"Hip Bursitis" Might Be the Wrong Diagnosis, Here's What's Usually Really Going On

Sharp pain on the outside of your hip. Worse when you lie on that side at night, worse walking up the stairs, maybe worse on that first kilometre of your walk before it eases off. If you've been told this is "hip bursitis" and sent away with rest, ice, and perhaps a cortisone injection, only for the pain to creep back a few months later, you're not alone, and you're not doing anything wrong. The label itself is very likely the problem.

Myth: It's Inflammation. Fact: It's a Tendon Under Load It Can't Handle

For years, pain over the bony point of the hip (the greater trochanter) was blamed on an inflamed bursa, a small fluid-filled cushion that sits between tendon and bone. It's an easy story: something's inflamed, so calm it down with rest and ice.

But when researchers actually looked at the tissue under the microscope, true bursa inflammation was rarely the main finding. What they consistently found instead was gluteal tendinopathy, wear-and-tear changes in the tendons of the gluteus medius and minimus, right where they attach to the hip bone (1). This is now understood to be the primary driver behind most cases of what's still commonly called "trochanteric bursitis" or greater trochanteric pain syndrome.

This condition is genuinely common, particularly in women in the peri- and post-menopausal years, and it can be seriously disabling, research has found the impact on day-to-day quality of life can be comparable to advanced hip arthritis. If it's stopping you sleeping properly, walking the dog, or getting through your day comfortably, it deserves more than "just rest it."

Why the Cortisone Shot Might Not Be Doing You Any Favours

A cortisone injection is often the first thing offered for hip pain like this, and it's easy to see the appeal, many people feel noticeably better within a few weeks. The problem is what happens after that.

A well-known clinical trial comparing cortisone injections against a structured education-and-exercise programme found the injection group did well early on, but by the one-year mark, their outcomes had dropped back to roughly the same level as people who'd received no active treatment at all. The education-and-exercise group, by contrast, held onto and kept building on their improvement over the full year (2). Steroids are also known to have a negative effect on tendon cells and collagen production over time, which may partly explain why the early relief doesn't tend to last.

None of this means cortisone is never appropriate, sometimes short-term relief is genuinely needed to get moving again. But relying on it as the main treatment, rather than pairing it with proper loading, tends to set people up for the same pain returning later.

The Everyday Habits Quietly Aggravating Your Hip

Unlike a lot of tendon injuries, gluteal tendinopathy isn't purely an "overuse" problem, it's largely a compression problem. Every time your leg crosses toward the midline of your body, the tendons get squeezed against the bone underneath them. A few very ordinary habits do this far more than people realise:

• Standing with your weight hitched onto one hip (the classic "hip hang" while waiting in a queue or chatting in the kitchen)
• Crossing your legs, at the knee or the ankle
• Sleeping on your side without something supportive between your knees, letting the top leg drop and compress the underside
• Cross-body IT band stretches, which feel like they're helping but load the tendon in exactly the wrong direction

None of these need to be avoided forever, but noticing and modifying them, especially at night, is often one of the fastest ways to take the edge off symptoms while the rehab work does the heavier lifting.

The Exercises That Actually Help (and the Ones That Don't)

Side-lying leg lifts are a rehab classic for hip pain, and they do make the glutes "burn". But burn isn't the same as building tendon capacity. Because the leg stays close to the body through that movement, it doesn't load the tendon through a long enough range to drive real change.

Exercises that load the glutes at a longer muscle length, think single-leg Romanian deadlifts, split squats, and single-leg hip thrusts, tend to be far more effective. At these longer lengths, the tissue takes on more passive tension, which appears to be a key trigger for tendon remodelling, alongside the muscle-strengthening benefit (3). A well-programmed single-leg RDL in particular tends to hit all three gluteal layers in one movement.

The other essential piece: progression needs to be gradual. A practical rule many physios use is to avoid increasing your walking distance, hill work, or exercise load by more than about 10% a week, helpful whether you're building back up to Sunday walks along the Tauranga waterfront or getting back into the garden without paying for it the next day.

Getting Back to Pain-Free, Properly

Recovering from gluteal tendinopathy isn't about getting another injection or waiting it out, it's a matter of steadily rebuilding what the tendon can tolerate, while taking the unnecessary compression out of your daily habits. Most people improve significantly with the right programme, but it does take consistency over months, not days.

If lateral hip pain has been dragging on, an individual assessment can clarify exactly what's driving it and what your rehab actually needs to look like.

Ready to get to the bottom of your hip pain? Book an appointment online with our physio team - we'll assess what's going on and build you a plan to get back to walking, sleeping, and moving comfortably again.

This article is general information and isn't a substitute for individual physiotherapy assessment. If you're experiencing ongoing hip pain, book an assessment with a qualified physiotherapist before starting a new exercise programme.

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References

1. Grimaldi, A., Mellor, R., Nasser, A., Vicenzino, B., & Hunter, D. J. (2024). Current and future advances in practice: tendinopathies of the hip. Rheumatology Advances in Practice, 8(2), Article rkae022. https://doi.org/10.1093/rap/rkae022
2. Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H., & Vicenzino, B. (2018). 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. British Journal of Sports Medicine, 52(22), 1464–1472. https://doi.org/10.1136/bjsports-2018-k1662rep
3. Collings, T. J., Bourne, M. N., Barrett, R. S., Meinders, E., Gonçalves, B. A. M., Shield, A. J., & Diamond, L. E. (2023). Gluteal muscle forces during hip-focused injury prevention and rehabilitation exercises. Medicine & Science in Sports & Exercise, 55(4), 650–660. https://doi.org/10.1249/MSS.0000000000003091

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