Causes, Symptoms, Diagnosis and Treatment

Understanding the Hip and Surrounding Soft Tissues

The hip is a large ball-and-socket joint formed by the femoral head and the acetabulum. While the joint itself is important, many cases of hip pain originate in the soft tissues that surround it.

Key structures include:

• Bursae: Small fluid-filled sacs that cushion and reduce friction between bone and soft tissue
• Tendons: Thick connective tissues that attach muscles to bone
• Muscles: Including the gluteal muscles and hip flexors, such as the iliopsoas muscle, which is responsible for hip flexion. Inflammation of the iliopsoas tendon can cause pain in the front of the hip or groin area.

When bursae become inflamed, the condition is called bursitis. When tendons become irritated or inflamed, it is called tendonitis.

Hip Bursitis

What Is Hip Bursitis?

Hip bursitis occurs when one of the bursae around the hip becomes irritated or inflamed. The most common type is trochanteric bursitis, which affects the bony point on the outer hip.

Another less common type is iliopsoas bursitis, which causes pain in the groin area.

Causes of Hip Bursitis

Hip bursitis may develop from:

• Repetitive stress or overuse
• Prolonged standing or walking
• Running or stair climbing
• Direct trauma or a fall onto the hip
• Spine conditions that alter walking mechanics
• Leg-length differences
• Rheumatoid arthritis or other inflammatory conditions
• Bone spurs or calcium deposits

Women and individuals over age 40 are more commonly affected, though it can occur at any age.

Symptoms of Hip Bursitis

Common symptoms include:

• Pain on the outside of the hip
• Tenderness when pressing on the hip
• Mild swelling near the hip
• Pain that radiates down the outer thigh
• Increased pain when lying on the affected side
• Discomfort with walking, climbing stairs or getting up from a seated position
• Pain that worsens at night

Early pain may feel sharp and intense. Over time, it may become achier and more widespread.

Treatment for Hip Bursitis

Most cases of hip bursitis improve with nonsurgical treatment that aims to reduce pain and improve function.

Conservative Treatment Options

• Activity modification
• Ice and nonsteroidal anti-inflammatory medications, such as ibuprofen or naproxen, when appropriate
• Physical therapy to improve flexibility and strength
• Stretching of the iliotibial band and hip muscles
• Temporary use of a cane if needed
• Image-guided corticosteroid injection

Corticosteroid injections into the inflamed bursa can provide significant symptom relief for many patients.

Surgical Treatment

Surgery is rarely needed. In persistent cases that do not respond to conservative care, minimally invasive removal of the inflamed bursa may be considered.

Hip Tendonitis

What Is Hip Tendonitis?

Hip tendonitis refers to inflammation or irritation of the tendons surrounding the hip joint. It often develops gradually due to repetitive activity or overuse.

Common types include:

• Gluteus medius or gluteus minimus tendonitis
• Hip flexor tendonitis
• Iliopsoas tendonitis
• Hamstring tendonitis near the hip

Tendonitis may also coexist with bursitis, particularly in the outer hip region.

Causes of Hip Tendonitis

Hip tendonitis may result from:

• Repetitive athletic activity
• Sudden increases in training intensity
• Muscle weakness or imbalance
• Poor biomechanics
• Tight hip muscles
• Prolonged sitting
• Previous injury

Athletes, runners, dancers and individuals who perform repetitive hip movements are at higher risk.

Symptoms of Hip Tendonitis

Symptoms vary based on the tendon involved but may include:

• Aching pain in the hip or groin area
• Pain in the front, side or back of the hip
• Pain with lifting the leg or climbing stairs
• Tenderness over the affected tendon
• Stiffness after activity
• Weakness or reduced performance
• Discomfort with prolonged sitting

Pain often worsens with movement and improves with rest in early stages.

Diagnosing Hip Bursitis and Tendonitis

Accurate diagnosis is essential because hip pain can originate from multiple structures, including the joint itself.

At OrthoTexas, evaluation may include:

• Complete medical history
• Physical examination
• Assessment of range of motion and joint stability
• Imaging tests such as X-rays or MRI

Clinical Examination

• Review of medical history
• Assessment of gait and posture
• Palpation of tender areas
• Strength and range-of-motion testing

Imaging

• X-rays to rule out arthritis or fracture
• MRI to evaluate soft tissue structures
• Ultrasound for real-time tendon evaluation

Advanced imaging helps confirm the diagnosis and rule out labral tears, stress fractures or hip impingement.

Treatment for Hip Tendonitis

Hip tendonitis treatment typically involves nonsurgical care.

Conservative Management

A personalized treatment plan is developed for each patient to address specific needs and severity. Conservative treatments are typically the first-line approach and may include:

• Rest and activity modification
• Ice and nonsteroidal anti-inflammatory drugs when appropriate
• Structured physical therapy to reduce pain and address tight muscles
• Strengthening of hip stabilizers
• Core strengthening
• Biomechanical correction
• Image-guided injections when indicated

Physical therapy is a cornerstone of recovery. Strengthening the gluteal muscles and improving hip mechanics reduces stress on the tendons and helps prevent recurrence. Heat therapy may also improve circulation and support tissue healing in appropriate cases.

Advanced Treatments

In rare cases of tendon degeneration where pain persists despite conservative care, advanced therapies or surgical intervention may be considered.

Prevention of Hip Bursitis and Tendonitis

Preventing hip bursitis and tendonitis begins with addressing modifiable risk factors. Maintaining a healthy weight reduces strain on the hip joint and surrounding soft tissues. Regular low-impact exercise, such as walking, swimming or cycling, can strengthen the hip muscles while minimizing joint stress.

Stretching exercises improve flexibility and reduce tension in the hip area. Warming up before activity and cooling down afterward help prepare muscles and tendons for movement. Practicing good posture and proper technique during sports and daily activities can also reduce risk.

If you have ongoing hip pain or a history of hip problems, consultation with an orthopedic specialist or physical therapist can help guide a safe and effective exercise program.

Complications of Hip Bursitis and Tendonitis

When not properly treated, hip bursitis or tendonitis can lead to hip pain and reduced mobility. Persistent inflammation may contribute to stiffness and limited range of motion.

In cases of untreated tendonitis, degeneration of the tendon, known as tendinosis, may occur. Severe cases may increase the risk of tendon rupture. Inflammation may also contribute to the development of other hip conditions over time.

Early diagnosis and treatment help decrease pain, restore function and reduce the risk of long-term complications.

When to See a Hip Specialist

You should seek evaluation if you experience:

• Persistent hip pain lasting more than a few weeks
• Pain that interferes with walking or sleeping
• Tenderness along the outer hip
• Pain after a fall or injury
• Symptoms that do not improve with rest

Early evaluation can help prevent inflammation and long-term complications.

Recovery After Hip Bursitis and Tendonitis

Recovery focuses on reducing pain, restoring mobility and preventing recurrence. Initial management typically includes rest, nonsteroidal anti-inflammatory drugs (NSAIDs) when appropriate and physical therapy.

As symptoms improve, a structured rehabilitation program helps strengthen the hip muscles and improve joint movement. Stretching and strengthening exercises reduce the likelihood of future flare-ups.

In some cases, corticosteroid injections may provide temporary symptom relief. With appropriate treatment and adherence to a rehabilitation plan, most individuals return to normal activities without ongoing discomfort.

Long-Term Outlook

With proper treatment, most patients recover fully from hip bursitis and tendonitis. Early intervention, targeted therapy and correction of underlying biomechanical issues are key to long-term success.