# Hip bursitis Hip bursitis is pain over the bony point on the outside of the hip (greater trochanteric pain syndrome). It mostly comes from the tendons of the buttock muscles where they attach to that bone, and sometimes from the small fluid sac over them (the bursa). We take the load off those tendons, then rebuild the strength of the hip muscles step by step. ## Symptoms - Pain over the bony point on the outside of the hip - Pain when lying on that side at night - Pain on stairs, hills and getting up from a low chair - Pain after a long walk, hike or run - Pain when standing on one leg - Tenderness when you press on the side of the hip - An ache that spreads down the outer thigh ## Assessment We start with where it hurts and what sets it off: stairs, hills, a long walk or run, lying on that side, standing on one leg. We ask what changed before it began: a new running plan, a big hiking week, a job with far more stairs. Then we examine the hip: - we press on the bony point of the hip (the greater trochanter) to find where it is tender - we test the strength of the muscles at the side and back of the hip, and watch you balance and step down on one leg - we look at how you stand, sit and walk, because leaning onto one hip or crossing your legs presses the tendons on the bone - we check the lower back and the hip joint, because both can send pain to the same spot ## Treatment The sore tendons are being squashed against the bone and overloaded. Treatment takes that load off, then builds their tolerance back up. It usually includes: - **Load management:** for a while we ease back what presses the tendons on the bone. That means no stretching the outer hip, no crossing your legs and no leaning onto one hip when you stand. Sleeping on the sore side goes too; a pillow between the knees helps. Walking, stairs and hills stay at a level that makes the pain no more than a little worse. - **Graded strengthening:** exercises for the buttock muscles that hold the pelvis level when you stand on one leg. They start gently, with the hip held still, and build to standing, stepping and single-leg work. This is the main treatment, because the right loading is what lets the tendons adapt. - **Hands-on treatment:** we work the muscles around the hip and the lower back to ease pain and tightness; see [manual therapy](https://backinactionphysiotherapy.com/services/manual-therapy). We do not press hard on the sore tendons, since that adds to the compression. - **Shockwave therapy:** one option when tendon pain lingers despite a good strengthening program, alongside it rather than instead of it. See [shockwave therapy](https://backinactionphysiotherapy.com/services/shockwave-therapy). ## Getting back to sport Runners and hikers get this often, usually after a change in training: more distance, more hills, a return after a break or a big alpine trip. It is also more common in women in middle age. The way back is stepped. We start with shorter, flatter outings, such as a loop of the Valley Trail. Distance comes back before climbing and descending, which the outer hip copes with last. You move on from each step when the pain the next day is no more than a little worse. There is no set date for a return to full training. Once the basics are solid, [strength and conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning) takes over. It builds towards what work, study and sport ask of the hip: long shifts on your feet, a full hiking week or a hilly run. ## When to come in Book an assessment if pain on the outside of your hip wakes you at night, stops you on stairs or hills, or cuts your runs and hikes short. Book too if it has lingered despite rest, or comes back each time you return to running. Go to the emergency department right away, or call 911, if any of these happen: - you cannot put weight on the leg after a fall - the hip is hot and swollen and you have a fever - after a fall, the leg looks shorter or turned outward ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Manual Therapy](https://backinactionphysiotherapy.com/services/manual-therapy) - [Strength and Conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### Should I stretch the outside of my hip? Usually not. Stretching the outer hip, such as pulling the knee across your body, presses the tendons against the bone and often makes this pain worse. The same goes for sitting with your legs crossed and leaning onto one hip when you stand. If the outer hip feels tight, that is usually the sore tendons, not a muscle that needs lengthening. We swap the stretching for strength work, which loads the tendons without squashing them. ### Can I keep running or hiking with hip bursitis? Often, yes. The rule is that the hip should feel no more than a little worse during the outing and the next morning. Hills and long descents are the hardest work for the outer hip, so flatter, shorter routes come first, and the climbing is added back in steps. Pushing through pain that keeps building is what tends to set this problem back, so when it climbs, cut the outing short and tell us. ### Should I get a cortisone injection for hip bursitis? Sometimes. A steroid injection can ease the pain for a time, and a doctor or nurse practitioner can discuss whether one suits you. On its own it does not change what caused the problem, so the pain can come back if the loading stays the same. We treat it as a window: while the hip is settled, we build the strength and habits that keep it that way. ### Why does it hurt to lie on my side at night? Pressure. Lying on the sore hip squashes the tendons and the bursa between the bone and the mattress. Lying on the other side can hurt too, because the upper leg drops across and pulls the tendons tight over the bone. A pillow between your knees keeps the upper leg level, and a soft layer on the mattress eases the pressure on the sore side. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*