Hip bursitis treatment: why outer hip pain is often a tendon problem

Pain on the outside of the hip, worse when you lie on that side or climb stairs, is usually called hip bursitis. The label is older than the evidence. Imaging studies now find tendon trouble in the gluteal muscles more often than an inflamed bursa, so the condition has a broader name: greater trochanteric pain syndrome, or GTPS. That matters for treatment, because the care with the best trial results is education and exercise that calm the tendon, and a cortisone shot is not the first answer.

What is hip bursitis, and what is greater trochanteric pain syndrome?

Greater trochanteric pain syndrome is pain over the bony point on the outside of your hip, the greater trochanter. It covers bursitis, gluteal tendon problems and a snapping iliotibial band. The StatPearls review notes that recent imaging more often finds abductor tendon tears, tendinosis and a thickened IT band than bursitis (StatPearls, 2024). A 2015 review concluded that tendinopathy of the gluteus medius and minimus is now recognized as a primary local source of lateral hip pain (Grimaldi and colleagues, 2015).

The American Academy of Orthopaedic Surgeons describes the typical pattern: pain at the point of the hip that is worse at night, when lying on the affected hip, and when getting up from a chair after sitting a while. It may also worsen with prolonged walking, stair climbing or squatting. Early on it can feel sharp; later it often becomes a spreading ache.

If you have been told "bursitis," the plan below covers both the bursa and the tendon.

Who gets outer hip pain, and why?

Women in midlife get it most. A 2024 meta-analysis reports that GTPS affects 17.6% of adults aged 50 to 79, particularly women (Rhim and colleagues, 2024). StatPearls cites a 2- to 5-fold higher risk in women than men and an association with higher body mass index. Tendons dislike the combination of compression and heavy load, and Grimaldi's review points to excessive hip adduction, where the thigh drifts across the midline, as a key factor.

The AAOS lists these risk factors:

• Repetitive stress, such as running, stair climbing, cycling or standing for long periods
• A fall onto the hip, or lying on one side for an extended time
• Spine disease, including scoliosis and arthritis of the lower spine, that changes how you walk
• A tight iliotibial band
• One leg noticeably shorter than the other
• Rheumatoid arthritis, previous hip surgery or an implant, and bone spurs or calcium deposits in the attaching tendons

The AAOS adds that weight loss, if you need it, and keeping hip muscles strong and flexible help prevent flare-ups.

How is lateral hip pain diagnosed, and what else could it be?

A clinician diagnoses GTPS mainly from your history and exam. StatPearls says the diagnosis is primarily clinical, with imaging used to tell it apart from other causes. Expect the clinician to press on the greater trochanter, check hip abduction strength and watch you stand on one leg. An X-ray comes first to exclude arthritis, impingement and dysplasia. MRI or ultrasound can show tendon changes or a tear.

Several look-alikes are worth ruling out. Here is how they tend to differ:

Source: examination and differential in StatPearls, 2024; stress fracture pattern from AAOS.

StatPearls states that concurrent back and hip pain with neural symptoms like weakness or numbness may indicate spinal pathology. If your lower back is part of the picture, our golf back pain guide covers that side. And if you are comparing this to a replaced hip, this is a different problem: our hip replacement recovery timeline covers surgery on the joint itself, while this guide covers the tendons outside it.

What is the best hip bursitis treatment to start with?

Start with education and exercise. The strongest single piece of evidence is the LEAP trial, published in the BMJ in 2018. It randomized 204 people aged 35 to 70 with MRI-confirmed gluteal tendinopathy (167 of them women) to a physiotherapy program of 14 sessions over eight weeks, one corticosteroid injection, or wait and see. Education plus exercise did better than injection and than waiting (Mellor and colleagues, BMJ, 2018).

Source: Mellor et al., BMJ, 2018. At 52 weeks the pain difference between exercise and injection was not statistically significant; the difference in global improvement was.

A 2024 meta-analysis of six trials and 733 people reached the same direction. It concluded that the evidence supports a strong recommendation for exercise as first-line treatment and that exercise beat injection for long-term global improvement, while noting the conclusion rests on few trials and a moderate number of patients (Kjeldsen and colleagues, 2024).

Two details from LEAP are worth your attention. The program was supervised, 14 sessions with a physiotherapist, and the authors noted that muscle strength did not differ between groups at eight weeks. They suggested the benefit may owe more to the education, which stressed avoiding postures and movements that compress the tendons against the trochanter and progressing load gradually. The trial's protocol also avoided hip stretching, which can place high compressive load on the tendons, and limited hip adduction in the exercises (Mellor and colleagues, 2016).

What should you change in daily life?

Reduce the positions that squeeze the tendon against the bone, and build load slowly. Think of any position that pulls the top thigh across the front of your body. Crossing your legs is one example. The research names adduction as a factor; applying it to everyday habits is our reading, so treat this list as a starting point for a conversation with a physical therapist:

• Uncross your legs when you sit.
• Notice standing with your weight dropped into one hip.
• Skip hip stretches that pull the knee across the body until a clinician says otherwise.
• If lying on the painful side wakes you, ask a physical therapist to help you set up your sleeping position.
• Trim the volume of what flares you (long hard-surface walks, stair repeats) rather than stopping all movement.
• Raise load a little at a time. Soreness the morning after is the sign you did too much.

The AAOS also lists activity modification, NSAIDs used cautiously and for limited periods, a cane or crutches for a week or more if needed, and physical therapy. Plan on months. StatPearls tells clinicians to set expectations that conservative approaches may take 3 months or more to ease symptoms fully.

Does a cortisone shot help hip bursitis?

A cortisone injection can bring relief, but in LEAP it faded relative to exercise. At eight weeks the injection group was ahead of wait and see; by 52 weeks its global improvement was no better than exercise and its pain was similar. The AAOS says an injection may provide temporary (for a few months) or permanent relief, that a repeat a few months later may help, and that limiting the number matters because long use may damage surrounding tissue.

A practical rule: an injection makes the most sense when pain blocks you from doing the exercise program, and it works best alongside that program. Ask your doctor whether it fits your case, especially if you have diabetes, because StatPearls notes injections can raise blood sugar.

Do shockwave and PRP help?

Shockwave has more support than PRP, with caveats: modest, short-term gains from trials with a high risk of bias.

A 2024 meta-analysis pooled eight trials with 754 patients and found that three weekly sessions gave short-term pain relief at 2 to 4 months, especially with focused shockwave. Seven of the eight trials had a high risk of bias, and the functional gain at six months did not exceed the minimal clinically important difference (Rhim and colleagues, 2024).

A multicenter trial of 103 people with chronic GTPS gave everyone the same exercise protocol and added real or sham focused shockwave: pain at two months fell from 6.3 to 2.0 with shockwave versus 4.7 with sham (Ramon and colleagues, 2020). That trial is from 2020, so read it as a snapshot, and it tested shockwave added to exercise.

PRP is less settled. A 2024 systematic review of four randomized trials found that two reported significant improvements and two found no difference, with wide variation in how PRP was prepared and injected. StatPearls says PRP is not considered the standard of care for this condition.

When is surgery considered?

Rarely. The AAOS says surgery is rarely needed and is considered if the bursa remains inflamed and painful after all nonsurgical treatments, by removing it. It calls the endoscopic version promising but still being studied. StatPearls reserves surgery for symptoms beyond 6 to 12 months that have not responded to conservative care, and a torn gluteal tendon is treated differently from bursitis.

Where do studio services fit?

Studio services fit beside the exercise plan. OutRecover offers shockwave, Class IV laser and PEMF. The only one of the three with GTPS trials in this guide's sources is focused shockwave, and those trials add it to exercise. The sources here do not include a trial of Class IV laser or PEMF in lateral hip pain, so we do not claim either one helps this condition. These are wellness services, they do not replace your doctor's or physical therapist's plan, and they are not a diagnosis.

• Shockwave. The focused shockwave page describes a handheld device that sends pulses you feel as tapping, with some tenderness during treatment. The shockwave research summary has the wider evidence.
• Class IV laser. Our laser therapy guide and laser service page explain what a session involves.
• PEMF. You stay fully clothed on a mat; see the PEMF guide and PEMF page.

For packages, OutResolve is built for chronic tendon pain and lists outer hip pain among its uses, pairing Class IV laser and/or shockwave with PEMF. OutRelief lists shoulder, hip and knee pain and arthritis pain, and adds red light and an IV option, so it fits if pain is wider than one spot. Both are plans for support, and your exercise program stays the foundation.

What should you do this week?

Get a diagnosis, change the habits that squeeze the tendon, and start a graded exercise plan. In order:

1. Get examined if you have not been, so arthritis, a back source, a stress fracture and a gluteal tear are checked.
2. Uncross your legs, stop standing on one hip, and change what flares you before you stop moving.
3. Ask for a physical therapist who treats tendons and will build a graded gluteal program.
4. Give it months, and judge progress by your morning-after pain.
5. See a doctor soon for fever with hip pain, pain after a fall, or pain that keeps climbing despite rest.
6. If you have tried exercise faithfully and are plateaued, ask about shockwave or an injection, and bring these sources.

Sources

1. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ, 2018. https://pubmed.ncbi.nlm.nih.gov/29720374/
2. Pumarejo Gomez L, Li D, Childress JM. Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). StatPearls, NCBI Bookshelf, updated February 2024. https://www.ncbi.nlm.nih.gov/books/NBK557433/
3. American Academy of Orthopaedic Surgeons. Hip Bursitis. OrthoInfo, updated 2024 to 2025. https://orthoinfo.aaos.org/en/diseases--conditions/hip-bursitis
4. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine, 2015. https://pubmed.ncbi.nlm.nih.gov/25969366/
5. Kjeldsen T, Hvidt KJ, Bohn MB, et al. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy, 2024. https://pubmed.ncbi.nlm.nih.gov/38295551/
6. Rhim HC, Shin J, Beling A, et al. Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials. JBJS Reviews, 2024. https://pubmed.ncbi.nlm.nih.gov/39297780/
7. Ramon S, Russo S, Santoboni F, et al. Focused Shockwave Treatment for Greater Trochanteric Pain Syndrome: A Multicenter, Randomized, Controlled Clinical Trial. Journal of Bone and Joint Surgery, 2020. https://pubmed.ncbi.nlm.nih.gov/32769596/
8. Mahajan U, Papaleontiou A, Imam MA, Mahmood A. Assessing Standardisation in Platelet-Rich Plasma (PRP) Injections for the Management of Greater Trochanteric Pain Syndrome (GTPS): A Systematic Review. Cureus, 2024. https://pubmed.ncbi.nlm.nih.gov/39734950/
9. Mellor R, Grimaldi A, Wajswelner H, et al. Exercise and load modification versus corticosteroid injection versus 'wait and see' for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskeletal Disorders, 2016. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1043-6
10. Mellor R, et al. LEAP trial full text (discussion of strength and education). BMJ, 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC5930290/
11. American Academy of Orthopaedic Surgeons. Hip Fractures. OrthoInfo, read 2026. https://orthoinfo.aaos.org/en/diseases--conditions/hip-fractures