Hip bursitis physical therapy in Carmel, Indiana

In most people with outer hip pain, the main problem is in the gluteal tendons, which attach the gluteus medius and minimus muscles to the bony point of the hip (the greater trochanter). The bursa, a small fluid sac over that bone, may also be irritated, but it is usually not the whole story. That is why many clinicians now use the broader term greater trochanteric pain syndrome.

This matters because it changes treatment. Tendons respond to the right kind of load and are irritated by compression, when the tendon is squeezed against the bone. Positions that pull the thigh across the body, such as crossing the legs, hanging on one hip while standing, or lying on the opposite side with the top knee dropping down, compress the tendons.

The condition is most common in women and in middle-aged and older adults, including around menopause, and it also affects runners and walkers who suddenly increase hills or distance. Weight gain, hip weakness and low back problems can contribute.

A typical story is a gradual ache that first shows up at night or on the stairs, then starts to bother longer walks. Some people trace it to a new routine, such as a step class, a hilly walking route, a stretch of long days standing at an event, or a change in how they carry a toddler on one hip. Others notice no trigger at all.

Because it changes the load on the tendon instead of just quieting pain for a while. In a 2018 randomized trial published in the BMJ, people with gluteal tendinopathy who received education and exercise did better at eight weeks than those given a single corticosteroid injection, and still reported better overall improvement at one year, although pain levels by then were similar.

Education covers posture and positions: standing evenly on both feet, not crossing legs, sleeping with a pillow between the knees, choosing higher chairs, and avoiding long, deep stretches of the outer hip, which compress the tendon.

Exercise begins with isometric holds, such as gently pressing the knee out against a strap while lying on your back, then progresses to bridges, side-lying work in a neutral position, step-ups, single-leg squats and loaded work with a kettlebell or cable. In a private suite your therapist can progress the load steadily over the weeks.

The early isometric holds matter more than they look. Holding a gentle contraction for 30 to 45 seconds may ease tendon pain for a short time afterwards, which makes it easier to tolerate the rest of the session and the walk home. As symptoms calm, the program shifts toward slower, heavier work that actually builds tendon capacity, and the holds become a warm-up or a tool for flare days.

• Isometric hip abduction holds in comfortable positions
• Bridges and wall-supported side work
• Step-ups and step-downs with level pelvis
• Sit-to-stand from progressively lower chairs
• Single-leg deadlifts and loaded carries

If you sleep on your side, put a pillow between your knees so the top leg does not drop across your body. If you sleep on your sore side, a soft mattress topper can reduce pressure. When standing, keep your weight evenly on both feet rather than hanging on one hip, and avoid crossing your legs when sitting.

Walking is usually fine, but long downhill stretches and stairs may need to be reduced for a while. On the Monon Trail, flat routes and shorter walks are often more comfortable than hilly park loops. Runners may need to trim mileage and avoid running on a cambered road.

If outer hip pain is waking you or limiting walks, the hip questionnaire takes about two minutes, and the matching team will call or text to discuss a therapist whose focus fits. Our page on hip pain when sleeping on your side has more tips for nights.