Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
Outer hip pain is commonly diagnosed as “hip bursitis” — but modern understanding has shifted. The primary driver of greater trochanteric pain is gluteal tendinopathy, not bursitis. This distinction matters enormously for treatment: the right approach produces excellent results; the wrong approach makes things worse.
Understanding Greater Trochanteric Pain Syndrome
The greater trochanter is the bony prominence on the outer hip. The gluteus medius and minimus tendons attach here, along with the trochanteric bursa. Current evidence shows that gluteal tendinopathy — degeneration of the gluteal tendons under excessive compressive and tensile load — is the primary pathology in most cases. The bursa becomes secondarily inflamed from the overloaded tendons compressing against it.
The IT band crossing the greater trochanter during hip movement creates the compressive load on the tendons. Positions that bring the hip past neutral adduction (crossing legs, lying on the side) maximise this compression.
Why Cortisone Alone Is Not Enough
Cortisone injections into the trochanteric bursa provide 4–8 weeks of pain relief in most patients. However, without addressing the underlying gluteal tendinopathy through progressive loading, the pain returns. The LEAP program trial (2018) found physiotherapy-led progressive loading produced superior 12-month outcomes compared to cortisone injection or wait-and-see.
Physiotherapy Treatment for GTPS
Phase 1: Load Management and Education (Weeks 1–4)
Avoid compressive loads: sleeping with a pillow between knees, avoiding crossed-leg sitting and hip adduction, no hip stretches (they increase compressive load). Isometric gluteal exercises in non-compressive positions. Education on the tendon model and why stretching is counterproductive.
Phase 2: Progressive Loading (Weeks 4–12)
- Isotonic gluteal strengthening: clamshells, side-lying hip abduction, hip extension
- Progressive weight-bearing loading: single-leg bridges, lateral step-ups, mini-squats
- Load monitoring: using pain monitoring to guide progression
Phase 3: Functional and Return to Activity (Weeks 12+)
Progressive return to walking distances, stairs, and desired activities. Runners and active people progress through running load gradually.
Frequently Asked Questions
What does hip bursitis (GTPS) feel like?
Pain at the outer hip (greater trochanter) that may radiate down the outer thigh. Worse with: walking (particularly with a Trendelenburg gait), lying on the affected side, climbing stairs, sitting cross-legged, or crossing the legs. Morning stiffness is common. The pain is often sharply aggravated by lying on the affected side at night.
Why is hip bursitis more common in women?
GTPS is 3–4 times more common in women than men. The wider female pelvis creates a greater Q-angle (hip-to-knee angle), which increases IT band compressive load on the gluteal tendons at the greater trochanter. Hormonal changes at menopause also affect tendon tissue quality. It is particularly common in women aged 40–60.
What positions and activities should I avoid with hip bursitis?
Avoid: crossing your legs (loads the IT band), standing with weight on one hip, lying on the affected side, sustained hip adduction (legs crossing midline). These positions compress the gluteal tendons against the greater trochanter. During rehabilitation, physiotherapy replaces these with positions that avoid compressive load while still maintaining activity.
How long does hip bursitis take to recover with physiotherapy?
Most patients with GTPS see significant improvement within 8–12 weeks of physiotherapy following the evidence-based LEAP program (Load, Education, Activity modification, Progression). Full recovery — particularly in active people with significant tendon degeneration — can take 3–6 months. The earlier treatment starts, the faster the recovery.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora