Hip Bursitis (Greater Trochanteric Pain Syndrome)
Greater trochanteric pain syndrome (GTPS) is the current preferred term for what was historically called trochanteric bursitis. It’s a common cause of outer hip and buttock pain, affecting runners, middle-aged women and those with altered hip mechanics. We now understand the pain often comes from the gluteal tendons (gluteus medius and minimus) rather than just the bursa — which changes how it’s best treated.
Why It Happens
The gluteal tendons wrap around the bony bump on the outer hip (greater trochanter). When these tendons are repeatedly compressed against the bone — through activities, posture or anatomical factors — they develop a tendinopathy. The adjacent bursa may also become inflamed.
Contributing Factors
- Weak hip abductor muscles (gluteus medius)
- Running with excessive hip crossover or a narrow stride
- Sudden increase in running distance or load
- Hip osteoarthritis or leg length difference
- Pelvic drop posture (Trendelenburg)
- More common in perimenopausal women
Symptoms
- Pain on the outside of the hip, sometimes spreading into the outer thigh
- Tenderness over the greater trochanter (the bony bump on the outer hip)
- Pain walking, climbing stairs, crossing the legs or lying on the affected side
- Worse after sitting with legs crossed or sleeping on one side
- Eases initially with walking but worsens if you overdo it
Treatment
Load Management (Critical)
Compressive loads on the tendon — crossing legs, sitting with hips below knees, lying on the side — aggravate tendinopathy. We’ll show you exactly which positions to avoid and for how long.
Gluteal Strengthening
Progressive, carefully dosed hip abductor and external rotator strengthening is the most effective long-term treatment. This is gradual — the tendons need to be loaded appropriately, not aggressively.
Manual Therapy and Dry Needling
Soft tissue work and dry needling to the gluteal muscles can reduce pain and improve muscle function, making exercise more achievable.
Running Analysis
For runners, we assess stride width, hip drop and cadence — small technique adjustments can dramatically reduce compressive forces on the tendon.
What Doesn’t Work
Stretching the ITB and hip into adduction compresses the tendon and typically makes GTPS worse. Cortisone injections can provide short-term relief but don’t address the underlying tendinopathy — exercises remain essential.
