Trochanteric Bursitis
Pain on the outside of the hip — why it happens, what to stop doing, and the home exercise program that helps most people without an injection or an operation.
Trochanteric bursitis is one of the most common reasons patients come to see me with hip pain, and most of them do not need surgery. The three handouts below are what I give my own patients. Print them, scan the video codes with your phone, and give the program 8–12 weeks.
The handouts
Understanding and Managing Trochanteric Bursitis
What it is, why it happens, the do’s and don’ts of sitting and sleeping, and the treatment plan. Start here. PDF · 3 pages
Exercise & Load Management Handout
The six-exercise home program in three phases, positions to avoid, and the pain “traffic light” for pacing yourself. PDF · 2 pages
Video Exercise Directory (QR codes)
A QR code for each of the six exercises. Point your phone camera at the code to watch a demonstration of the correct form. PDF · 2 pages
What is trochanteric bursitis?
Bursitis is inflammation of the small, fluid-filled sacs that lubricate the motion between body parts. Trochanteric bursitis specifically refers to inflammation on the side of your hip, over the bony point called the greater trochanter.
While the pain is felt on the outside of the hip, it is usually a symptom of underlying mechanical issues rather than a standalone injury. The pain can sometimes radiate down the side of the thigh to, but not past, the knee.
This condition is also called gluteal tendinopathy or greater trochanteric pain syndrome; the exercise handouts use those names.
Why is this happening?
Think of your hip like a complex machine. When the parts are out of alignment, it creates friction. Your bursitis is likely caused by a combination of:
- Tightness. Your inner thigh muscles and your IT band (the tight band running down the outside of your thigh) may be too tight, pulling on the hip structure.
- Weakness. Weakness in your buttock (gluteal) and abdominal muscles can lead to mechanical imbalance. This is especially common in women over 50.
- Abnormal mechanics. Your hip may be moving in a way that puts unnecessary pressure on the bursa.
- Age and inactivity. As we age and become less active, our muscle strength decreases, which decreases our tolerance for activity.
Some facts you should know first
From the LEAP trial (Mellor et al., BMJ 2018), which compared the three approaches head to head.
That is why the program below is built on education and exercise, not injections.
The do’s and don’ts
Small changes in how you sit, stand, and sleep can significantly reduce daily inflammation. Doing the same activities in a “bad” position over and over keeps the bursa irritated.
Sitting and mobility
- Adjust your chair. Avoid low, soft couches or deep recliner chairs. These put the hip in a position that aggravates the bursa.
- Knees lower than your groin. When sitting, try to keep your knees lower than your groin. This takes the pressure off the painful bursa. You may need to sit on a firm pillow (or two) to achieve the correct height.
- Avoid crossing your legs. This creates uneven pressure and increased tension on the bursa.
- Driving and bucket seats. If you have a “bucket seat” in your car, try to elevate your buttock on a small pillow to prevent the sides of the seat from pressing against the bursa.
Sleeping
- Mattress support. A 2-inch memory foam topper on your mattress can provide the extra cushioning needed for a more comfortable night’s sleep.
- Side-lying. Avoid lying directly on the painful hip. When lying on your other side, place 1–2 firm pillows between your knees and ankles so the top leg does not sag across your midline.
Important: do NOT stretch by pulling your knee across your body toward the opposite shoulder, and avoid lying on the painful side. Both press the irritated gluteal tendons against the bone. Foam rolling the outer thigh and the inner-thigh stretch below are fine.
| Activity | Avoid (compresses the tendon) | Do instead |
|---|---|---|
| Sitting | Crossing legs at knees or ankles; low, soft, deep couches and chairs; sitting with knees together | Feet flat, knees parallel or wide; a higher, firm chair with cushion support; hips slightly higher than knees |
| Standing | “Hanging on one hip”; standing with legs crossed or feet together | Weight evenly on both feet, feet hip-width apart |
| Sleeping | Lying directly on the painful side; lying on the other side with no pillow (the leg sags across) | Unaffected side with 1–2 firm pillows between knees and ankles, or on your back with a pillow under the knees |
| Stretching | Pulling the knee across the body or toward the opposite shoulder | Foam rolling the outer thigh (not over the bony point) and the inner-thigh stretch |
Treatment and recovery
To manage the pain and improve your mobility, I recommend a multi-modal approach.
Targeted stretching
It is essential to lengthen the inner thigh muscles and the IT band.
The best way to stretch the IT band is with a foam roller: lie on your side with the roller under the outside of your thigh and slowly roll between the hip and the knee. Do not roll over the bony points at the hip or knee.
To stretch the inner thigh (adductor) muscles, sit with the soles of your feet together and gently push your thighs apart with your hands or elbows. Hold 30 seconds and repeat 3 times. You can also do this sitting in a chair with your knees apart.
Temperature therapy
Frequent icing of the area can help numb the pain and reduce active inflammation.
Over-the-counter medication
Voltaren gel can be applied up to 4 times a day to manage localized pain.
Drugs like Advil (3 pills 3 times a day) or Aleve (2 pills 2 times a day) can be beneficial when used for short periods of time (2 weeks). Take them with food. Do not use them if you have kidney, liver, or heart disease, or a history of stomach ulcers.
Footwear adjustments
If you notice pain specifically on your “long leg,” a heel lift in the opposite shoe to even out your leg lengths is helpful for some patients.
Formal physical therapy
Therapists can teach you how to properly do your exercises in a way that is less painful for you. Call 952-993-5900 to make a PT appointment. Your doctor can place an order for therapy in your chart.
Home exercise program
Strengthening the hip (gluteal) muscles is the most important part of treatment. Follow the Exercise & Load Management Handout and the Video Exercise Directory above. The six exercises are listed below with the same video links.
The six exercises
The program follows the LEAP trial protocol: start with Phase 1, and move to the next phase as the exercises become comfortable. Each video opens on YouTube in a new tab. Sets and repetitions are on the handout.
Phase 1 — pain relief and activation (low load)
1. Double-leg glute bridge
Lie on your back, knees bent, feet flat and hip-width apart. Squeeze your buttocks and lift your hips until your body is a straight line from shoulders to knees. Hold 5–10 seconds, 8–12 repetitions, 2–3 sets daily.
Phase 2 — progressive strengthening (moderate load)
2. Side-lying hip abduction
Lie on your uninjured side, hips rolled slightly forward. Keep the top leg straight, toe pointing forward or slightly down, and raise it 15–20° without letting your hip roll backward. 10–12 repetitions, 2–3 sets, 3–4 days a week.
3. Modified neutral clamshell
Lie on your uninjured side with knees bent to 45° and hips straight. Keeping your heels together, raise the top knee 20–30° without letting the pelvis roll back. 10–12 repetitions, 2–3 sets, 3–4 days a week.
4. Standing hip abduction with support
Stand next to a sturdy table or cabinet with both hands on it. Keeping your torso upright and pelvis level, lift the outer leg sideways 15–20° with the toe pointing forward or slightly inward; hold briefly, then lower with control. 10–12 repetitions per side, 2–3 sets, 3–4 days a week.
Phase 3 — functional strength (higher load)
5. Controlled low-step step-up
Face a 4–6 inch step. Step up with the affected leg, pressing through the midfoot and heel with the pelvis level and the knee over the second toe (no inward collapse). 8–10 repetitions, 2–3 sets, 3 days a week.
6. Standing hip hike on a step
Stand on one foot at the edge of a step with the other leg hanging off. Keep the standing knee straight but not locked. Slowly let the free hip drop, then squeeze the standing-side buttock to lift it above level. 8–12 repetitions, 2–3 sets, 3 days a week.
Pacing yourself: the pain traffic light
| Zone | Pain during and after exercise | What to do |
|---|---|---|
| Green | 0–3 out of 10, settles within 24 hours | Continue, and progress as tolerated. |
| Yellow | 4–5 out of 10, mild discomfort that settles by the next morning | Stay at the current level. Do not add repetitions or sets until it is stable. |
| Red | 6 or more out of 10, or morning stiffness or a flare lasting more than 24 hours | Reduce repetitions and sets, or drop back to Phase 1 until the pain settles. |
How long does it take?
Tendon tissue remodels slowly. In the LEAP trial, noticeable pain reduction and functional improvement typically came within 8 to 12 weeks of diligent exercise and load management, with strength continuing to improve over 6 to 12 months. Avoiding the compressing positions every day (crossing your legs, low chairs, stretching the knee across your body) is just as important as doing the exercises.
When to come back and see me. If you have followed the program carefully and have no meaningful improvement after 12 weeks, or your symptoms steadily worsen, an office evaluation is warranted. I will re-examine you for a tendon tear, muscle degeneration, or another cause of hip pain, and we will discuss whether an MRI or other treatment makes sense. Call 952-831-8742.
Sources
- Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial (the LEAP trial). BMJ 2018;361:k1662.
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther 2015;45(11):910–922.