Hip Bursitis & Gluteal Tendinopathy: who to see and what helps

Hip Bursitis & Gluteal Tendinopathy · Kitchener, Waterloo & Cambridge

Pain over the bony point on the outside of the hip was long called hip bursitis. It is now usually called greater trochanteric pain syndrome, because the tendons of the buttock muscles are thought to be the source more often than the bursa. In a trial of 204 people, a program of education and exercise did better than a cortisone injection. At CARESPACE the first visit is with a physiotherapist or a chiropractor, who assesses the hip and starts treatment that day.

What hip bursitis and gluteal tendinopathy are

The bony point you can feel on the outside of your hip is the greater trochanter. Two buttock muscles, gluteus medius and gluteus minimus, attach to it by tendons, and a fluid-filled sac called a bursa sits over it as a cushion. Pain here was traditionally put down to an inflamed bursa (trochanteric bursitis). Surgical, tissue and imaging studies have since attributed it to tendinopathy of those two tendons, with or without a problem in the bursa. Greater trochanteric pain syndrome is the name that covers both.

A glute strain is different: a buttock muscle stretched or torn, like any other pulled muscle. See Muscle Strain.

Symptoms

• Pain at the point of the hip, which can spread down the outside of the thigh as far as the knee
• Pain when lying on that side, often bad enough to disturb sleep
• Pain with weight-bearing activity
• Tenderness when you press on the bony point
• Sometimes a limp

Who gets it, and why

It is most common in women between 40 and 60; the trial described below cites a figure of one in four women over 50. It can start after sudden unaccustomed exercise, a fall, prolonged weight-bearing or sporting overuse. Jogging and long-distance cycling are named too, and so is prolonged standing, which describes most shifts on a plant or warehouse floor. Lower-back problems, a difference in leg length, rheumatoid arthritis and previous surgery are listed as risk factors.

How it is diagnosed

By examination. Two findings carry most of the weight: tenderness when the greater trochanter is pressed (without it, the diagnosis is unlikely) and pain within 30 seconds of standing on the affected leg. An X-ray is usually normal and is used to check for other causes. Ultrasound or MRI is a second step, considered when the pain has not responded to treatment, and MRI changes at these tendons are commonly found in people with no symptoms.

When hip pain is an emergency

The warning signs below are the ones the NHS, the UK’s health service, lists for hip pain, with the Ontario equivalent of what it tells people to do. Call 911 or go to an emergency department if you have severe hip pain after a fall or injury, you are unable to walk or put weight on your leg, or you have any tingling or loss of feeling in your hip or leg after an injury. Severe pain and being unable to walk after a fall can mean a broken hip. Do not drive yourself.

Go to an urgent care clinic or an emergency department the same day if you have severe hip pain that started suddenly without a fall or injury, your hip is swollen and feels hot, the skin around your hip has changed colour, or you have hip pain, feel generally unwell and have a high temperature (or feel hot, cold or shivery). A hot, swollen hip with a fever can be a joint infection.

Hip or groin pain that comes on with running or hard training needs medical assessment the same day, at an urgent care clinic or emergency department if you cannot reach a physician or nurse practitioner. It can be a stress fracture in the neck of the thigh bone, which can shift out of place and then needs surgery. A normal X-ray does not settle it, because X-rays alone cannot rule out a stress fracture. Protect the leg with crutches until the diagnosis is confirmed. Stress Fractures has more.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner if hip pain is stopping you doing normal activities or affecting your sleep, is getting worse or keeps coming back, has not improved after two weeks of looking after it yourself, or comes with hip stiffness that lasts more than 30 minutes after you wake up.

A word on sleep, since the list above mentions it. Pain when lying on the sore side is part of the usual pattern of this condition. The NHS line is general advice for hip pain that nobody has examined; a physiotherapist or chiropractor can assess this pattern, and can tell you if anything points to a cause that needs a physician.

What the evidence says about treating it

• Education plus exercise: the main trial. An Australian trial of 204 people aged 35 to 70, with pain for more than three months, compared 14 physiotherapy sessions over eight weeks (tendon-loading advice and daily hip-strengthening exercises) with one corticosteroid injection and with waiting. At eight weeks, 77% of the exercise group rated themselves at least moderately better, against 58% after injection and 29% of those who waited.
• The lead held at a year, with a caveat. At 52 weeks the figures were 78%, 57% and 52%. On pain scores alone, the exercise and injection groups were by then no different from each other, and both were better than waiting.
• Injections work early and fade. A British review for family doctors says corticosteroid injections give effective short-term pain relief in 70 to 75% of cases, but that at 12 months trials show no difference from watching and waiting.
• Positions matter. The same review says positions that bring the thigh across the body, such as crossing the legs, should be avoided, and suggests sleeping with one or two pillows between the legs.
• Sources disagree on stretching the IT band. The American orthopaedic surgeons’ page suggests exercises to stretch it. The British review lists IT band stretches among the positions to avoid.
• Pooled trials: short-term gains only. A network meta-analysis covering 13 trials found that structured exercise was the only treatment to improve function significantly over no treatment at one to three months, that shockwave therapy and platelet-rich plasma injections may ease pain over the same period, and that at 6 to 12 months no treatment was significantly better than none for pain.
• Dry needling: one small trial, and no win in the pooled analysis. In 43 people followed for six weeks, dry needling was no worse than a cortisone injection for pain and function. Dry needling was also one of the treatments in the pooled analysis, where only shockwave and platelet-rich plasma did significantly better than no treatment for pain at one to three months.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit. A corticosteroid injection, with the orthopaedic surgeons’ advice to limit the number. Anti-inflammatory medicine, used cautiously and for limited periods. Platelet-rich plasma injections and shockwave therapy; the British review notes that the UK’s national guideline body recommends shockwave only under special circumstances. A scan, or a surgical opinion in the rare case that has not improved with non-surgical care.

How each CARESPACE service treats it

Physiotherapy

The program tested in the trial was delivered by physiotherapists, and it had two parts. The first is education: which positions and movements press the tendons against the bone, and how to build activity back up gradually. The second is exercise done daily at home, to strengthen the hip abductor muscles and control how far the thigh drifts across the body. A physiotherapist can assess the hip and build a plan of that kind. Some CARESPACE physiotherapists offer dry needling; the evidence list above gives its one small trial and the pooled result.

See our physiotherapy team →

Chiropractic

This condition can be mistaken for hip osteoarthritis or for pain referred from the lower back. A chiropractor can examine the hip, pelvis and lower back together to sort out which is which, and check for a difference in leg length. Treatment can include soft-tissue work, advice on positions and loading, and the strengthening exercises the evidence supports.

See our chiropractic team →

Massage Therapy

The evidence here is thin. The British review lists soft tissue therapy among the measures for the early, painful phase, next to rest, ice and taping; none of the trials above tested massage. A Registered Massage Therapist can work on the muscles of the buttock and outer thigh while the hip is sore, in addition to the exercise program.

See our massage therapy team →

Kinesiology

A kinesiologist can supervise hip abductor strengthening, the core of the exercise program above, and progress it toward longer walks, stairs, running or a full day on your feet. In the pooled analysis, structured exercise was the one treatment that improved function over no treatment in the short term.

See our kinesiology team →

Other services people ask about

Acupuncture. None of the sources listed here report a trial of acupuncture for this condition; the nearest evidence is the dry needling trial above.

Where most people start

With a physiotherapist or a chiropractor. Both assess and treat at the first visit.

How your team works together

The physiotherapist or chiropractor you start with sets the positions to change and the exercises. Massage therapy can be added while the area is tender, and a kinesiologist can take on the strengthening as it progresses. If the pain has not responded, your practitioner can tell you when to ask a physician about an injection or a scan.

Browse by service: physiotherapists, chiropractors, registered massage therapists and kinesiologists.

What to expect at your first visit

1. The pattern of the pain: nights, standing, walking, and any recent change in activity.
2. The examination. Pressing over the bony point, standing on one leg, hip strength and movement, and a check of the lower back.
3. Treatment at that visit and a plan to leave with: positions to change, and the first exercises.

What you can do at home

• Avoid sitting with your legs crossed.
• Sleep with one or two pillows between your legs.
• Avoid the activities that bring the pain on, and long periods of standing.
• Use an ice pack on the sore area, and a cane for a week or more if the hip is very sore.
• If you are overweight, losing weight reduces the pressure on the hip.
• Ask a pharmacist about pain relief.

How long it lasts

About three in four people doing the exercise program rated themselves at least moderately better by eight weeks. Among those who only waited, 29% said the same at eight weeks and 52% at a year. The sources we read give no figure for how often it comes back.

Hip bursitis and gluteal tendinopathy treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener, Massage Therapy in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo, Massage Therapy in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is it bursitis or gluteal tendinopathy?

Studies point to the tendons, with or without the bursa, which is why one name now covers both.

How should I sleep with hip bursitis?

Lying on the sore side is what typically hurts. The British review for family doctors suggests one or two pillows between your legs.

Is a cortisone injection worth having?

It can give quick relief: in the trial, 58% of people were at least moderately better eight weeks after one injection. Education and exercise did better at eight weeks and at a year. Whether an injection suits you is a conversation with a physician.

How is this different from hip arthritis?

Osteoarthritis is the most common cause of pain at the front of the hip in older adults, and difficulty putting on shoes and socks points toward it. With this condition the pain is on the outside and that task is not usually a problem. See Hip Osteoarthritis.

Where can I get treatment for hip bursitis in Cambridge?

At our Hespeler Road location, starting with Physiotherapy in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Mellor R, 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. BMJ, 2018.
• Gazendam A, et al. Comparative Efficacy of Nonoperative Treatments for Greater Trochanteric Pain Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Clinical Journal of Sport Medicine, 2022.
• Speers CJB, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. British Journal of General Practice, 2017.
• Brennan KL, Allen BC, Munoz Maldonado Y. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy, 2017.
• Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis. American Family Physician, 2021.
• MyHealth Alberta. Trochanteric Bursitis. Current as of July 2024.
• American Academy of Orthopaedic Surgeons. Hip Bursitis and Hip Strains. OrthoInfo.
• Robinson PG, Campbell VBD, Murray AD, Nicol A, Robson J. Stress fractures: diagnosis and management in the primary care setting. British Journal of General Practice, 2019.
• NHS. Hip pain in adults. Reviewed November 2025.

Related conditions

Hip Pain
Hip Osteoarthritis
IT Band Syndrome
Piriformis Syndrome
Sciatica

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