The most telling sign of hip bursitis is point tenderness on the bony bump on the outer side of your hip, called the greater trochanter. If pressing firmly on that spot reproduces a familiar ache that radiates down the outside of your thigh, you’re looking at the most common presentation of the condition. But hip bursitis can show up in more than one location, and several other hip problems mimic it closely, so the details matter.
Where the Pain Shows Up
There are two main types of hip bursitis, and the pain location is different for each.
The far more common type is trochanteric bursitis, now often called greater trochanteric pain syndrome. The pain sits on the outer point of the hip and typically radiates along the outside of the thigh toward the knee. In some cases it extends below the knee or wraps around into the buttock. It’s not a deep, interior hip pain. It lives on the surface, right where the bony prominence of your upper thighbone juts outward.
The second type is ischial bursitis, which affects the bursae near your sit bones, the bony points you feel when you sit on a hard chair. This one produces a dull, deep ache in the lower buttock or back of the thigh. Prolonged sitting and exercise both make it worse, and you can usually pinpoint the exact spot that hurts. Some people notice visible swelling or have trouble sleeping because they can’t find a comfortable position.
Movements and Positions That Trigger It
Trochanteric bursitis has a distinctive set of triggers that help separate it from other hip conditions. The pain tends to flare during or after these activities:
- Lying on the affected side. This is one of the hallmarks. Many people first notice the problem because their hip aches at night when they roll onto that side.
- Climbing stairs or walking uphill. The repeated hip flexion and the load on the outer hip muscles aggravate the inflamed bursa.
- Getting up from a chair after sitting for a while, especially from a low seat.
- Crossing your legs or sitting with your knees together, which puts tension across the outer hip.
The pain is generally worse at night and can disturb sleep, which is a useful clue during self-assessment. If your hip bothers you most in the morning and loosens up as you move, that pattern points more toward arthritis than bursitis.
A Simple Self-Check
You can do a rough version of what a clinician does in the office. Lie on your unaffected side so the sore hip faces the ceiling. Use your fingertips to press firmly along the bony prominence on the outer hip. The greater trochanter is easy to find: it’s the hard bump roughly at pocket level on the side of your thigh. If pressing directly on it, or just behind and above it, reproduces the pain you’ve been feeling, that’s the single most reliable physical finding for trochanteric bursitis.
You can also test for pain with resisted movement. While standing, have someone push inward against your knee as you try to push your leg outward. If this triggers your familiar lateral hip pain, it suggests irritation of the bursa or the tendons that glide over it.
How It Differs From Hip Arthritis
Hip arthritis and hip bursitis are frequently confused because they both cause hip pain, but the pattern is different in ways you can track at home.
Arthritis pain tends to settle deep in the groin or front of the hip. It’s stiffest in the morning and after long periods of sitting still, then gradually eases with gentle movement. Over time, you’ll notice your hip losing range of motion: it becomes harder to put on socks, get into a car, or rotate your leg inward.
Bursitis pain lives on the outside of the hip, not the groin. It’s worse at night rather than in the morning, and it intensifies when you lie on the affected side. Range of motion is often preserved. You can still move the hip through its full arc, but certain positions hurt because of pressure on the inflamed bursa rather than damage inside the joint itself.
Who Gets It Most Often
Women develop hip bursitis roughly three times more often than men. In a large epidemiological study, 15% of women and about 7% of men had the condition on at least one side. Among people reporting hip pain specifically (without accompanying knee or widespread pain), the rates were even higher: 24% of women and 9% of men. Age and race did not significantly change the risk.
Several structural and lifestyle factors raise your chances. A difference in leg lengths, even a modest one, tilts the pelvis and changes how force distributes across the outer hip with every step. Scoliosis creates a similar imbalance. Repetitive activities like running, cycling with a poorly fitted bike, or standing for long hours on hard surfaces all contribute. Previous hip surgery, a fall onto the outer hip, or weakness in the gluteal muscles that stabilize the pelvis are also common precursors.
What a Doctor’s Exam Adds
If your self-check is suggestive but you want confirmation, a clinical exam can pin things down. Doctors use a few specific maneuvers beyond simple palpation.
The FABER test (an acronym for flexion, abduction, and external rotation) involves lying on your back while the examiner places your ankle on your opposite knee and gently presses the bent knee toward the table. Pain on the outer hip during this maneuver supports a bursitis diagnosis. The Trendelenburg test checks the strength of your hip abductor muscles: you stand on the affected leg, and if your pelvis drops on the opposite side, it signals weakness in the muscles that cross over the bursa, a frequent contributor to chronic cases.
Imaging is usually unnecessary. Most hip bursitis is diagnosed through the physical exam alone. If the picture is unclear, or if symptoms don’t improve with initial treatment, an ultrasound or MRI can confirm fluid in the bursa or reveal tendon damage. X-rays don’t show bursitis directly, but they’re sometimes ordered to rule out a stress fracture or arthritis.
Signs of Something More Serious
Most hip bursitis is a nuisance, not a danger. But bursae can become infected, a condition called septic bursitis, and that requires prompt treatment. Watch for these warning signs layered on top of your hip pain:
- Skin redness and warmth spreading over the outer hip
- Significant swelling that develops quickly
- Fever, chills, or a general feeling of being unwell
- Pain that is severe and worsening rather than achy and stable
Septic bursitis is more common in people with weakened immune systems or an open wound near the hip. If you have a combination of these symptoms, especially fever with a red, hot, swollen hip, that warrants same-day medical evaluation rather than a wait-and-see approach.