Hip Bursitis

Hip bursitis refers to inflammation of the bursae around the hip joint. Bursae are small, fluid-filled sacs that act as cushions between bones and soft tissues such as muscles, tendons, and skin. Their role is to reduce friction and allow smooth, low-resistance movement. Around the hip, there are several bursae, but the two most commonly involved in bursitis are the greater trochanteric bursa and the iliopsoas bursa.

The hallmark of hip bursitis is pain. However, the quality, location, and triggers of that pain provide important clues for diagnosis and appropriate management. Most patients with greater trochanteric bursitis report a dull, aching pain on the outside of the hip that may radiate down the lateral thigh. This pain is usually worse with activities that put stress on the hip, such as walking, running, climbing stairs, or standing from a seated position. Many patients also experience tenderness when pressing on the outside of the hip and discomfort when lying on the affected side at night.

With iliopsoas bursitis, pain is typically felt deep in the groin, often exacerbated by lifting the knee, prolonged standing, or pivoting movements. In more advanced or chronic cases, stiffness and a reduced range of motion may develop as a protective response to ongoing irritation. Pain may also flare during or after extended periods of sitting, particularly if the hips are flexed.

Hip bursitis is most often caused by repetitive stress or irritation of the bursae. Activities that involve prolonged running, cycling, stair climbing, or standing can overload the soft tissues around the hip. Biomechanical factors such as leg length discrepancy, abnormal gait patterns, weakness of the hip abductors or core muscles, and tightness in surrounding muscles (such as the IT band or hip flexors) can increase stress on the bursa. In many cases, these factors act together over time to produce gradual irritation rather than a single traumatic event.

Acute injury to the hip can also lead to bursitis. A fall directly onto the hip or blunt trauma may injure the bursa and surrounding tissues, triggering inflammation. In some individuals, hip bursitis is associated with other medical conditions that promote inflammation, such as rheumatoid arthritis, gout, or systemic inflammatory disorders. Less commonly, an infection of the bursa (septic bursitis) may occur.

Diagnosing hip bursitis begins with a detailed clinical history and a thorough physical examination. Clinicians at The Joint Preservation Clinic will ask about the onset of symptoms, the activities that worsen or relieve pain, and any recent injuries. During the physical exam, the provider will assess points of tenderness, evaluate muscle strength, observe gait mechanics, and check the range of motion of the hip joint. Special maneuvers may be used to reproduce the pain and help differentiate bursitis from other causes of hip or groin discomfort.

In many cases, the clinical presentation alone is sufficient to diagnose hip bursitis, particularly when the pain is localized to the outside of the hip with tenderness over the greater trochanter and there are no red flags for more serious conditions. However, imaging studies may be ordered to support the diagnosis or rule out other potential causes of hip pain, such as arthritis, labral tears, stress fractures, or tendon pathology. Laboratory tests are not routinely required for typical cases of hip bursitis.

Accurate diagnosis is essential because the treatment of hip pain depends on identifying the specific structures involved and addressing contributing factors. The Joint Preservation Clinic emphasizes a comprehensive approach, combining clinical evaluation with appropriate imaging and functional assessment to tailor a treatment plan that addresses both symptoms and underlying causes. Early recognition and intervention can prevent chronic pain and functional limitations, allowing patients to return to their daily activities with improved comfort and mobility.