Trochanteric bursitis is caused by repeated friction or pressure on the fluid-filled sac (bursa) that sits over the bony point of your outer hip. The most common triggers are repetitive movements, direct trauma like a fall, and structural imbalances in the legs or pelvis that change how forces travel through the hip. Women over 50 are disproportionately affected, with roughly 15 percent of women aged 50 to 70 experiencing outer hip pain compared to about 7 percent of men in the same age range.
What Happens Inside the Hip
The greater trochanter is the bony bump you can feel on the outside of your upper thigh. A bursa sits between this bone and the thick band of tissue (the iliotibial band, or IT band) that runs from your pelvis down to your knee. The bursa’s job is to reduce friction so the IT band can glide smoothly over the bone during walking, running, and climbing stairs.
When that bursa is irritated, whether from too much friction, a sudden impact, or inflammation from another condition, it swells and produces excess fluid. That swelling is what causes the aching or burning pain on the outside of your hip that often worsens when you lie on that side, climb stairs, or sit for a long time. In many cases, the nearby tendons of the gluteal muscles are also irritated, which is why doctors increasingly use the broader term “greater trochanteric pain syndrome” to describe this type of outer hip pain.
Repetitive Stress and Overuse
The single most common cause is repetitive motion that creates friction over the bursa. Running, cycling, and long-distance walking are frequent culprits because each stride involves the IT band sliding back and forth across the greater trochanter. Over thousands of repetitions, that friction inflames the bursa. Standing for prolonged periods, especially on hard surfaces, can have a similar cumulative effect.
You don’t need to be an athlete. Jobs that involve repetitive hip movements, prolonged standing, or frequent stair climbing put the same kind of stress on the outer hip. Even habits like always crossing the same leg when sitting can gradually increase tension on one side. The common thread is any motion or posture that repeatedly compresses or rubs the bursa against bone.
Direct Trauma and Injury
A single hard impact to the outer hip can trigger bursitis almost immediately. Falling onto your side, bumping your hip against a hard surface, or even lying on one hip for an extended period (during surgery recovery or prolonged bed rest, for example) can compress the bursa enough to cause swelling. This type of traumatic bursitis tends to come on suddenly, unlike the gradual onset from overuse. Anyone can develop trochanteric bursitis after a fall or direct injury, regardless of age or activity level.
Structural Imbalances
The way your body is built plays a significant role. A leg length discrepancy is one of the clearest structural risk factors. When one leg is even slightly longer than the other, it creates an asymmetry in posture and gait that places extra stress on the hip, lower back, knee, and ankle. Differences under 10 millimeters (roughly three-eighths of an inch) are usually well tolerated, but a discrepancy of 10 millimeters or more can lead to chronic hip pain and accelerated joint wear over time.
Other structural factors include a naturally wider pelvis (one reason the condition is more common in women), prior hip surgery that changes the mechanics of the joint, scoliosis, and knee or foot problems that alter your walking pattern. Anything that shifts your gait away from its normal alignment increases the repetitive load on the outer hip.
Weak or Tight Muscles
Muscle imbalances around the hip are both a cause and a perpetuating factor. Weak gluteal muscles, particularly the medium-sized gluteus medius that stabilizes your pelvis when you stand on one leg, force the IT band to work harder. That extra tension increases friction over the bursa. Tight hip flexors and a tight IT band compound the problem by pulling the soft tissues more snugly against the bone.
This is why trochanteric bursitis often develops in people who are relatively sedentary. Sitting for hours each day shortens the hip flexors and weakens the glutes, creating exactly the combination of tightness and weakness that loads the bursa. It also explains why the condition frequently responds well to targeted strengthening and stretching, even without other treatment.
Who Gets It Most Often
The typical profile is a woman over 50, and the numbers are striking. In a large community study of adults aged 50 to 70, unilateral (one-sided) outer hip pain was present in 15 percent of women and 6.6 percent of men. Bilateral pain, affecting both hips, showed up in 8.5 percent of women and just 1.9 percent of men. The female-to-male ratio is approximately 4 to 1.
Several factors explain the gender gap. Women tend to have a wider pelvis, which increases the angle at which the IT band crosses the greater trochanter. Hormonal changes after menopause also weaken tendons and reduce the resilience of soft tissues around the hip. Age itself is a factor for both sexes: tendons and bursae lose elasticity over time, and the cumulative effect of decades of walking and weight-bearing adds up.
Underlying Medical Conditions
Certain systemic conditions make the bursa more vulnerable to inflammation. Rheumatoid arthritis is one of the most well-established links; the same immune-driven inflammation that attacks joints can also target bursae. Gout and other crystal-deposit diseases can inflame bursae directly when crystals accumulate in or near the sac. Thyroid disorders, particularly an underactive thyroid, have also been associated with increased risk.
Being overweight matters, too. Extra body weight increases the mechanical load on the hip with every step, and excess adipose tissue produces inflammatory signals that can make soft tissues more prone to irritation. Even moderate weight loss can meaningfully reduce the forces acting on the outer hip during walking.
Previous Hip Surgery or Bone Spurs
Hip replacement surgery and other procedures that alter the anatomy around the greater trochanter are a recognized trigger. The surgical approach itself may disturb the bursa, and changes in leg length or hip mechanics after surgery can create new friction patterns. Bone spurs (osteophytes) that develop on the greater trochanter from arthritis or aging can also roughen the surface the IT band slides over, irritating the bursa with every movement.
How These Causes Overlap
In practice, trochanteric bursitis rarely has a single cause. A typical scenario might involve a woman in her mid-50s with mild gluteal weakness, a slightly wider pelvis, and a new walking routine. No single factor would be enough on its own, but together they create enough repetitive friction to inflame the bursa. Understanding which factors apply to you is what makes targeted treatment, usually a combination of activity modification, strengthening exercises, and occasionally a corticosteroid injection, more effective than a one-size-fits-all approach.