Trochanteric Bursitis (Greater Trochanteric Pain Syndrome)

Although the term "hip bursitis" remains common, clinicians today more accurately call this condition greater trochanteric pain syndrome (GTPS), and it is one of the most frequent causes of pain felt on the outer side of the hip, often radiating down the thigh ^[1]. What was once thought to be inflammation of a single bursa is now understood, in most cases, to be related to wear of the side hip muscle tendons (gluteus medius and minimus) — that is, gluteal tendinopathy ^[1]. The good news is that the vast majority of cases resolve without surgery, through load management, targeted exercise and physiotherapy ^[6].

In this guide we explain, in clear language and based on authoritative sources, what trochanteric bursitis is, how it presents, why it develops, how it is diagnosed, and especially the central role of physiotherapy in treatment.

What is trochanteric bursitis (greater trochanteric pain syndrome)?

On the outer, upper part of the hip joint there is a bony prominence at the top of the thigh bone (femur); this prominence is called the greater trochanter ^[2]. The small, fluid-filled cushion that sits over this bony point and reduces friction between muscle and bone is the trochanteric bursa. In the classic definition, irritation, damage or inflammation of this bursa was called "trochanteric bursitis" ^[2].

In recent years, however, imaging and clinical studies have shown that lateral hip pain is often not caused by the bursa alone. For this reason clinicians now prefer the more inclusive term greater trochanteric pain syndrome (GTPS) ^[1]. This syndrome gathers several different problems under one umbrella: trochanteric bursitis, tendinopathy or tears of the gluteus medius and minimus muscles, and snapping of the iliotibial band ^[1].

This distinction has practical importance. In one series of ultrasound examinations, roughly half of people with lateral hip pain had gluteal tendinopathy, while isolated bursitis (on its own) was found in only a small minority ^[1]. In other words, for most patients the real problem is load-related wear in the tendon, and the swelling in the bursa is often a secondary finding that accompanies it. This explains why treatment should aim not merely to suppress inflammation, but to make the tendon able to carry load healthily again ^[6].

GTPS is quite common. It is reported to affect roughly 10-25% of the population in developed countries ^[1]. Among patients who present to primary care with hip pain, about 10-20% have this syndrome ^[4]. It is most common in people aged 40-60 and in women ^[1][4].

What are the symptoms?

The most prominent feature of greater trochanteric pain syndrome is pain and tenderness on the outer (lateral) side of the hip ^[2]. This pain usually begins at the point over the greater trochanter and radiates down the outer surface of the thigh, sometimes also toward the buttock ^[5]. Patients typically describe the following complaints:

• ·Pain on the outer side of the hip: The pain is felt most strongly directly over the greater trochanter, as a sharp or deep tenderness that worsens with finger pressure ^[2].
• ·Pain when lying on the affected side: For many patients this is the most bothersome symptom. Waking at night when lying on the painful hip is common ^[3].
• ·Pain when standing up after sitting: It is typical for the pain to become noticeable in the first few steps after rising from prolonged sitting ^[2].
• ·Pain with movement: Walking, especially climbing stairs, running, squatting or crossing the legs can all increase the pain ^[2][1].
• ·Pain with single-side loading: Standing on one leg or putting weight through the affected side (for example, dressing while standing on one foot) can trigger the pain ^[4].

The pain usually has an intermittent, insidious onset; over time it can reach a level that disrupts daily life and disturbs sleep ^[6]. Symptoms can fluctuate over weeks or even months. In more acute presentations where bursitis predominates, mild swelling and a sensation of warmth on the outer side may be added to the picture; however, joint swelling itself is not typical in GTPS.

An important point: none of these symptoms alone confirms the diagnosis. Hip osteoarthritis, referred pain from a lumbar disc, sacroiliac joint problems or pathology inside the hip joint can produce similar complaints ^[4]. For this reason the exact location of pain (outer side, groin, or back) and the movements that trigger it help guide the differential diagnosis.

Causes and risk factors

At the root of greater trochanteric pain syndrome lies exposure of the soft tissues on the outer side of the hip — particularly the gluteal tendons and the bursa — to more load than they can tolerate ^[6]. Over time this overload leads to wear in the tendon (tendinopathy) and accompanying bursal irritation. The main mechanisms are:

• ·Gluteal tendinopathy: Wear of the tendons where the gluteus medius and minimus muscles attach to the greater trochanter, under repetitive pressure and tension. This is the most common underlying cause of GTPS ^[1].
• ·Repetitive mechanical pressure and overuse: Climbing many stairs, standing for long periods, lifting heavy loads, or sports such as running and cycling that place repetitive load on the hip ^[2].
• ·Trauma: Falling onto or bumping the outer side of the hip, or lying on one side for a long time, can directly irritate the bursa ^[2].
• ·Iliotibial band tightness: Tightness of this thick band of tissue that runs down the outer thigh increases friction over the trochanter ^[5].
• ·Biomechanical and postural problems: A leg-length difference, spinal curvature (scoliosis), hip bone spurs (osteophytes) and postural problems can increase pressure on the bursa ^[2].

The strongest risk factors include:

• ·Sex and age: It is markedly more common in women and in the 40-60 age range ^[1][4]. In a large community-based study, unilateral GTPS was found in about 15% of women and 6.6% of men ^[1].
• ·Excess weight: GTPS is strongly associated with being overweight; it increases the load on the lateral hip tissues ^[3].
• ·Weak hip abductor (side) muscles: Weakness of the muscles that keep the pelvis level increases the load falling on the tendons and worsens the condition ^[6].
• ·Coexisting conditions: Inflammatory joint diseases (such as gout or rheumatoid arthritis), diabetes, thyroid disease and previous hip surgery can increase the risk ^[2].

How is it diagnosed?

Greater trochanteric pain syndrome is largely a clinical diagnosis; that is, the clinician usually reaches the diagnosis through a detailed history and physical examination ^[4]. The clinician first asks when the pain started, which movements aggravate it, whether lying on the affected side at night triggers the pain, and about work and sport habits ^[2].

On physical examination, the two most valuable findings are:

• ·Direct palpation (tenderness on pressure): Marked pain when pressure is applied over the greater trochanter (the "jump sign") is typical. This finding carries a high predictive value for pathology seen on magnetic resonance imaging (MRI); if there is no pain on palpation over the trochanter, GTPS is unlikely ^[4].
• ·Single-leg stance test: The patient is asked to stand on the affected leg for 30 seconds. Reproduction of lateral pain within this time is a valuable finding in favour of GTPS ^[4].

It is known that no single test is sufficient on its own, but combining several tests increases diagnostic accuracy ^[4]. The clinician also assesses hip range of motion, abductor muscle strength, and whether the pain is being referred from the lower back.

When is imaging needed? Imaging is not always required to diagnose GTPS. However, if the diagnosis is uncertain, another problem is suspected, or the pain does not settle despite appropriate treatment, the clinician may request further tests ^[4]:

• ·X-ray: Used mainly to rule out other conditions such as hip osteoarthritis ^[2].
• ·Ultrasound or MRI: May be used to show fluid in the bursa, wear in the tendon, or possible tears ^[2][4].

The purpose of these steps is not merely to answer "is there bursitis," but to understand the true source of the pain (tendon, bursa, or another structure) and to plan treatment accordingly.

Treatment options

In greater trochanteric pain syndrome, the good news is that the vast majority of cases improve with non-surgical (conservative) treatment ^[1][6]. The main goal of treatment is not just to suppress pain; it is to reduce the excess load on the tendon and bursa and to help the tissue become able to tolerate more load over time ^[6].

The main conservative treatment steps are:

• ·Load management and activity modification: Temporarily reducing or modifying the movements that trigger the pain (for example, long walks, climbing many stairs, lying on the affected side) is the cornerstone of treatment ^[2][3]. The aim here is not complete inactivity, but staying active at a level that does not irritate the tissue ^[3].
• ·Physiotherapy and exercise: Programmes that strengthen the hip, back and core muscles, and stretch them where needed, are central to treatment. Trochanteric bursitis almost always improves with physiotherapy ^[5].
• ·Pain control: When the clinician considers it appropriate, short courses of pain relievers or anti-inflammatory medicines (NSAIDs) may be used to reduce pain and inflammation. Medicines should be used on a clinician's advice and for a limited period ^[2].
• ·Assistive devices: During a painful phase, an assistive device such as a cane can help reduce the load placed on the hip while walking ^[2].
• ·Corticosteroid injection: May be administered by a clinician to relieve symptoms in the short term ^[2][5]. However, an important study (the LEAP trial) showed that an education-plus-exercise programme produced better medium- and long-term outcomes than a single corticosteroid injection or a "wait and see" approach ^[6]. For this reason an injection is generally considered alongside an exercise-based programme rather than on its own.
• ·Surgery: Very rarely needed. It is generally considered in resistant cases lasting longer than six months that do not respond to other treatments (for example, to repair a tendon tear or remove the bursa) ^[2].

Recovery time varies from person to person. Although some cases settle within a few weeks, longer-standing presentations — particularly those accompanied by gluteal tendinopathy — may require a rehabilitation process of 6-12 months for full recovery ^[3]. For this reason patience and adherence to the programme are important.

How does physiotherapy help?

Physiotherapy is at the heart of treatment for greater trochanteric pain syndrome, and current evidence highlights it as one of the most effective approaches ^[6]. This is because the root of the problem is most often overload of the tendon and weakness of the side hip muscles; this resolves durably not through rest or an injection alone, but through a structured exercise and load-management programme ^[6].

One of the most important studies to show this clearly is the LEAP trial. In this study of 204 people with gluteal tendinopathy, an exercise programme combined with load-management education was compared with a single corticosteroid injection and a "wait and see" approach. At 8 weeks, 77% of the education-plus-exercise group were at least "moderately better," compared with 58% in the injection group and only 29% in the wait-and-see group; moreover, this advantage was maintained at one year ^[6]. This shows that "the right exercise" can offer a more durable solution than an injection for most patients.

The physiotherapy process typically includes the following elements:

• ·Load management: Recognising and temporarily reducing the daily movements that irritate the tendon (crossing the legs, lying on the affected side, postures that compress the hip inward); then gradually and progressively increasing the load again ^[6][3]. This aims to settle the tendon into the balance between "avoidance" and "overloading."
• ·Strengthening the hip abductor muscles: Strengthening exercises targeting the gluteus medius and minimus muscles that keep the pelvis level, progressed gradually so as not to flare the pain ^[5][6]. Strengthening these muscles reduces the load falling on the tendons.
• ·Trunk and hip stabilisation: Strengthening the back and core (trunk) muscles helps the hip to be loaded more evenly during walking and standing ^[5].
• ·Flexibility and soft-tissue work: If there is tightness in the iliotibial band and surrounding muscles, stretching and manual techniques to address it may be added to the programme ^[5].
• ·Movement and gait retraining: Re-organising daily movement habits (sitting, standing up, climbing stairs) so they place less strain on the tendon.

At FizyoArt, we deliver this process in the patient's own home with a personalised programme. For home-based rehabilitation of orthopaedic hip pain, you can review our Istanbul orthopaedic rehabilitation (at home) and Ankara orthopaedic rehabilitation (at home) services. A manual therapy (at home) in Izmir approach to tightness in the iliotibial band and surrounding soft tissues can support this programme. For older adults in particular, our home physiotherapy for older adults in Antalya service, which also includes balance and safe-movement training, can help reduce the risk of falls.

What can be done at home; who is it suitable for, and who is it not?

Simple measures applied at home can support the physiotherapy programme to reduce pain and prevent recurrences. The main home-care steps recommended by NHS and clinical sources are:

• ·Avoid lying on the affected side: At night, sleeping on your back with a pillow under your knees, or lying on your good side with a pillow between your legs (to keep the hip in line), can reduce night pain ^[3].
• ·Try to stay active: Complete inactivity is not advised. Where possible, try to stay active and at work, modifying your duties if necessary ^[3].
• ·Temporarily reduce triggering movements: Limit situations that aggravate the pain, such as long walks, climbing many stairs, crossing the legs and placing prolonged load on the affected side ^[2][6].
• ·Weight management: Excess weight is strongly associated with GTPS. Studies show that a 10% weight loss can provide roughly a 50% reduction in symptoms ^[3]. For this reason, weight management is an important part of treatment for suitable individuals.
• ·Gradual exercise: Continuing the exercises given by your physiotherapist regularly, at a level that does not markedly increase pain, supports recovery ^[6].

Who is a home-based approach suitable for? For most patients whose diagnosis is clear, whose pain fluctuates with rest and load modification, and who carry no red flags (see the section below), home-based physiotherapy and care are appropriate and effective ^[6].

For whom is a home approach alone not suitable? People with fever; rapidly increasing redness, swelling or warmth in the hip (suspected infection); sudden severe pain after trauma; numbness or weakness in the leg; uncontrolled night pain; or a history of cancer or inflammatory joint disease should first be assessed by a clinician ^[2][4]. In these situations, medical evaluation takes priority over spending time on ice or exercise at home.

When should you see a doctor? (red flags)

Most lateral hip pain does not point to a serious illness; however, some symptoms require evaluation without delay. The following are warning signs that you should consult a health professional:

• ·The 6-week rule: If the pain does not improve within 6 weeks despite appropriate home care and activity modification, it is sensible to talk to a health professional ^[3].
• ·Pain that disrupts daily life: Pain that prevents walking, working or sleeping ^[2].
• ·Signs of infection: Fever, rapidly increasing redness in the hip, marked warmth and swelling.
• ·Sudden severe pain after trauma: Pain that begins after a fall or blow and makes weight-bearing difficult should be evaluated for a possible fracture or tendon tear ^[2].
• ·Neurological symptoms: Numbness or tingling spreading down the leg, or marked loss of strength (which may suggest a problem originating in the lower back).
• ·Unexplained weight loss, night sweats or a history of cancer: Require evaluation to rule out less common serious causes.

These red flags help distinguish simple mechanical pain from more serious conditions. When in doubt, seeking a clinician's opinion is the safest path rather than self-diagnosis.

Short summary (TL;DR)

• ·What it is: Hip bursitis — more accurately, greater trochanteric pain syndrome (GTPS) — is a common condition that causes pain on the outer side of the hip. In most cases the real problem is gluteal tendon wear (tendinopathy), with bursitis often accompanying it ^[1].
• ·Who gets it: Most common in women aged 40-60; excess weight and weak hip side muscles increase the risk ^[1][4][3].
• ·Symptoms: Outer-side pain, worse when lying on the affected side, and pain when standing up after sitting and climbing stairs ^[2][3].
• ·Diagnosis: Usually clinical; tenderness on pressure and the single-leg stance test are valuable. Imaging is done when needed ^[4].
• ·Treatment: The vast majority improve without surgery. Load management plus exercise-based physiotherapy is central and can produce better long-term outcomes than injection ^[6].
• ·At home: Avoid lying on the affected side, stay active, reduce triggers, and apply weight management if appropriate ^[3].
• ·When to see a doctor: Seek help for pain that does not improve in 6 weeks, signs of infection, severe pain after trauma, or neurological symptoms ^[3][2].

Frequently Asked Questions

Are hip bursitis and greater trochanteric pain syndrome the same thing?

They largely describe the same condition, but "greater trochanteric pain syndrome (GTPS)" is a more inclusive and up-to-date term. It used to be thought that the pain came only from inflammation of the bursa; today we know that in most cases the real problem is gluteal tendon wear, with the bursitis picture accompanying it ^[1]. For this reason clinicians now mostly use the term GTPS.

Does hip bursitis go away on its own?

Many mild cases may settle over time with a reduction of triggering activities and appropriate care. However, in longer-standing presentations accompanied by tendon wear, spontaneous full recovery can be slow and may take 6-12 months ^[3]. A structured exercise programme both speeds recovery and reduces the risk of recurrence ^[6].

Does exercise increase the pain — should I still do it?

In a well-planned programme, exercise is the cornerstone of recovery. The aim is to start at a level that does not irritate the tendon and to increase the load gradually. While mild, controlled discomfort is acceptable, movements that markedly and persistently increase pain should be deferred. Establishing this balance under the guidance of a physiotherapist is the safest path ^[6].

I cannot lie on the affected side — what can I do?

This is a very common complaint. Lying on your back with a pillow under your knees, or lying on your good side with a pillow placed between your legs to keep the hip in line, can reduce night pain ^[3]. These simple adjustments can noticeably improve sleep quality.

Should I have a corticosteroid injection?

A corticosteroid injection can relieve pain in the short term and may be recommended by a clinician for some patients ^[2][5]. However, research shows that an education- and exercise-based programme produces better medium- and long-term outcomes than a single injection ^[6]. For this reason an injection is generally considered alongside an exercise programme rather than as a standalone solution. The decision should be made individually together with your clinician.

Does losing weight really help?

Yes — for people who are overweight, it can make an important difference. There is a strong link between GTPS and excess weight, and studies report that a 10% weight loss can provide roughly a 50% reduction in symptoms ^[3]. Weight management supports treatment by reducing the load on the lateral hip tissues.

Does this condition require surgery?

Very rarely. The vast majority of cases improve without surgery through load management, exercise and physiotherapy ^[1][6]. Surgery is generally reserved for resistant cases lasting longer than six months that do not respond to all other treatments, or for significant tendon tears ^[2].

Can greater trochanteric pain syndrome come back?

It can recur if the triggering mechanical causes are not corrected. Persistent weakness of the side hip muscles, continuing to overload the hip, or maintaining excess weight increase the risk of recurrence ^[6][3]. For this reason, continuing the exercises that keep the hip strong even after the pain has gone, and paying attention to load management, is the key to long-term prevention.