Hip Bursitis

There's no single test that confirms it ⁹, and several different problems can produce pain around the hip. The ones a clinician will want to rule in or out ^{2 9}:

• Gluteal tendinopathy or a gluteal tendon tear: as above, the most likely actual cause of the pain you're calling bursitis
• Hip osteoarthritis, a problem in the hip joint itself, not the tissues on its outside
• Femoroacetabular impingement or a labral tear, where the joint's bony shape or its rim of cartilage is involved
• Pain referred from the lower back, where the source is the spine, not the hip
• A stress fracture, a hip fracture or avascular necrosis (loss of blood supply to the ball of the joint). Less common, but real
• Inflammatory conditions such as rheumatoid arthritis, which can cause bursitis themselves ¹

One test earns its place: standing on the painful leg alone. Pain within 30 seconds of single-leg standing on that side has been reported with a positive predictive value of 100% ⁹. Even so, no single test is enough. Accuracy comes from combining findings, which is what an assessment is for.

You usually won't need a scan to be told what this is. Outer hip pain is diagnosed from your history and a physical examination, with the clinician pressing over the bony point of the hip to see whether it's tender ^{1 6}. When an X-ray, ultrasound or MRI is ordered, it's mainly to rule other injuries or conditions out ^{1 6}.

If infection or gout looks possible, your GP may draw a little fluid from the area with a needle and send it off for testing, and may order a blood test too ⁵.

Outer hip pain is mostly a loading problem, so The Well Motion Recovery Path™ is built around what your hip can tolerate. You step up a phase when the hip copes with more, whatever the calendar says.

• Reset: the first week or two. Ice and rest from the activity that sets it off ^1,5, and less time lying on the sore side, which presses the tendons against the bone ^3,6. Expect nights to be the slowest thing to change. We move you on once the pain has stopped building through the day.
• Rebuild: most of the work. The graded loading programme, with manual therapy where it helps you tolerate the exercises and shockwave therapy to discuss if the pain is stubborn. Expect some soreness as the load goes up. We move you on when the hip handles what your day asks of it.
• Return: for most people that means sleep, stairs and long walks more often than sport, because this is mainly a condition of middle age ^7,9. We test the tasks you want back. You leave with a strength programme and a plan for flare-ups.

How long it usually takes. Recent cases should settle within a few weeks ⁵. Pain that has lasted over three months takes longer: the Australian trial ran its programme for 8 weeks ³. That is one trial, in people with tendon problems confirmed on MRI, so your timeline may differ.

Nobody has run a trial on preventing outer hip pain before it starts. The nearest tested evidence comes from people who already have it:

• Stop squashing the sore spot. The education in the Australian trial taught people to avoid positions that press the gluteal tendons against the hip bone, and to build load up gradually ³. Lying on one side for long periods is one such position, and a recognised risk factor ⁶.
• Keep the hip muscles strong. Across six trials, exercise slightly reduced hip pain over the long term compared with a control group ⁴.
• Break up repetitive load. Running, stair climbing, cycling and long spells of standing are all listed as overuse triggers ⁶, so take breaks during repetitive tasks ¹.
• Mention your back and knees. In a study of 3,026 adults aged 50 to 79, outer hip pain was more common in people with low back pain or knee osteoarthritis, and the authors suspect the way the leg moves is part of the reason ⁷. Raise either at your assessment.
• Weight and hip bursitis. The link is weaker than often claimed. In the study of 3,026 adults it disappeared once knee osteoarthritis and low back pain were accounted for ⁷, though a smaller Australian study linked outer hip pain with weight carried around the hips ¹⁰. No trial has tested whether losing weight eases it.