Hip Bursitis (Trochanteric Pain): Relief and Exercises
Published
Local Physiotherapist - Stephen Hayward, County Durham & Teesside
Pain on the outside of your hip that aches when you walk, hurts when you lie on that side at night, and makes crossing your legs uncomfortable? This is the classic pattern of trochanteric pain syndrome — often called hip bursitis — and it is one of the most common causes of hip pain in adults.
Greater trochanteric pain syndrome (GTPS) affects the outside of the hip, where the large gluteal tendons attach and a small fluid-filled sac (the trochanteric bursa) sits. When these structures become irritated — whether the bursa is inflamed (bursitis) or the tendons are degenerated (tendinopathy) — the result is pain on the bony prominence at the side of your hip.
What it feels like
Typical symptoms include:
- Pain on the outside of the hip, often described as an ache or sharp pain
- Pain that worsens when lying on the affected side at night
- Pain when walking, climbing stairs or standing up from a chair
- Tenderness when pressing the bony bump on the side of the hip
- Pain when crossing the legs or sitting with legs crossed
- Sometimes pain radiating down the outside of the thigh
The condition is more common in women, particularly after the menopause, and in people over 40. It can also affect runners and cyclists.
What causes trochanteric pain syndrome?
The condition is usually caused by a combination of:
- Weak hip muscles: The gluteus medius and minimus muscles on the side of the hip stabilise the pelvis during walking. When they are weak, the tendons and bursa are overloaded.
- Increased compression: The iliotibial (IT) band passes over the bursa. If the hip muscles are weak, the IT band compresses the bursa with every step.
- Activity changes: Sudden increases in walking, running or standing
- Weight gain: Increases load on the hip structures
- Hormonal changes: Menopause can affect tendon health
- Poor biomechanics: Flat feet, leg length differences or poor running technique
What to avoid (and why it matters)
One of the most important aspects of treating trochanteric pain is reducing the compressive forces that irritate the bursa and tendons. Avoid or minimise:
Aggravating activities to avoid
- Lying on the affected side: This directly compresses the bursa. Sleep on the other side with a pillow between your knees, or on your back.
- Crossing the legs: Compresses the structures on the outside of the hip. Keep your knees parallel when sitting.
- Sitting with legs crossed or tucked under: Same mechanism — keep feet flat on the floor.
- Side leg raises while lying on the affected side: This exercise, often recommended for hip strength, actually compresses the bursa. Do standing side leg raises instead.
- Hill walking and stairs: These increase the load on the hip abductors. Reduce temporarily while you build strength.
- Prolonged standing on one leg: Shift weight between legs regularly.
The key to recovery: hip strengthening
Research shows that strengthening the hip abductor muscles is the most effective treatment for trochanteric pain syndrome. The goal is to build the capacity of the gluteus medius and minimus so that they can support the pelvis during walking without overloading the tendons and bursa.
The programme below progresses from gentle to more challenging. Start at the stage that is appropriate for your pain level.
Stage 1: Isometric and non-weight-bearing
1. Clam shells
Lie on your unaffected side with your knees bent and stacked. Keeping your feet together, lift the top knee like a clam shell opening. Hold for 2 seconds and lower slowly. Do 3 sets of 12. This strengthens the gluteus medius without compressing the bursa.
2. Standing hip abduction (unaffected side)
Stand holding a chair for support. Lift the affected leg out to the side, keeping it straight. Lower slowly. Do 3 sets of 12. By lifting the affected leg (rather than standing on it), you work the muscles without weight-bearing compression.
3. Bridging
Lie on your back with knees bent and feet flat. Lift your hips off the floor, squeezing your buttocks. Hold for 2 seconds and lower. Do 3 sets of 12. This strengthens the glutes and hamstrings.
Stage 2: Weight-bearing and resistance
4. Wall pushes (isometric hip abduction)
Stand sideways next to a wall, with the affected hip towards the wall. Lift the affected leg slightly and push the outside of the knee against the wall. Hold for 10 seconds. Repeat 5 times. This isometric exercise strengthens the hip muscles without movement.
5. Resistance band side steps
Place a resistance band around your ankles. Stand with feet hip-width apart. Take 10 small steps sideways in one direction, then 10 back. Keep tension on the band throughout. Do 3 sets. This is one of the best exercises for the gluteus medius.
6. Single-leg stand
Stand on the affected leg, holding a chair for support. Hold for 30 seconds. Progress to 60 seconds, then try without support. This trains the hip muscles to stabilise the pelvis in a functional position.
Stage 3: Functional and progressive
7. Single-leg squat (mini)
Stand on the affected leg next to a wall for fingertip support. Bend the standing knee slightly (no more than 30 degrees), keeping the knee over the foot. Return to standing. Do 3 sets of 10. This builds functional strength.
8. Step-ups
Step up onto a low step with the affected leg, then step down. Do 3 sets of 10. Progress to a higher step as strength improves. This mimics the demands of stairs.
9. Side plank
Lie on your unaffected side. Prop yourself up on your forearm. Lift your hips so your body is in a straight line. Hold for 20 seconds. Repeat 3 times. This builds endurance in the hip muscles.
Pain management while you strengthen
- Ice: 15 minutes of ice on the outside of the hip after exercise can reduce irritation
- Heat: Before exercise, a warm pack can relax tight muscles
- Pain relief: Paracetamol or ibuprofen can help in the short term — follow package instructions
- Modify sleep: Sleep on the unaffected side with a pillow between your knees, or on your back
- Footwear: Supportive shoes with good cushioning reduce impact on the hip
Other treatment options
- Manual therapy: Your physiotherapist may use massage or mobilisation to address tight muscles and joint stiffness
- Shockwave therapy: May help chronic cases of tendon involvement
- Corticosteroid injection: Can provide short-term relief for bursitis but does not address the underlying muscle weakness. Best used alongside a strengthening programme.
- Weight management: Reducing body weight reduces load on the hip structures
When to see a physiotherapist
Trochanteric pain can be stubborn and is easy to aggravate. A physiotherapist can:
- Confirm the diagnosis and rule out other causes of hip pain (e.g. hip osteoarthritis, referred back pain)
- Assess your hip strength, walking pattern and biomechanics
- Design a progressive strengthening programme tailored to your stage
- Provide manual therapy for pain relief
- Advise on activity modification, sleep position and footwear
- Guide your return to walking, running or sport
Frequently asked questions
How long does hip bursitis take to heal?
Hip bursitis typically takes 6 to 12 weeks to resolve with proper management. Some cases take longer. The condition can be stubborn because the hip bears weight with every step. Consistency with strengthening exercises and avoiding aggravating activities (particularly lying on the affected side and crossing the legs) are key to recovery.
Should I exercise with hip bursitis?
Yes, but the right exercises. Strengthening the hip abductor muscles (gluteus medius and minimus) is the most effective treatment for trochanteric pain syndrome. Avoid exercises that compress the outside of the hip, such as side leg raises while lying on the affected side. Start with isometric and non-weight-bearing exercises, then progress gradually.
Can physiotherapy help with hip bursitis?
Yes. Physiotherapy is the primary treatment for trochanteric pain syndrome. A physiotherapist can confirm the diagnosis, identify contributing factors such as weak hip muscles or poor walking mechanics, design a progressive strengthening programme, provide manual therapy and advise on activity modification and sleeping position.
Hip pain stopping you sleeping or walking?
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About Stephen Hayward
Stephen Hayward is an HCPC registered physiotherapist providing home visits across County Durham and Teesside. His background combines musculoskeletal rehabilitation, falls prevention, elderly rehabilitation and post-operative recovery. Stephen is a CSP member and provides home physiotherapy visits across County Durham and Teesside.