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Hip Bursitis and Outer Hip Pain: Physical Therapy in Brooklyn

By Dr. Jack Engelberg, PT, DPT · · 4 min read

Pain on the outside of the hip that makes it hard to lie on your side at night, climb the stairs out of the subway, or stand on one leg to put on your pants is very common, especially in women over 40. For years it was simply called "hip bursitis." Today clinicians usually call it greater trochanteric pain syndrome (GTPS), because the tendons around the hip are often more involved than the bursa itself. Whatever the name, physical therapy is one of the most effective treatments.

What Is Greater Trochanteric Pain Syndrome?

The greater trochanter is the bony point you can feel on the outside of your upper thigh. Several structures sit over it:

  • The gluteus medius and minimus tendons — muscles that stabilize the pelvis when you stand on one leg and walk
  • Bursae — small, fluid-filled sacs that reduce friction
  • The iliotibial (IT) band — a thick band of tissue running down the outside of the thigh

In GTPS, the gluteal tendons are usually irritated or overloaded (gluteal tendinopathy), sometimes with an inflamed bursa as well. Compression of the tendons against the bone, such as when lying on your side or crossing your legs, tends to aggravate them.

Common Symptoms

  • Pain and tenderness on the outside of the hip, sometimes down the outer thigh
  • Pain lying on the affected side, and sometimes on the opposite side, since the top leg drops across
  • Pain getting up from a chair or climbing stairs
  • Pain standing on one leg
  • Pain after walking for a while, especially uphill
  • Pain sitting with legs crossed or in a low chair

What Causes Outer Hip Pain?

  • Changes in activity — a sudden increase in walking, running or stair climbing
  • Compressive positions — crossing your legs, standing with your weight sunk into one hip, sleeping on your side
  • Hip muscle weakness, particularly of the gluteal muscles
  • Hormonal changes — GTPS is more common in women around and after menopause
  • Other conditions — such as knee arthritis or low back problems that change how you walk
  • A direct fall onto the side of the hip

It's important to distinguish GTPS from pain coming from the hip joint itself, which is usually felt in the groin, or from the low back.

How Physical Therapy Helps

Research supports education and progressive exercise as an effective treatment for gluteal tendinopathy, with benefits that tend to last longer than a single corticosteroid injection.

Evaluation

Your therapist will pinpoint the source of the pain, check hip strength and range of motion, analyze how you walk and stand on one leg, and screen your back and the hip joint.

Treatment May Include

  • Education about compression — learning which positions and habits keep irritating the tendons
  • Isometric exercises — gentle holds that calm the tendon
  • Progressive gluteal strengthening — building from easy exercises to standing, functional and weight-bearing work
  • Movement retraining — walking, stair climbing and single-leg standing with better pelvic control
  • Manual therapy — for related stiffness in the hip or back
  • Graded return to walking, running or fitness classes

Stretching the IT band, which was once common advice, can actually compress the tendons and is often not helpful for this condition.

What You Can Do at Home

  • Avoid crossing your legs when sitting.
  • Stand evenly on both feet rather than hanging on one hip.
  • Sleep smart. If you lie on your side, place a pillow between your knees. A soft topper may help if lying on the sore side is unavoidable.
  • Sit higher. Very low chairs and couches increase strain; add a cushion.
  • Take stairs one at a time for a while if they flare symptoms.
  • Try a gentle isometric. Lying on your back with a belt around your knees, gently push your knees outward into the belt and hold for 30 seconds, repeating a few times.

When to See a Physical Therapist

Book an evaluation if:

  • Outer hip pain has lasted more than a couple of weeks
  • It's disrupting your sleep
  • It limits walking, stairs or exercise

See a physician if hip pain follows a fall, if you can't bear weight on the leg, if there is fever, redness or swelling, or if pain is severe and getting worse at rest.

Frequently Asked Questions

Is it bursitis or tendinitis?

Often both, but the tendons are frequently the main issue. That's why strengthening is so important.

Will a cortisone shot fix it?

An injection can reduce pain in the short term for some people, but studies suggest that education plus exercise gives better longer-term results.

Could my hip pain be coming from the joint instead?

Yes. Pain felt in the groin is more typical of hip joint problems, such as arthritis or hip dysplasia. A thorough evaluation helps tell them apart.

Ready to get started? Call the Refuah office nearest you

Schedule an evaluation by phone, or book online at refuahpt.com.

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About the author. Dr. Jack Engelberg, PT, DPT is a Doctor of Physical Therapy and owner of Refuah Physical & Occupational Therapy, with offices in Midwood and Boro Park, Brooklyn, and on Staten Island.

Medical disclaimer: This article is for general education only and is not medical advice, diagnosis or treatment. Everyone’s situation is different. Talk with your physician or a licensed physical therapist about your symptoms. If you think you have a medical emergency, call 911.

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