Overview
The greater trochanter is the bony knob on the outside of the hip. The gluteus medius and minimus tendons attach to it, a thin bursa cushions them, and the iliotibial band slides over the top each time the leg swings. “Trochanteric bursitis” is the traditional name, but imaging has shown the bursa is rarely the main problem. In most patients the gluteal tendons are the irritated tissue — thickened, sometimes partly torn — with the bursa inflamed alongside. Hence the current name, greater trochanteric pain syndrome.
The distinction matters because tendons do not recover with rest; they recover with the right amount of load and by stopping the compression that irritates them. What decides treatment is whether the tendon is intact or torn, how long the problem has been present, and whether the habits that compress it have changed. Almost everyone improves without surgery.
Common Symptoms
- Pain over the outer hip, sharply tender to press on, sometimes spreading down the outer thigh but not below the knee
- Pain lying on the affected side at night, and often on the other side too because the top leg drops across the body
- Pain on stairs and hills, getting up from a chair, and standing on one leg to dress
- A limp or ache after walking or running distances that used to be comfortable
- Pain sitting with the legs crossed or after a long drive
Outer-hip tenderness is the distinguishing feature. Pain felt in the groin points to the joint itself — hip arthritis in older patients or impingement in younger ones — and pain that runs past the knee with numbness or tingling is more likely sciatica.
Causes & Risk Factors
The gluteal tendons are compressed against the trochanter whenever the thigh crosses toward the midline: sleeping on the side, crossing the legs, standing with the weight hung on one hip, and running with a narrow step. Weak hip abductors let the pelvis drop with each stride, which adds to that compression. The condition is most common in women between 40 and 60. In younger patients and runners it usually follows a training spike: a new running program, a hiking trip, a jump in mileage or hills.
How It Is Diagnosed
The diagnosis is made on the exam. Dr. O'Donnell locates the tenderness precisely over the trochanter, then loads the gluteal tendons: standing on the affected leg for 30 seconds, resisted abduction in the FABER position, and the external de-rotation test. A Trendelenburg sign — the pelvis dropping on single-leg stance — suggests the tendon is weak or torn rather than merely irritated.
An AP pelvis X-ray rules out arthritis and may show calcification at the tendon insertion. Ultrasound shows tendon thickening, bursal fluid and partial tears, and guides the injection when one is given. MRI is ordered when a full-thickness gluteal tendon tear is suspected because of weakness or a Trendelenburg gait, or when symptoms have not improved after about 3 months of proper treatment. Existing scans can be uploaded through mymedicalimages.com ahead of a visit.
Treatment Options
Non-operative care
This is the treatment for the great majority, and it has three parts. The first is the one most often skipped: compression has to stop. A pillow between the knees in bed, no crossed legs, no hanging on one hip, and a wider step in walking and running. Second, the tendon is loaded progressively rather than rested: isometric abductor holds in the first weeks, then bridges, side-lying and standing abduction, and step-ups over 8 to 12 weeks. Aggressive iliotibial band stretching is avoided because it compresses the tendon further. Third, pain is managed so the program can proceed: a short course of anti-inflammatories, and for a hip too painful to exercise or sleep on, an ultrasound-guided corticosteroid injection into the bursa. The injection relieves pain for weeks to months but is not a cure on its own, and repeated injections weaken the tendon, so Dr. O'Donnell limits them and pairs each with the loading program. Shockwave therapy is an option for a tendon that has not settled after 3 to 6 months.
When surgery is considered
Surgery is uncommon. Endoscopic bursectomy with release of the tight iliotibial band is reserved for pain that has persisted 6 to 12 months despite everything above, and repair of a full-thickness gluteus medius tear is considered when MRI confirms the tear and it is causing weakness and a limp.
Recovery & What to Expect
There is no fixed protocol for this condition because progression depends on how the tendon responds to load. The timeline below is a conservative general guide, advanced or slowed on symptoms.
| Phase | Timing | What happens |
|---|---|---|
| Settle | Weeks 0–2 | Stop compressing positions, pillow between the knees, anti-inflammatories or injection if needed. Isometric abductor holds. Walking within comfort. |
| Early loading | Weeks 2–6 | Bridges, side-lying and standing abduction, sit-to-stand with control. Night pain should be improving. No running yet. |
| Progressive strengthening | Weeks 6–12 | Step-ups, single-leg squats, weighted abduction, balance. Walk-jog progression once single-leg stance is pain-free. |
| Return to full activity | Months 3–6 | Running, hills and hiking rebuilt gradually. Maintenance strength work twice a week. |
Desk work and driving are not interrupted; the main daily adjustment is how you sit and sleep. Progression is individualized, and a hip that is not improving by 3 months is re-imaged rather than pushed.
Frequently Asked Questions
How long does trochanteric bursitis take to heal?
Most patients improve noticeably within 6 to 8 weeks once the compressing positions are stopped and a progressive abductor-loading program is under way, and are back to full activity by 3 to 6 months. Hips that have hurt for a year or more take longer.
Should I stretch my IT band for hip bursitis?
No. Stretches that pull the thigh across the body compress the gluteal tendons against the trochanter and usually make the pain worse. The tissue responds to strengthening, not stretching: isometric holds first, then progressive abductor exercises. Avoiding crossed legs and side-lying without a pillow does more than any stretch.
Do cortisone injections work for trochanteric bursitis?
In the short term, yes. An ultrasound-guided corticosteroid injection into the bursa relieves pain for weeks to months in most patients, which makes it useful for a hip too sore to exercise or sleep on. It is not a cure on its own, and repeated injections weaken the tendon, so it is paired with a loading program.
Can I keep running with greater trochanteric pain syndrome?
Not at full volume during the first weeks, because running loads the tendon with every stride. Walking within comfort is fine. Running is reintroduced with a walk-jog progression once you can stand on the affected leg for 30 seconds without pain, then mileage and hills are added gradually.
Why does my hip hurt when I lie on it at night?
Lying on the affected side presses the gluteal tendons and bursa directly against the mattress, and lying on the other side lets the top leg drop across the body, which compresses the same tendons from the inside. A pillow between the knees keeps the thigh level and is one of the most effective things you can do.
This page is for general education and is not a substitute for a medical evaluation. Treatment recommendations depend on your individual diagnosis and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.