Greater trochanteric bursitis refers to inflammation or irritation of one of the small fluid-filled “cushions” (bursae) on the outside of the hip, near the greater trochanter (the bony point you can feel on the outer upper thigh). These bursae help reduce friction between tendons and bone during movement.
In modern practice, many cases that used to be labelled “trochanteric bursitis” are now grouped under a broader diagnosis called Greater Trochanteric Pain Syndrome (GTPS). This is because imaging and research have shown that gluteal tendinopathy (irritation or degeneration of the gluteus medius/minimus tendons) and tendon tears are often the main driver, with bursitis sometimes present and sometimes not. In other words, the bursa can be involved, but it is frequently not the only issue and not always the primary cause of pain. :contentReference[oaicite:0]{index=0}
People typically describe pain on the outside of the hip that can spread down the outer thigh, and it is commonly worse when:
- lying on the affected side,
- walking or standing for longer periods,
- climbing stairs or hills, or
- getting up from a chair.
This can be very disruptive to sleep and daily routines, and it often leads to limping or avoiding activity. The good news is that most cases respond well to conservative care when the diagnosis is accurate and the rehab plan addresses the real driver (often tendon overload and compression).
Physiotherapy for greater trochanteric bursitis / GTPS is one of the most effective approaches. A physiotherapist will confirm that your pain is coming from the lateral hip tissues (and not the lower back, hip joint arthritis, or a stress fracture), then guide a targeted GTPS rehab program. That usually means changing the positions that compress the painful tissues, building hip abductor strength (gluteus medius/minimus), improving pelvic control, and gradually reintroducing walking, stairs, running, or sport-specific loads.
Key Facts
- GTPS tends to affect middle-aged or older women more often, especially those with lower limb weakness or altered walking patterns. 🔗
- A large community-based study reported unilateral GTPS prevalence of around 15% in females and 6.6% in males aged 50 to 70 years, showing how common lateral hip pain of this type can be. 🔗
- GTPS is commonly related to overuse or small injuries of the gluteus medius/minimus tendons and surrounding bursae. 🔗
Risk Factors
- Female sex and age over 40 (GTPS is reported as more common in females over 40).
- Sudden increases in walking, running, stair climbing, hills, or standing demands.
- Hip abductor weakness or poor endurance (gluteus medius/minimus) leading to higher tendon load during gait.
- Pelvic control deficits (pelvic drop) and habitual postures that compress the lateral hip, such as standing “on one hip”.
- Lumbar spine, hip joint, or knee issues that alter walking mechanics and increase lateral hip load.
- Higher body mass may increase load on the hip abductors and is discussed as a common association in some cohorts.
Symptoms
- Pain and tenderness on the outside of the hip over the greater trochanter (often very sore to press).
- Pain that can spread down the outer thigh (sometimes mistaken for “sciatica”, but without true nerve-root signs).
- Pain when lying on the affected side, often causing night pain and disrupted sleep.
- Pain with walking, especially longer distances, and pain with standing for prolonged periods.
- Pain on stairs or hills, and discomfort when getting up from a chair or out of the car.
- Limping or reduced confidence loading the affected leg, especially during flare-ups.
- Pain when standing on one leg (for example while putting on pants) or when the pelvis drops to one side.
Aggravating Factors
- Sleeping on the sore side or lying with the top knee dropped forward (increasing compression on the lateral hip).
- Walking long distances, especially if your stride or pelvic control places higher load on the hip abductors.
- Stairs, hills, step-ups, and repeated sit-to-stand tasks.
- Prolonged standing with weight shifted onto one hip (“hanging on one hip”).
- Running, side-stepping, and sports requiring cutting or single-leg stability when symptoms are irritable.
- Sudden increases in activity (new walking program, return to running, long hikes, extra work shifts).
Causes
Greater trochanteric bursitis and GTPS are usually load-related conditions. The tissues on the outside of the hip (gluteal tendons and bursae) become painful when they are repeatedly compressed and overloaded without enough recovery. A classic example is a jump in walking or running volume, or a period of reduced activity followed by “getting back into it” quickly.
Although bursitis is part of the name, many people with classic “trochanteric bursitis” symptoms have a primary issue in the gluteus medius and/or gluteus minimus tendons. These tendons function like the “stabilisers” of the hip. They keep the pelvis level during walking and single-leg tasks. If they are weak, irritated, or degenerative, the tendon can become sensitive, and nearby bursae may also become reactive. Radiology references and reviews describe trochanteric syndrome/GTPS as commonly involving gluteal tendinopathy or tears, with bursitis sometimes present and sometimes not. :contentReference[oaicite:1]{index=1}
Common contributing factors include:
- Compression positions: side-lying on the painful hip, crossed legs, or standing with the hip pushed out to the side.
- Hip abductor weakness: reduced strength or endurance in gluteus medius/minimus increases strain with walking and stairs.
- Pelvic control issues: if the pelvis drops during single-leg stance (common when fatigued), the lateral hip tissues are loaded harder.
- Sudden load changes: a sharp increase in walking, running, stairs, or hills.
- Body composition and age factors: GTPS is reported as more common in females over 40 and is discussed as more common in obese females in imaging reviews (noting this is not the cause for every person). :contentReference[oaicite:2]{index=2}
Physiotherapy targets these contributors directly. That is why a strong greater trochanteric bursitis physiotherapy plan is not just pain relief, but a structured pathway back to normal walking, sleep, and sport.
How Is It Diagnosed?
A physiotherapist can usually diagnose greater trochanteric bursitis/GTPS through a detailed history and physical examination. The hallmark is localised pain and tenderness over the greater trochanter combined with symptoms that worsen with side-lying, walking, stairs, and single-leg loading.
Your physiotherapist will also look for:
- pain reproduction with resisted hip abduction (testing gluteal tendon load),
- pain with single-leg stance or step-down tasks,
- pelvic control issues (Trendelenburg-type patterns), and
- movement habits that increase tendon compression (crossed legs, hip-hanging stance).
Because lateral hip pain can sometimes come from the lower back, hip joint arthritis, stress fractures, or referred pain, physiotherapists also screen for red flags and differential diagnoses. If symptoms are severe, atypical, or not responding to appropriate rehab, imaging may be considered to clarify tendon pathology, rule out other issues, or guide injection decisions.
Importantly, your diagnosis should guide treatment. If your pain is truly driven by tendon overload and compression, physiotherapy will prioritise load modification and progressive strengthening rather than only “anti-inflammatory” approaches.
Investigations & Imaging
- Ultrasound
- Can show bursal fluid/distension and can assess gluteal tendons for tendinopathy or tears; also useful for guiding injections when required.
- MRI
- Useful when symptoms persist or diagnosis is unclear; assesses gluteus medius/minimus tendons, bursae, and other hip region pathology. Often used to distinguish bursitis from gluteal tendinopathy/tear patterns.
- X-ray
- Does not show bursae or tendons directly, but may be used to assess hip osteoarthritis, bony morphology, or other causes of lateral hip pain when clinically suspected.
- Diagnostic injection (local anaesthetic with or without corticosteroid)
- May help confirm the lateral hip tissues as the pain source and can provide short-term symptom relief to support rehabilitation progression.
Grading / Classification
- GTPS with predominant gluteal tendinopathy
- Pain is mainly driven by gluteus medius/minimus tendon overload, commonly worsened by walking, stairs, and single-leg tasks; bursitis may or may not be present.
- GTPS with trochanteric bursitis
- Bursal irritation may contribute, sometimes with imaging evidence of bursal distension; still commonly co-exists with tendon pathology and responds best to load management plus strengthening.
- GTPS with partial or full-thickness gluteal tendon tear
- More severe tendon pathology can present with greater weakness, persistent pain, and difficulty progressing rehab; may require specialist input if function remains significantly limited.
Physiotherapy Management
Physiotherapy for greater trochanteric bursitis (often managed as GTPS) focuses on reducing compression and overload at the lateral hip, then rebuilding the strength and endurance of the gluteal tendons so they can tolerate everyday activity again.
Many people are told the bursa is “inflamed” and that rest is the solution. Rest may reduce pain temporarily, but it often does not solve the underlying load problem. Physiotherapy is about changing how the tissues are loaded, and gradually increasing capacity so you can sleep on your side, walk further, climb stairs, and return to sport without repeated flare-ups.
A physiotherapist will individualise your plan based on what triggers symptoms (walking vs sitting vs stairs), your hip strength and pelvic control, and how irritable the condition is. A good program usually includes:
- education on positions that compress the tendon and bursa (and how to avoid them),
- graded strengthening of the hip abductors and supporting lower-limb muscles,
- movement retraining for walking and stairs, and
- activity pacing and gradual return to impact if you run or play sport.
Healthdirect (Australia) highlights that exercise can ease GTPS symptoms and help prevent recurrence, aligning with a physiotherapy-led approach.
Exercise
Physiotherapy exercises are usually progressed through phases. The key principle is to strengthen the tendon without repeatedly compressing and irritating it. That means choosing the right exercise positions at the right time.
Phase 1: calm the hip and start low-irritability strength. Early on, exercises often focus on gentle hip abductor activation in positions that do not compress the lateral hip. Many people flare with side-lying hip abduction early, especially if it places pressure directly on the sore area. A physiotherapist may start with supported isometrics (static holds), standing hip abduction with light resistance, or modified bridge variations, depending on what you tolerate. If pain is highly irritable, the goal is consistency rather than intensity.
Phase 2: build gluteal tendon capacity. As symptoms settle, strengthening becomes more progressive and functional. This often includes targeted gluteus medius/minimus strengthening, plus gluteus maximus and trunk control to improve pelvic stability. Exercises commonly progress toward: step-ups, controlled single-leg stance drills, hip hinge patterns, and squat variations within a comfortable range. Clinical practice guidelines and protocols commonly emphasise progressive resistance and criterion-based progression rather than rushing into painful positions.
Phase 3: return to walking, stairs, running and sport. Once strength and control improve, rehab progresses toward the tasks you need: longer walks, hills, stairs, and if relevant, running and cutting. A physiotherapist will typically increase volume first, then intensity, while watching your 24-hour symptom response. The target is to rebuild tolerance without repeatedly provoking sharp night pain or next-day limping.
Because many cases are tendon-dominant rather than pure bursitis, exercise is not optional. It is the core of long-term recovery and recurrence prevention.
Activity Modification
Activity modification is crucial in the early stage because GTPS pain is often driven by compression and overload. Physiotherapists commonly recommend temporarily reducing:
- long walks (especially on cambered surfaces),
- stairs and hills in high volume,
- running and lateral drills, and
- standing with your hip pushed out to the side.
Sleep modification is one of the biggest wins. If you cannot avoid side-sleeping, a physiotherapist may suggest using pillows to keep the top leg supported and reduce hip adduction (which compresses the lateral hip). Many people also benefit from avoiding crossed legs and low chairs that encourage hip adduction.
The goal is not to stop moving. It is to reduce the specific triggers while you build strength and gradually return to normal loads.
Manual Therapy
Manual therapy can help some people with greater trochanteric bursitis/GTPS, particularly when pain has led to protective stiffness in the hip, pelvis, and lower back. Physiotherapists may use soft tissue techniques to reduce guarding in surrounding muscles and joint mobilisation to improve movement options.
Manual therapy is most valuable when it supports your ability to do the active part of rehab. For example, if hip flexor tightness or lumbar stiffness is altering your walking pattern, treating these contributors can reduce lateral hip load and help you progress strengthening. Manual therapy alone is rarely enough because tendon-driven pain needs progressive loading to improve long-term tolerance.
Postural Retraining
Postural retraining for GTPS is less about “perfect posture” and more about pelvic control and load distribution during real life. A common aggravator is standing with weight shifted onto one hip. This places sustained compression and load through the painful lateral hip tissues. Physiotherapists coach more even weight-bearing and strategies to reduce prolonged single-hip loading at work and home.
Gait retraining can also help. If you limp or reduce stride on one side, other tissues can become irritated and recovery can stall. A physiotherapist may work on step length, cadence (for runners), trunk position, and hip control so the gluteal tendons share load more efficiently and the bursa is less irritated.
Bracing & Taping
Bracing is not commonly required for greater trochanteric bursitis/GTPS. Taping is sometimes used short-term to improve comfort and confidence, particularly to cue pelvic position and reduce painful movement patterns during walking.
Footwear and orthotics may be considered in selected cases where foot mechanics or leg alignment is clearly contributing to lateral hip load, especially in people who walk long distances for work. These are usually supportive strategies alongside a strengthening-focused rehab plan, not stand-alone solutions.
Dry Needling
Dry needling may be used by some physiotherapists to reduce secondary muscle guarding in the gluteals, tensor fascia latae (TFL), or lateral thigh muscles that tighten protectively when the hip is painful. This can sometimes help people tolerate walking and exercise progression.
Dry needling does not change tendon capacity by itself. If your pain is primarily tendon-driven, the long-term change comes from progressive strengthening and reducing compressive aggravators, with dry needling used only as an adjunct when it meaningfully improves function.
Shockwave
Shockwave therapy (extracorporeal shockwave therapy, ESWT) is sometimes used as an adjunct for persistent GTPS, particularly when gluteal tendinopathy features are prominent. It is usually most effective when paired with an exercise-based rehab program rather than used in isolation.
If shockwave is considered, a physiotherapist will usually still prioritise load management and progressive strengthening, using ESWT to support pain reduction so you can progress exercises and walking tolerance more comfortably.
Heat & Ice
Heat and ice can be used for short-term symptom relief. Ice may help after activity flare-ups when the lateral hip feels hot or sharply painful. Heat can be helpful if muscle guarding is prominent and you need to relax tissues before gentle movement.
These strategies are supportive. In physiotherapy for greater trochanteric bursitis, they are usually used to help you stay consistent with your rehab exercises and walking plan.
Tens
TENS may help some people manage pain, particularly if sleep is disrupted or pain limits early activity. It can reduce pain sensitivity enough to help you keep walking and complete your strengthening program.
TENS is an adjunct. The core of GTPS recovery remains education, load modification, and progressive strengthening.
Education
Education is one of the most important parts of GTPS rehab. People often think they need to “stretch the ITB” or “rub out the bursa”, but in many cases the key problem is that the gluteal tendons are overloaded and compressed. Learning which positions compress the tendon and bursa (side-lying, crossed legs, hip-hanging stance) helps you reduce flare-ups quickly.
Education also covers pacing. Many people have a boom-bust cycle: they do more on a good day, pain flares at night, then they rest for days. Physiotherapists teach you how to build activity gradually using your 24-hour response as feedback, so the tendon adapts rather than repeatedly flaring.
Other
Other helpful components of GTPS physiotherapy management include:
Sleep set-up: pillow strategies to reduce hip adduction and compression, and guidance on how to change sleep position without constantly flaring symptoms.
Work and daily-life planning: strategies to reduce prolonged standing “on one hip”, modify stairs and hills temporarily, and plan walking dose increases.
Return-to-running progressions: if you run, your physio will usually build a plan that increases volume first, then speed and hills, while monitoring next-day pain. This prevents recurring lateral hip flare-ups that can otherwise drag on for months.
Other Treatments
Other treatments may be used alongside physiotherapy depending on severity and response.
Medication: Your GP may recommend short-term anti-inflammatory medication or analgesia to manage symptoms and allow you to stay active.
Corticosteroid injection: An injection into the trochanteric bursa region may reduce pain for some people, particularly in highly irritable cases. It is generally considered an adjunct, not a cure, because if tendon overload and compression are not addressed, symptoms often recur. NICE CKS includes injection as a management option in primary care pathways for appropriate cases.
Imaging-guided procedures: Ultrasound-guided injections are sometimes used to improve accuracy.
Shockwave: ESWT may be used as an adjunct for persistent tendon-dominant presentations, ideally alongside progressive loading.
Even when these options help, long-term improvement usually depends on completing greater trochanteric bursitis physiotherapy exercises and changing the daily movement and sleep habits that repeatedly compress the lateral hip.
Surgery
Surgery is rarely needed for greater trochanteric bursitis/GTPS. It may be considered only when there is confirmed significant tendon tearing or persistent severe symptoms that do not respond to a well-structured conservative program, and after specialist assessment. In surgical pathways, physiotherapy remains essential pre- and post-operatively to restore strength, pelvic control, and walking tolerance, and to reduce the risk of ongoing pain after surgery.
Prognosis & Return to Activity
Most people with greater trochanteric pain syndrome (GTPS) improve with conservative management, but recovery speed depends on how long symptoms have been present and how quickly contributing loads can be modified. Early in the condition, simple changes like adjusting sleep positions and avoiding movements that compress the outside of the hip, combined with a progressive strengthening program can lead to meaningful improvement within weeks.
Longer-standing pain often takes more time to settle, as the gluteal tendons may have reduced strength and the nervous system can become more sensitive to loading. In these cases, consistent rehabilitation and careful pacing are essential to recovery.
Return to activity is best guided by your function and how your symptoms respond over a 24-hour period. Positive signs of progress include better sleep, less pain during single-leg activities, improved walking without limping, and reduced discomfort when climbing stairs. A physiotherapist can help guide your rehab, from early strength work through to higher-level or sport-specific activities while minimising the risk of flare-ups.
Complications
- Persistent night pain and sleep disruption, especially if side-lying compression is not modified.
- Chronic gluteal tendinopathy symptoms and reduced walking tolerance if strengthening and load management are not addressed.
- Secondary issues such as low back, knee, or opposite hip pain due to limping and altered gait over time.
- Reduced activity levels and deconditioning from avoidance, leading to slower recovery and recurrent flare-ups.
Preventing Recurrence
- Avoid prolonged compression positions: don’t stand “hanging” on one hip, avoid crossed legs, and reduce time side-lying on the painful hip.
- Use a pillow strategy at night to reduce hip adduction and tendon compression (support the top leg so it doesn’t drop forward).
- Maintain gluteal strength year-round. Ongoing hip abductor strengthening helps the tendons tolerate walking, stairs, and sport without flare-ups.
- Increase walking, running, hills, and stairs gradually rather than in sudden spikes, especially after time off or injury.
- If running, progress volume first, then speed and hills, and back off early if night pain or next-day limping increases.
When to See a Physio
- Your pain is severe, worsening, or associated with fever, unexplained weight loss, or feeling systemically unwell (needs medical assessment).
- You cannot weight-bear normally, or you have sudden severe pain after a fall or impact (rule out fracture or significant tendon injury).
- You have persistent night pain that does not improve with simple sleep and load modifications.
- Your symptoms have not improved after 2 to 4 weeks of sensible activity modification and home strategies.
- You want a structured <strong>physiotherapy for greater trochanteric bursitis</strong> plan to return to walking, stairs, running, or work demands.
- You have recurrent flare-ups and want a long-term prevention strategy (gluteal strengthening and load progression).