Is hip bursitis really a bursa problem?

Usually not. The name stuck before ultrasound could show what was going on. When we scan a sore outer hip, the most common finding is a thick, frayed tendon. That tendon belongs to the gluteus medius and minimus, the muscles that keep your pelvis level when you stand on one leg. The bursa next to it may be a little swollen, but it is mostly a bystander.

That matters for treatment. A bursa is a fluid sac. A tendon is a rope of collagen that needs load to heal. Treat the rope like a sac and you get a few good weeks, then the pain comes back. Doctors now call the whole picture greater trochanteric pain syndrome. Patients still call it hip bursitis, and so do we.

Who gets it? Mostly women in their 40s, 50s and 60s. Hormone changes after menopause alter how tendons hold water and collagen. Add a few extra pounds, a habit of standing with one hip pushed out, or crossing your legs, and the tendon gets squeezed against bone all day. Insulin resistance plays a part too. High blood sugar stiffens collagen, and stiff collagen frays faster.

How do you tell hip bursitis from back pain?

This is why the page lives on a back pain site. The outer hip and the low back share nerves, and many people have both. A lumbar MRI almost always shows something. So the hip gets missed while the back gets the injections.

• Lying on that side hurts. Hip bursitis pain wakes you when you roll onto it. Back pain usually does not care which side you sleep on.
• One finger can find it. Press on the bony point at the side of the hip. If that is the pain you know, the tendon is a strong suspect.
• Standing on one leg hurts. Hold for 30 seconds on the sore side. Pain at the outer hip points to the tendon.
• The pain stops above the knee. It can spread down the outer thigh. Pain that runs past the knee into the foot, with numbness, points to a nerve in the back.

We check both at the same visit. If the back and hip are both involved, we treat whatever drives most of the pain first. Read more on telling hip pain from back pain and on low back pain on one side.

Why do cortisone shots for hip bursitis stop working?

The first shot often works well. Cortisone calms pain fast, and trials show it beats doing nothing for the first few weeks. Then it fades. The second shot does less. The third may barely help.

Here is the chain. Cortisone turns down inflammation, but it also slows the cells that build new collagen. A tendon that is already short of good collagen gets weaker with each round. Pain drops, you do more, the weak tendon gets squeezed again, and the pain returns sooner. It is like painting over a crack in the wall. It looks fine until the wall moves.

That is not a reason to fear cortisone. One shot to get you through a bad month is reasonable. Repeating it every few months for years is the trap.

When is PRP a good choice for hip bursitis?

PRP stands for platelet-rich plasma. We draw your blood, spin it, and collect the platelets. Platelets carry growth signals that tell tendon cells to lay down new collagen. Under ultrasound we place that concentrate into the damaged part of the tendon, not just the bursa around it. It fits best when:

• Pain has lasted three months or more despite exercise.
• Ultrasound shows tendon damage without a full tear.
• Cortisone helped for a while and then stopped helping.
• You want to avoid surgery, or surgery is not a good option for you.

Results depend on dose. A tube with few platelets is not the same treatment as a high-dose concentrate placed exactly where the tendon is worn. We count the platelets we deliver. If the tendon is torn through, or the pain is really coming from the hip joint, we say so and change the plan. For a worn joint we also use bone marrow concentrate or microfragmented fat; see hip arthritis.

What happens on the day of a PRP injection for the hip?

You are awake. We numb the skin with local anesthetic. There is no sedation, so most people drive themselves home. The blood draw and spin take about half an hour. The injection itself takes minutes, guided by ultrasound so we can watch the needle reach the tendon.

Expect soreness for about 48 hours. That ache is the repair signal starting, so we ask you to skip anti-inflammatory pills like ibuprofen for a while. Walking is fine. Heavy hip work waits. Then the exercise plan starts, and it is the half of the treatment that makes the tendon strong again. The number of injections follows how you respond, not a preset package.

Orthobiologic procedures are done at our regenerative clinic at 4477 Woodson Rd in St. Louis. You check in at the front desk and staff route you from there. PRP is not covered by insurance. HSA and FSA funds can generally be used.

What does the research say about PRP for hip bursitis?

A 2026 review of randomized trials pooled studies on outer hip tendon pain. In most of them, PRP did as well as or better than the comparison. Pooled hip function scores favored PRP. A 2025 review of gluteal tendon trials found PRP gave better function than cortisone in the short term. It also found that exercise with education helped in its own right.

Our position is plain. For a worn gluteal tendon that has failed exercise and cortisone, a guided, dosed PRP injection followed by real strength work is a sound next step before anyone talks about surgery.

What can you do about hip bursitis this week?

• Stop crossing your legs, and stop standing with your weight hanging on one hip.
• Sleep on your back or the good side, with a pillow between your knees.
• Do not stretch the sore side hard. Stretching the outer hip squeezes the tendon against bone.
• Start gentle holds: lie on your back, squeeze a pillow between your knees, then lift your hips into a short bridge. No pain spike.
• If you carry extra weight around the middle or your blood sugar runs high, that is part of the tendon story. We treat it as part of the plan.

Frequently asked questions

Is hip bursitis the same as trochanteric bursitis?

Yes. Trochanteric bursitis is the older medical name. Most of these cases are really a worn gluteal tendon, which is why doctors now use the term greater trochanteric pain syndrome.

Can hip bursitis cause back pain?

It can feel that way. The ache can reach the buttock and outer thigh, and people limp to protect it, which loads the back. Treating the hip often calms the back. See sacroiliac joint pain for another place the hip and back overlap.

How long does PRP take to work for hip bursitis?

Most people notice change over six to twelve weeks, not overnight. Tendon rebuilds slowly. The first two days are sore, then the ache settles while the exercise plan builds strength.

Is PRP better than a cortisone shot for hip bursitis?

Cortisone works faster. PRP tends to hold longer and does not weaken the tendon. For pain that keeps coming back after cortisone, PRP is the better next step in our view.

Will I need surgery for hip bursitis?

Rarely. Surgery is for a tendon torn away from the bone that does not respond to other care. Most people never get near that point.

Should I see a back doctor or a hip doctor?

You need someone who examines both. Many people have both problems at once, and treating only one leaves half the pain behind. We check the hip and the back at the same visit.

Related reading

• Hip pain or back pain?
• Hip arthritis
• Hamstring tendonitis
• Pain at night
• Low back pain on one side
• Orthobiologics for back, spine and hip pain: PRP, bone marrow and fat

Point to the bony spot on the side of your hip and tell us what happens when you lie on it. That takes a minute and changes the plan.