and Craigieburn. If you cannot put weight on your leg after a fall, or your hip pain comes with a fever or you feel very unwell, call 000 or go to your nearest emergency department straight away. If hip pain follows a fall but you can still walk on it, see your GP promptly.

This article is general information only and is not a substitute for individual advice. Speak with a registered physiotherapist or your GP about your own symptoms before starting any treatment or exercise program.