How to Get Rid of Hip Bursitis: What Actually Works

Most people who search for hip bursitis relief are actually dealing with a condition that has been renamed: what doctors once called trochanteric bursitis is now understood, in the majority of cases, to be a problem with the tendons of the gluteal muscles rather than with the bursa itself. That distinction matters because it changes which treatments are worth your time. The approaches with the strongest evidence include targeted physical therapy, corticosteroid injections for short-term relief, shockwave therapy, and addressing biomechanical issues like weak hip muscles or poorly fitting footwear. Getting better usually takes months rather than weeks, and some treatments that feel good early on fade over time.

What “Hip Bursitis” Actually Is

For decades, doctors attributed pain on the outside of the hip to inflammation of the trochanteric bursa, the small fluid-filled sac that cushions the bony prominence at the top of your thighbone. The standard diagnosis was “trochanteric bursitis.” Imaging and surgical research over the past two decades has rewritten that understanding. Gluteal tendinopathy, meaning degeneration or damage to the tendons of the gluteus medius and gluteus minimus muscles where they attach to the greater trochanter, is now considered the primary local source of lateral hip pain.¹ The broader umbrella term used today is greater trochanteric pain syndrome, or GTPS, which covers the tendon problems, any genuine bursal inflammation, and the muscle imbalances that often accompany them.²

This is not just a naming exercise. If the real problem is tendon degeneration rather than an inflamed bursa, treatments aimed purely at suppressing inflammation will only buy you time without fixing the underlying issue. It also explains why so many people find that anti-inflammatory drugs or a cortisone shot help for a few weeks and then the pain creeps back. The tendon itself needs to be loaded, strengthened, and given time to remodel.

Why Lateral Hip Pain Develops

GTPS affects roughly one in ten to one in four people in developed countries, depending on the population studied, and it is far more common in women than men.³ Post-menopausal women between 45 and 63 are the group hit hardest. Declining estrogen levels reduce collagen production, thinning the tendons and increasing the likelihood of tendon damage and rupture.⁴

Biomechanically, the condition often traces to weakness in the hip abductor muscles. When your gluteus medius cannot do its job of stabilizing the pelvis during walking or standing on one leg, the tendon gets overloaded with every step. Muscle imbalances, a wider pelvis, a leg-length discrepancy, or habitual postures like standing with your weight shifted to one hip can all pile compressive load onto the tendon at the greater trochanter. Running on cambered roads, sleeping on the affected side, or repeatedly crossing your legs adds to the problem.

Anti-Inflammatories and Activity Modification

The simplest first step is reducing the load on the irritated structures while managing pain. Nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen can partially relieve the pain and are a reasonable starting point while you figure out a longer-term strategy.⁵ They work best for acute flares rather than as a chronic solution.

Activity modification matters more than most people realize. This does not mean total rest. It means avoiding the specific positions and movements that compress the tendon against the bone:

Sleeping: Avoid lying on the painful side. A pillow between your knees when lying on the opposite side reduces tension on the hip.
Standing: Stop hitching your hip out to one side or leaning into the painful hip.
Sitting: Avoid crossing your legs or sitting in low, deep chairs that force the hip into sharp angles.
Exercise: Temporarily reduce activities that repetitively load the outside of the hip, such as hill running, stair climbing, or lateral band walks done too aggressively too soon.

These modifications are not treatments in themselves, but without them, the treatments described below tend to work less well.

Physical Therapy and Strengthening

If you do one thing, this should probably be it. Targeted exercise to strengthen the hip abductors and improve pelvic stability is the intervention with the most durable long-term evidence. The gluteus medius and gluteus minimus need to be gradually loaded in a way that stimulates tendon remodeling without triggering more pain. A good physiotherapist will start with isometric exercises (where the muscle contracts without moving the joint), progress to slow, controlled movements against resistance, and eventually move to functional exercises like single-leg balance work and step-ups.

The catch is that it takes time. You should expect a minimum of eight to twelve weeks before seeing meaningful improvement, and sitting pain in particular can be slow to resolve, sometimes persisting for up to a year.⁶ People who understand that timeline upfront tend to stick with the program rather than abandoning it after a few weeks for the next injection or quick fix.

Corticosteroid Injections

A cortisone shot into the trochanteric area is one of the most commonly offered treatments, and the evidence paints a specific picture: it works well in the short term and fades over time. In a primary care trial, about 55% of patients who received an injection had recovered at three months, compared with 34% in the usual care group. By twelve months, the groups had converged; roughly 60% in each group had recovered, with no meaningful difference between them.⁷

A systematic review found that symptom resolution following corticosteroid injection ranged widely, from about half of patients to nearly all, depending on whether other treatments like physical therapy were added.⁸ The injection buys a window of reduced pain that can be valuable if you use it to start a strengthening program. Used in isolation, it tends to wear off. One long-term primary care study found that patients who had received a corticosteroid injection had roughly a threefold better chance of recovery at five years compared with those who had not, which suggests that the pain-free window may enable behavioral changes that compound over time.⁹

One risk to be aware of: repeated corticosteroid injections are associated with worse surgical outcomes if you eventually need an operation. Higher numbers of prior injections have been identified as a prognostic factor for poorer results.¹⁰ So while one or two injections can be genuinely useful, the “just keep getting shots every few months” approach is not a good long-term strategy.

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) delivers acoustic energy pulses to the affected area. It sounds futuristic, but it has been accumulating a solid evidence base for lateral hip pain. A randomized trial comparing shockwave therapy, home exercises, and corticosteroid injection found that shockwave therapy produced the best results at four months, with a 68% success rate compared with 41% for home training and 51% for corticosteroid injection. By fifteen months, both shockwave therapy and home training had pulled well ahead of cortisone, which had declined to a 48% success rate.¹¹

A separate single-blind randomized study found that both shockwave therapy and corticosteroid injection improved pain and function at three weeks, with improvements lasting to three months, and neither treatment proved superior to the other.¹² A systematic review pooling multiple randomized trials found that ESWT produced lower pain scores than other treatments at two to four months. Focused shockwave therapy appeared to reduce pain more than the radial type.¹³

Shockwave therapy is not available everywhere and is not always covered by insurance, but if you have access to it, the evidence positions it as one of the more effective options, especially if you want to avoid injections or have already tried cortisone without lasting benefit.

Dry Needling

Dry needling involves inserting thin monofilament needles into trigger points and tender areas around the hip. A randomized clinical trial directly comparing dry needling to cortisone injection for GTPS found that dry needling was not inferior: it provided comparable pain relief and functional improvement at six weeks.¹⁴ A systematic review of dry needling for hip conditions confirmed short-term pain reduction and improvements in range of motion and muscle force, with no serious side effects reported.¹⁵

Dry needling is worth considering if you want to avoid corticosteroids, particularly if repeated injections concern you or if you are already combining other treatments. It does not carry the tendon-weakening risks associated with cortisone. The evidence is still smaller in volume than for injections or shockwave therapy, but what exists is encouraging.

Platelet-Rich Plasma Injections

Platelet-rich plasma (PRP) involves drawing your own blood, concentrating the platelets, and injecting the preparation into the damaged tendon. The idea is that growth factors in the platelets stimulate tissue repair. A double-blind randomized trial compared a single PRP injection to a single corticosteroid injection for gluteal tendinopathy. At two and six weeks, there was no difference. By twelve weeks, the PRP group had pulled ahead: about 82% of PRP recipients achieved a meaningful clinical improvement, compared with roughly 57% in the corticosteroid group.¹⁶

This is a single trial, and PRP preparations vary a lot between clinics, so the results should be interpreted with some caution. PRP is also typically not covered by insurance, and costs can be substantial. Still, for people who have not responded to physical therapy and want an injection-based option that may have more durable effects than cortisone, it is one of the more interesting recent findings in this space.

Custom Foot Orthotics

This one surprises most people. A cohort-controlled trial found that adding custom-made foot orthotics to corticosteroid injection dramatically improved outcomes. At four months, 90% of patients who received both the injection and custom orthotics reported recovery, compared with only 40% in the group that received the injection alone. The orthotics group also had far fewer recurrences.¹⁷ A systematic review of foot orthoses for hip pain conditions, including trochanteric pain, found moderate improvement in pain following their use.¹⁸

The logic is straightforward. If abnormal foot mechanics, a subtle leg-length discrepancy, or poor arch support are altering your gait, your hip has to compensate with every step. Fix the foundation, and you reduce the repetitive stress at the top of the chain. If you have been dealing with recurring lateral hip pain and no one has ever looked at your feet, it is worth asking a podiatrist or sports physiotherapist about an assessment.

Weight Management

Higher body mass index is an independent risk factor for worse outcomes with GTPS, showing up both as a predictor of persistent symptoms and as a prognostic factor for poorer surgical results.¹⁰ A study of obese patients before and after bariatric surgery found that every participant had lower-extremity musculoskeletal conditions before surgery. After weight loss, only about a third still did, and pain and function scores improved across the board. The change in BMI was the main factor driving the improvement in pain.¹⁹

This does not mean you need bariatric surgery. The point is that excess weight meaningfully increases the mechanical load on the hip tendons, and reducing that load, even by a moderate amount, can change the math for your recovery. For someone carrying significant extra weight, a weight-loss effort can be as therapeutically important as any injection or therapy session.

When Surgery Becomes the Conversation

Surgery is reserved for people who have genuinely exhausted conservative treatments over a sustained period. The most common procedure is endoscopic trochanteric bursectomy, sometimes combined with iliotibial band release, performed through small incisions with a camera.²⁰ For cases involving significant gluteal tendon tears, open or endoscopic tendon repair may be considered.

The surgical evidence is thinner than the conservative evidence, and outcomes are not guaranteed. Certain factors make surgical outcomes less favorable: higher BMI, a history of many prior corticosteroid injections, longer delay from symptom onset to surgery, smoking, emotional distress, fibromyalgia, hypothyroidism, and prior lumbar spine surgery.¹⁰ If several of those factors apply to you, an honest discussion with your surgeon about realistic expectations is essential before committing.

The Recovery Timeline

GTPS is often a stubborn condition. A primary care study tracking patients over years found that after one year, at least 36% still had trochanteric pain. After five years, 29% remained symptomatic.⁹ The strongest predictor of persistent pain at one year was having osteoarthritis in the lower limbs, which nearly quintupled the risk of ongoing symptoms.

These numbers can feel discouraging, but they represent the full spectrum of patients, including those who may not have pursued structured treatment. The people who combine a genuine strengthening program with biomechanical corrections and one or two well-timed interventions tend to fare better than those who rely on a single modality. The condition rewards persistence and the willingness to address multiple contributing factors rather than hunting for a single cure.

How Mental Health Fits In

People with persistent GTPS do not just have a hip problem. Compared with pain-free individuals, they show higher levels of depression and anxiety, reduced quality of life, and impaired pain processing. In one cross-sectional study, about a quarter of the variation in pain and disability was explained by just three factors: depression, hip abductor strength, and the time it took to climb stairs.²¹

Depression and chronic pain feed each other in well-documented ways. Depressed individuals tend to be less physically active, which weakens the hip muscles further, which worsens the tendon problem, which increases pain, which deepens the depression. If you have been struggling with lateral hip pain for months and your mood has taken a hit, treating the mood is not a distraction from treating the hip. It is part of treating the hip. Talk to your doctor about this if it applies to you, and do not wait until every physical intervention has been tried first.

Septic Bursitis and When to Worry

Rarely, bursitis can be caused by infection rather than mechanical overload. Septic bursitis is more common in superficial bursae like the elbow or kneecap than in the deep trochanteric bursa, but it does occur. Fever is a suggestive sign, though an inconsistent one: it has been reported in anywhere from 20% to 77% of patients with septic bursitis.²² If your hip pain comes on rapidly, is accompanied by redness, warmth, or swelling, and especially if you have a fever or a recent wound or injection at the site, get it evaluated promptly. Septic bursitis requires antibiotics and sometimes surgical drainage, and a strengthening program will not fix it.

Getting the Diagnosis Right

Before committing to a treatment plan, it is worth making sure the pain is actually coming from the lateral hip structures and not from somewhere else. Hip osteoarthritis, lumbar spine problems, and referred pain from the lower back can all masquerade as or coexist with trochanteric pain.²³ If you have groin pain rather than pain on the outside of the hip, or if the pain radiates below the knee, those are clues that something else may be going on.

Imaging is not always necessary but can help when the diagnosis is unclear or when a tendon tear is suspected. MRI sensitivity for gluteal tendon tears ranges widely, from about a third to nearly all cases, depending on the study. Ultrasound tends to be more consistent, with sensitivity of 79% to 100% and a high positive predictive value.²⁴ A skilled clinician can often diagnose GTPS on physical examination alone, using a combination of tenderness over the greater trochanter, pain with specific hip movements, and weakness on resisted hip abduction. Imaging becomes most useful when you are considering PRP injection (which should be placed precisely into the tendon) or evaluating for a tear that might change the surgical calculus.

1
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