Bursitis or Gluteal Tendinopathy? How to tell the difference (and what to do next)
- Emma Glynn
- Aug 11, 2025
- 5 min read
Updated: Aug 15, 2025
By Emma Glynn - The Hip & Knee Physio
Quick take:
Pain on the outside of the hip is often blamed on “bursitis.” In many active adults, especially walkers and runners, the gluteus medius/minimus tendon is a major driver (gluteal tendinopathy). Getting the label roughly right matters because the first steps can differ.
This article is general information only and not a substitute for personalised assessment.
What do we mean by bursitis vs. gluteal tendinopathy?
Trochanteric bursitis: irritation of the fluid-filled bursa over the outside of the hip.
Gluteal tendinopathy: load-related sensitivity of the gluteus medius/minimus tendons where they attach at the greater trochanter.
They can co-exist. Early management usually focuses on pacing load, reducing compressive positions, and introducing strength work you can tolerate.
Why the label matters (for early management)
Bursae dislike compression and spikes in pressure (e.g., lying directly on the sore side).Tendons dislike sudden load jumps and respond best to graded strengthening. Both benefit from sensible activity modification, sleep position tweaks, and a progressive plan rather than long stretches of rest or endless stretching.
Scans rarely change these first steps unless there are red flags. If pain is severe, night-waking, or not improving, book an assessment.
Simple self-checks (not diagnostic)
These aren’t diagnoses, just patterns you can notice this week:
Side-lying increases pain (especially on the sore side) → consider tendon compression sensitivity.
Long walks/standing/stairs flare later that day or the next morning → common in tendon overload.
Recent bump/fall onto the outside hip with warmth/swelling → can point more bursal.
Deep outside-hip stretching gives temporary relief but symptoms return or worsen later.
If you’re unsure, start with pacing and basic strength; avoid deep stretch holds into pain.
Common mistakes that keep lateral hip pain hanging around
More stretching, less strength. Tendons adapt to progressive loading, not just mobility work.
Big step-count spikes after a “rest week.” Tendons hate sudden jumps.
Sleeping on the sore side without knee support, compresses the tendon area overnight.
Running with a narrow step width → more pelvic drop → higher lateral hip load.
Chasing scans first. Imaging often doesn’t change early, evidence-informed care.
Safe first steps this week
Adjust daily loads
Keep walking (most days), but clip distance/pace so pain settles within 24 hours.
Reduce long single-leg stances (e.g., when brushing teeth, lightly rest the free foot on a step).
Start simple strength (3–4×/week)
Aim for mild, manageable effort (muscle working is fine; sharp pain is not).
Isometric wall lean — Stand side-on to a wall, feet slightly away, lean gently through the hip.20–30 seconds × 3 per side.
Supported step-downs — Small step, slow control, slight hip hinge, hold rail for balance. 6–8 reps per side.
Side-lying hip abduction — Neutral hip, small range, slow tempo.2 × 8–10 per side.
If pain spikes sharply or lingers beyond 24–36 hours, reduce range/reps and try again.
Walking & sleep tweaks that help
Walking
Try a slightly wider step to reduce pelvic drop.
Keep distance at a level that settles within 24 hours (slight ache is OK; sharp/lingering pain = too much).
Build gradually week to week.
Sleep
If side-lying, place a small pillow between knees to reduce outside-hip compression.
If you prefer the sore side, add a second pillow under the top leg so it doesn’t roll across and compress the hip.
These adjustments don’t replace rehab—they simply make it easier to tolerate daily load while you build strength.
When to get help
Pain wakes you regularly or isn’t improving.
You’re unsure if it’s tendon, bursa, or something else.
You’ve tried DIY changes for 2–3 weeks without progress.
Next step options (choose what suits you):
Take the 2-minute self-assessment quiz for general guidance. →
Explore the Gluteal Tendinopathy Kickstarter (6-week home plan with clear progressions) →
Want to see a physio in-person?
Booking an initial consult is the best way to get clear on your options. You’ll leave with a personalised plan, a clearer understanding of what’s driving your pain, and evidence-based strategies you can use straight away.
If you’re in Melbourne or Camberwell and need experienced hip and knee physio, book a consultation with APA Titled Hip and Knee Physio - Emma, today.
👉 Call now on 9978 9833 or book online to take the first step toward pain-free movement.
FAQs
Do I need a scan first?
Often no. Early management is guided by symptoms and function. Scans are considered if there are red flags or if you’re not responding as expected.
Can I keep walking?
Yes, with pacing. Choose distances that settle within 24 hours, then build gradually.
How long does improvement take?
Varies by person. Many notice change over 6–8 weeks with consistent, progressive loading and sensible activity tweaks.
Who this article is (and isn’t) for
This guide is for adults with lateral hip pain who want safe first steps at home. It’s not designed for post-op care, acute inability to weight-bear, or pain with systemic symptoms. If that’s you, book an assessment (in-person Camberwell or telehealth).
What to do now
Take the 2-minute self-assessment quiz (general info only). → [Quiz link]
Explore the Gluteal Tendinopathy Kickstarter (6-week, physiotherapist-designed home plan). → [Program link]
Book an assessment for personalised care. → [Bookings link]
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The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.
While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan.
Always seek the advice of a qualified healthcare provider before starting any exercise program, particularly if you are experiencing pain, injury, or a pre-existing medical condition.
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References
Education + exercise works for gluteal tendinopathy (LEAP RCT).Mellor R, Bennell K, Grimaldi A, et al. BMJ 2018;361:k1662. Education + exercise outperformed corticosteroid injection and wait-and-see at 8 weeks and remained superior at later follow-ups. BMJ
Gluteal tendinopathy is a primary source of lateral hip pain (not just “bursitis”).Grimaldi A, Fearon A. JOSPT 2015;45(11):910–922. Clinical commentary integrating pathomechanics and management for gluteal tendinopathy/GTPS. jospt.org
GTPS clinical features and case definition.Fearon A, Scarvell JM, Neeman T, et al. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med 2013;47(10):649–653. bjsm.bmj.com
Diagnosis is clinical; imaging rarely changes early management.NICE CKS: Greater trochanteric pain syndrome — Diagnosis & assessment (UK primary-care guidance). cks.nice.org.uk
Typical symptoms + self-care (including pillow between knees; avoid compressive postures).Royal Berkshire NHS: Greater Trochanteric Pain Syndrome (patient leaflet, 2024). Royal Berkshire NHSUnited Lincolnshire Hospitals NHS: Greater Trochanteric Pain Syndrome (patient leaflet, 2025). United Lincolnshire Hospitals
Load management + progressive strengthening principles in tendon rehab.Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology. Br J Sports Med2016;50(19):1187–1191. bjsm.bmj.com
Step-width modification: wider steps reduce hip adduction angle/moment (biomechanics).Sports Medicine – Open 2024 systematic review: The Biomechanical Influence of Step Width on Typical Locomotor Activities. Findings: increasing step width reduces hip adduction angle/moment; a plausible clinical cue for some hip/lateral chain problems. SpringerOpen
Practice guideline overview for GTPS (load-management focus).Ohio State University Wexner Medical Center: GTPS Clinical Practice Guideline
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