Your "Hip Bursitis" Probably Isn't Bursitis
Someone comes in holding a scan report. The word on it is bursitis.
They've usually been told the same thing. There's a small fluid-filled cushion on the outside of your hip, it's inflamed, and a cortisone injection will settle it down.
Sometimes they've already had the injection. It helped for a few weeks. Then the pain came back.
Here's what I tell them.
That word on the report is probably wrong. And because the label is wrong, the treatment that follows it is often wrong too.
This isn't me disagreeing with their doctor for the sake of it. The research on this shifted years ago, and the name of the condition has officially changed. A lot of people just haven't been told.
What the scans actually show
A large study looked at 877 patients with pain on the outside of the hip. Every one of them had an ultrasound.
Nearly 80% had no bursitis at all.
Only 8% had bursitis on its own. Meanwhile, half of them had a problem with the gluteal tendons instead. Another 29% had thickening or tearing of the band that runs down the outside of the thigh.
The researchers were blunt about what this means. The cause is usually a combination of problems in the gluteal tendons and that band. Bursitis shows up in only a minority of people.
Medical references now describe trochanteric bursitis as a misnomer when it's used for all outer hip pain. True primary bursitis is rare.
The condition has been renamed. It's now called greater trochanteric pain syndrome, and most of the time the real problem is the tendon.
It's also far more common than people realise. Around 15% of women aged 50 to 70 have it on one side, and women get it about twice as often as men.
Why the label matters so much
This isn't a technicality. The two problems need opposite treatment.
Bursitis is inflammation. Inflammation responds to rest and anti-inflammatories. Calm it down, let it settle.
Tendinopathy isn't really inflammation. It's a tendon that has become disorganised and weakened under load it couldn't handle. And a weak tendon doesn't get stronger by resting.
Think about a callus on your hand. It builds up because of gradual, repeated load. Stop using your hands and the callus disappears. Your skin gets softer, not tougher.
Tendons work the same way. They need load to rebuild.
So treat a tendon problem like a bruise, and you make it weaker. That's why so many people rest, take the anti-inflammatories, feel a bit better, go back to normal, and flare up again within weeks.
The treatment didn't fail them. It was aimed at the wrong thing.
What the research says about cortisone
This is the part most people haven't heard.
A randomised trial published in the BMJ compared three approaches in 204 people with gluteal tendinopathy. One group got education about managing load, plus specific exercises. One group got a cortisone injection. One group did nothing and waited.
At eight weeks, 77% of the education and exercise group reported meaningful improvement. The cortisone group was 59%. The wait and see group was 29%.
Pain scores told the same story. The exercise group dropped to 1.5 out of 10. Cortisone was 2.7. Waiting was 3.8.
They followed everyone for a full year. The exercise group was still reporting better overall improvement than the cortisone group at 52 weeks.
So cortisone does beat doing nothing. That's worth saying clearly. But a properly structured loading program beat the injection, both at eight weeks and a year later.
Has the injection been offered as the whole plan rather than a bridge to rehab? It's fair to ask what happens after it wears off.
Why it happens in the first place
Here's the mechanical version.
On the outside of your hip there's a bony bump. That's the top of your thigh bone. Your gluteal tendons attach to it, and a thick band of tissue runs straight over the top.
When your glutes are strong, they hold your pelvis level as you walk. The tendons do their job without being squashed.
When the glutes aren't doing enough, your hip drops slightly with every step. That drop pulls the band tight and presses it into the tendon underneath.
Compression is the real enemy here. Not movement, not exercise. Compression.
And a lot of everyday habits compress that tendon without you noticing.
Crossing your legs. Standing with your weight hanging on one hip. Sleeping on your side without a pillow between your knees. Sitting in low, soft chairs. Deep stretches that pull your knee across your body, which is often exactly what people are told to do.
That last one catches people out. The classic "stretch your ITB" advice frequently makes this condition worse, because the stretch position is a compression position.
Three things to change this week
None of these cost anything, and all three reduce compression.
Stop crossing your legs. Sit with both feet on the floor. This is the single most common aggravator I see, and most people do it without thinking for hours a day.
Put a pillow between your knees at night. Without it, your top leg drops forward and compresses the tendon against the bone all night long.
Stop hanging on one hip when you stand. Waiting in a queue, holding a child, doing the dishes. Keep your weight even across both feet.
Give these a fortnight. Reducing compression won't rebuild the tendon on its own. But a lot of people notice the background ache settles once they stop irritating it all day.
What proper management looks like
Getting this right has three parts.
The first is an accurate diagnosis. That means a proper examination rather than reading a label off a report. Testing which tendon is involved, how it responds to load, and whether the pain is genuinely coming from the hip at all. Pain on the outside of the hip can also be referred from the lower back, and that changes everything about what you do next.
The second is load management. Working out what's compressing the tendon in your day and removing it, which is what the three changes above start.
The third is progressive loading. Building the gluteal tendons back up in a structured, gradual way. This is the part with the strongest evidence behind it, and it's the part people most often skip.
I'll be straightforward about my role here. For gluteal tendinopathy, the evidence points clearly to education and exercise as the core treatment. What I add is accurate assessment, and addressing the things further up the chain that may be contributing.
If your pelvis isn't sitting level, or your lower back mechanics have changed, that affects how your hip loads with every single step. Sometimes the tendon is where the pain is, but not where the problem started.
Where to start: hip bursitis treatment in Clyde North
If you've been told you have hip bursitis and the treatment hasn't held, it's worth finding out what's actually going on.
That's what our ClearSpine Pain Assessment is built for. We perform five targeted tests designed to find what's really driving your symptoms. They show where load is concentrating and what the path forward looks like.
I see people from across Melbourne's southeast, including Berwick, Cranbourne, Narre Warren, Officer and Beaconsfield, here at the clinic in Clyde North.
If you're ready to stop guessing, book your ClearSpine Pain Assessment or call us on (03) 5915 9895.
The name on your scan report isn't a treatment plan. It's just a starting point, and sometimes it's the wrong one.
(An important note: hip pain after a fall, pain that stops you weight-bearing, or pain with fever or unexplained weight loss needs medical assessment first. See your GP or go to emergency.)
Dr. Ashley Cherrett (BAppSc(Chiro), BHlthSc) is the principal chiropractor and owner of Cherrett Chiropractic in Clyde North, Melbourne. He practises using the Chiropractic BioPhysics (CBP) technique, a structured, evidence-based approach to spinal correction. This article is educational and does not constitute medical advice. Individual results vary, and all care is based on individual assessment.
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