Signs and Symptoms
Common symptoms include:
- Pain and tenderness on the outside of the hip, at the bony point you can feel under the skin
- Pain that can spread down the outside of the thigh
- Pain when lying on the affected side, which can disturb sleep
- Pain when getting up from a chair, climbing stairs, walking longer distances or standing on one leg
- Aching after sitting with the legs crossed
Outer hip pain is different from groin pain, which more often points to arthritis inside the hip joint. Both can happen together.
What Causes It?
The bursa and gluteal tendons on the outside of the hip can become irritated from repeated pressure or strain. Common contributors include:
- Weak hip muscles, particularly the gluteus medius, which steadies the pelvis when you walk
- Overuse from walking, running, stair climbing or standing for long periods
- Lying on one side for long periods, or a fall onto the hip
- A difference in leg length, low back problems or hip arthritis that change how you walk
It is most common in middle-aged and older adults and is more common in women.
How We Diagnose It at POPB
Diagnosis is usually made from your history and a hands-on exam that checks where you are tender, how your hip muscles work and how you walk. Your physician will also check the hip joint and lower back, since both can cause similar pain.
X-rays are taken on site to look for arthritis or other bone problems. Diagnostic ultrasound in our office can show the bursa and gluteal tendons in real time and help guide an injection. MRI is available if a tendon tear is suspected. Hip bursitis is treated by Dr. Press, Dr. Kerr, Dr. Adelman and Dr. Baskin.
Non-Surgical Treatment Options
Most people improve without surgery. Treatment usually includes:
- Physical therapy in our office focused on hip and core strength, stretching and walking mechanics. This is the foundation of treatment, and your therapist shares your chart with your physician.
- Changes to activity, avoiding lying on the painful side, and a pillow between the knees at night
- Ice and anti-inflammatory medication, if safe for you
- A cortisone injection, often ultrasound-guided, to calm pain so you can make progress in therapy
- Shockwave therapy for stubborn cases. Coverage varies by plan, so ask our team.
- PRP (platelet-rich plasma, prepared from your own blood) may be discussed for gluteal tendon problems. Evidence is still developing, results vary, and insurance usually does not cover it.
Surgical Options
Surgery is rarely needed. It may be considered when pain persists for many months despite a full course of therapy and injections, or when imaging shows a significant tear of the gluteal tendons. Options include removing the inflamed bursa or repairing the torn tendon. Your physician will discuss whether surgery makes sense for you.
Recovery
Many people feel better within 6 to 12 weeks of consistent strengthening, although some cases take longer. An injection can ease pain within days, but continuing your exercise program helps lower the chance that the pain returns. Timelines vary.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, X-rays, diagnostic ultrasound, physical therapy and cortisone injections, subject to your co-pay, co-insurance and deductible. Coverage for shockwave therapy varies by plan, and PRP is usually not covered.
HMO and managed-care plans require a referral from your primary care physician before your visit. Our staff verify your benefits when you call.
When to Be Seen
Call our office if outer hip pain lasts more than a few weeks, keeps you from sleeping on that side, or makes you limp. If the hip is hot, red and swollen with fever, or you cannot bear weight after a fall, go to the emergency room or call 911.
