Part of Greater trochanteric pain syndrome
What causes hip bursitis to flare up, and what to do about it
Warning signs, and when to get help
What causes hip bursitis to flare up?
Flares come in two shapes, and the second one surprises people. The worst combination for a tendon is thought to be a hard pull delivered while it is pressed against bone, and for the gluteal tendons that press comes from the thigh crossing the midline of the body (Grimaldi and colleagues, 2015). So one group of triggers is about how hard the tendon was pulled, and the other is about how long it was squeezed.
Things that pulled harder than usual:
- A walk that was longer than your current normal, or the same walk on hills instead of the flat.
- A day of stairs, especially carrying something up them, because each step puts your whole weight through one hip.
- A new exercise, or three steps up the program instead of one.
- Going back to a sport, a class or a job after a quiet spell, at the level you left off at.
- Standing for hours, particularly if you tend to hang your weight on one hip while you do it.
Things that squeezed it for longer than usual:
- A long drive or a flight in a low seat.
- An evening on a soft, low sofa instead of the chair you have sorted out at home.
- A week on a hotel mattress that left you sleeping on the painful side.
- An afternoon at a desk with your legs crossed, which is the posture most people cross back and forth across all day without noticing.
- Carrying a child on one hip.
The Cambridge University Hospitals leaflet names hip hanging and long spells in low chairs among the aggravating postures, and asks for walking distance to be kept short and for hill walking and stair climbing to be avoided where that is possible. The Kingston and Richmond leaflet lists crossed legs, low chairs, standing with the weight shifted onto one hip, and lying on the painful side.
Those are the triggers for this particular week. Why you got the condition at all is a separate question, and the leaflets answer that too. Kingston and Richmond names gaining weight, long spells standing, and tightness or weakness in the muscles around the hip as what makes a person prone to it. Cambridge points at the change instead of the person, naming a sudden increase in load, such as hill walking, a much longer walk than usual or a lot of stairs, and a direct knock onto the bony point.
And a good number of flares have no identifiable trigger at all. That is common enough that hunting for one you cannot find is not a useful way to spend the week. Sitting and crossing your legs with outer hip pain covers the compression half in detail, and the greater trochanteric pain syndrome program carries the positions list the whole condition is managed with.
What to do in the first few days of a flare
Take the load off and keep the hip moving. Change one thing at a time, so you can tell what helped.
- Halve the walking and take more of it. Three short trips on flat ground usually sit better than one long one, and getting out at all beats a day in a chair.
- Raise the seats. A firm cushion on the sofa, a dining chair instead of the armchair, and your hips level with or a little above your knees rather than below them.
- Uncross everything. Both feet on the floor, knees apart rather than stacked, weight even on both sides when you stand.
- Fix the night first, because it is the longest loaded position of your day. Off the painful side, with something between your knees thick enough to keep the upper knee level with the upper hip. Why outer hip pain is worse at night explains why that matters more than it sounds.
- Leave the stretches alone. The outer hip and buttock stretches pull the thigh across the body, which is the compressed position, and the Cambridge leaflet says plainly that stretching increases compression over the bony point.
- For symptom relief, NHS self-care advice for hip pain includes an ice pack wrapped in a towel on the sore area for up to 20 minutes every 2 to 3 hours, along with paracetamol (acetaminophen) or an ibuprofen gel. Keep ice off skin that has lost feeling. Ask a pharmacist if you are not sure a medicine suits you. Never stop or change a prescribed medicine on your own.
What is not on that list is anything that treats the flare as inflammation to be put out. Injections, shockwave and surgery are a separate conversation with your doctor, and the parent program's section on them sets out what the trials found.
Should you stop the exercises?
No. Scale them, and keep the hip doing something every day.
This is the point where the old vocabulary does real damage. The word bursitis points toward inflammation, and inflammation points toward rest. A tendon problem points the other way. The 2025 gluteal tendinopathy masterclass makes that case directly, arguing for setting aside rest and corticosteroid injection as first-line management in favor of education, load management, progressive exercise and attention to general health (Grimaldi, Ganderton and Nasser, 2025). A 2024 review of 6 trials in 733 people with this condition recommends exercise as the first treatment (Kjeldsen and colleagues, 2024).
Take out the single leg work first, then the step ups and step downs, then the band work. Those load one hip hardest, and they are also the ones a sore hip performs with the worst control. Keep the holds, which load the muscle without the leg traveling anywhere, and keep the supported versions of everything you do standing. The isometric clamshell, the glute bridge, the side to side weight shift and sit to stand from a higher chair are the usual fall-back set, and the stages on the parent page are what you drop back through. The numbers on each exercise page are general starting points, so during a flare take the bottom of the range, and the parent program says where to build from. Your physio will adjust this.
Cut the numbers before you cut the list, and read the result the next morning. No worse on standing up means the amount was right and you can repeat it. Sorer, or a worse night, means less tomorrow, not nothing.
If you have had a hip replacement or other hip surgery, follow the program from your surgical team and physio instead. If you have high blood pressure, breathe steadily through every hold and never hold your breath.
If you have fallen in the past year, feel unsteady on your feet, or take medicines that make you dizzy, keep a hand on a kitchen counter or the back of a sturdy chair for the whole of the standing exercises, practice only when someone else is at home, and ask your doctor or physio about a falls check. If you live alone, that rule still stands, so plan around it rather than ignoring it. Do the exercises that ask for someone to be at home at your physio appointments or in a class instead, keep to the seated and supported work when you are on your own, and ask your physio which of the standing exercises you may do alone. Keep your phone in a pocket rather than in another room, so you can reach it from the floor, and ask about an alarm you wear.
If you do fall and cannot get up, or you think you may have hurt your head, neck, back or hip, stay where you are, keep warm and call emergency services, or get someone to call for you. Do not let anyone haul you up first.
How long does a flare last?
Nobody has measured it in this condition, and we are not going to fill that gap with somebody else's number.
The figures that circulate for flare length were produced in knee osteoarthritis. A knee joint is not a tendon at the side of the hip, and the two are loaded by different activities. Our own page on hip arthritis flare ups refuses to borrow those numbers even for the hip joint, for the same reason. Borrowing them for a tendon would be worse again.
What is published is the course of the condition as a whole. The Kingston and Richmond leaflet says symptoms usually improve within 3 to 6 months. The Cambridge leaflet says the best results come from at least 12 weeks of exercise. In the LEAP trial the physio program ran for 8 weeks, and that group still had better overall improvement than the injection group at a year (Mellor and colleagues, 2018). None of those is a flare duration, and all of them tell you the timescale you are working on.
In practice, a flare that is going to settle usually starts heading the right way within a week or two once the load comes down. That is clinical experience and nothing more. Watch the direction, not the day count: a flare that has not begun to ease after about 2 weeks, or flares arriving closer together, is a reason to book a review.
Why does it keep coming back?
Because the thing that caused the first one is still true.
The familiar sequence runs like this. The hip settles over a few weeks, normal walking comes back, the stairs stop being a decision, and the exercises fall away because they were only ever there to fix the pain. Nothing has changed about how much the tendon can take, so the next ordinary busy week flares it again. That is reasoning from the mechanism, not a measured finding, and it matches what the trials did: the programs that worked kept loading the hip for weeks after the pain had improved.
So the useful target is not getting out of this flare. It is being able to meet an ordinary week without one. That means staying on the program past the point where it feels necessary, keeping the seat heights and the night set-up as habits rather than as treatment, and stepping activity up in increments you could repeat the next day. Exercises to avoid with outer hip pain covers the ones that most often restart it, and hip pain when walking covers rebuilding distance.
If flares keep arriving despite all that, the plan needs looking at rather than repeating. Overlapping conditions are common in this area, the hip joint and the lower back included, and the 2022 ISHA physiotherapy agreement names both among the things to screen for in anyone with pain on the side of the hip (Disantis and colleagues, 2023).
When it is not a flare at all
None of what follows is managed with a few lighter days.
A hot, swollen hip, a change in the color of the skin over it, or hip pain with a fever or feeling hot, cold and shivery. That is same-day medical help, an emergency department if you feel very unwell, and the warning list below carries the sepsis signs that mean calling emergency services.
Severe hip pain after a fall, or not being able to put weight on the leg after one, is an emergency. And here is the one that gets missed: new hip or groin pain after even a small fall, if you are older, have low bone density or have taken steroid tablets long term, needs advice the same day even if you can still walk.
Severe pain that arrived suddenly without a fall, or pain getting worse quickly over a few days, also needs same-day advice and not a lighter week.
New pain in the groin with a hip that has become stiff, or pain spreading below the knee with pins and needles. Those point away from the tendons, and outer hip pain sets out the wider list.
Night and rest pain that keeps building whatever you do with positions, which has its own timing on the warning list and a faster route if you have had cancer or are losing weight without trying.
When to see a physio or doctor
Book a routine appointment with a doctor or physio if a flare has not started to ease after about 2 weeks, if flares are coming more often, or if outer hip pain is stopping you sleeping or doing what you normally do. New hip pain that has not improved after 2 weeks of looking after it at home is worth getting checked (NHS).
Bring the two or three days before the flare started, not just the flare. The long drive, the hill, the hotel bed, the extra set: that is the information a clinician can use, and it is the part people have forgotten by the time they are seen.
Some signs need help faster, from an emergency visit to a doctor within a few days. They are listed under the warning signs below, each with its own timing.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
Get help today
- Same day: the hip is hot and swollen, the skin around it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a child or teenager has sudden pain in the hip, thigh or knee, is limping, or cannot put weight on one leg. Get an urgent appointment with a doctor the same day. If they have a high temperature or seem very unwell, go to an emergency department. This page is for adults, and hip pain in children has different causes.
- Same day: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. See your doctor within a few days.
- Within a few days: new pain in the groin or buttock, and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
- Within 2 weeks: pain that spreads down the leg below the knee, especially with numbness or tingling in the leg or foot. The pain may be coming from your lower back rather than the hip tendons. Book an appointment with a doctor or physio.
- Within 2 weeks: the pain is mostly in the groin rather than on the outside of the hip, or the hip is stiff and hard to bend, for example when you put on socks. This points more toward the hip joint itself, such as hip osteoarthritis. Book an appointment with a doctor or physio so the cause can be checked.
Common questions
What causes hip bursitis to flare up?
A change in how much the tendons were loaded, or a change in how much they were compressed. The first group is the long walk, the hill, the day of stairs, carrying something heavy upstairs, a new exercise, or going back to a sport after weeks off. The second group is the long drive, the low sofa, a week on a hotel mattress on the sore side, or an afternoon with your legs crossed at a desk. Tendons are thought to tolerate compression against bone plus hard pulling worst of all (Grimaldi and colleagues, 2015), so a day that delivered both is the classic set-up. Plenty of flares arrive with nothing identifiable, which is common enough that failing to find a cause does not mean you missed one.
What should I do when hip bursitis flares up?
Take the load down and keep the hip working. Shorten the walks and take more of them, stay off hills and stairs where you can, raise the seats you use, keep off the sore side at night with something between your knees, and drop to the easiest versions of your exercises rather than stopping them. Judge it by the next morning: if the hip is no worse when you stand up, the amount was right. The Cambridge University Hospitals leaflet asks for walking distance to be kept short and hill walking and stair climbing avoided where that is possible, and names hip hanging and long spells in low chairs among the aggravating postures.
Should I stop my exercises during a flare?
Scale them, not stop them. The treatment for this condition is loading, so stopping removes the thing that was working and leaves the tendon less able to take the next ordinary day. Take out the single leg work, the step ups and step downs and the band work first, keep the holds and the supported work, cut the repetitions to the bottom of the range, and hold a counter for anything standing. Each exercise page gives a general starting dose, and for this condition the parent program's lower figures come first, so take the bottom of the range and build the repetitions before you add a second set. Your physio will adjust this.
How long does a hip bursitis flare last?
There is no published figure for this condition, and this page will not borrow one. The flare-duration numbers in circulation were measured in knee osteoarthritis, which is a different tissue in a different joint, and a number that travels between conditions without anyone checking is how a false fact gets established. What is published is the course of the condition itself: the Kingston and Richmond NHS leaflet says symptoms usually improve within 3 to 6 months, and the Cambridge University Hospitals leaflet says the best results come from at least 12 weeks of exercise. In practice most flares that are going to settle start heading the right way within a week or two of the load coming down, and that is clinical experience rather than research.
Should I rest it or keep moving?
Keep moving, with less load. Resting an irritated tendon feels right and tends to buy a worse next week, because the tissue loses tolerance while you wait. The 2025 gluteal tendinopathy masterclass argues directly for setting aside the anti-inflammatory model, rest and corticosteroid injection included, as first-line management, in favor of education, load management, progressive exercise and general health (Grimaldi, Ganderton and Nasser, 2025). So the middle path is short and frequent rather than long and ambitious.
Does ice help a hip bursitis flare?
It may take the edge off, and it is not treatment. NHS self-care advice for hip pain includes an ice pack wrapped in a towel held against the sore area for up to 20 minutes, repeated every 2 to 3 hours, along with paracetamol (acetaminophen) or an ibuprofen gel. Keep ice off skin that has lost feeling, and do not use it to cover up a hip that is hot, red or swollen, which needs checking the same day. Ask a pharmacist if you are not sure a medicine is right for you. Never stop or change a prescribed medicine on your own.
Why does my hip bursitis keep coming back?
Usually because the load went back up before the tendon had the strength to meet it. The pain settles after a few quiet weeks, the walking and the stairs return to normal, the exercises quietly stop, and the tendon is back where it started with a normal week to survive. This is clinical reasoning rather than a measured finding, and it fits the evidence: the trial program that worked best ran for 8 weeks with daily home exercise and still had people doing better than an injection group a year later (Mellor and colleagues, 2018), and a 2024 review of 6 trials with 733 people recommends exercise as the first treatment for this condition (Kjeldsen and colleagues, 2024). Recurring flares are a reason to have the program reviewed, not a reason to do less.
References
- Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine. 2015;45(8):1107-1119. https://doi.org/10.1007/s40279-015-0336-5
- Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. https://doi.org/10.1136/bmj.k1662
- Mellor R, Grimaldi A, Wajswelner H, Hodges P, Abbott JH, Bennell K, Vicenzino B. Exercise and load modification versus corticosteroid injection versus 'wait and see' for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskeletal Disorders. 2016;17:196. https://doi.org/10.1186/s12891-016-1043-6
- Grimaldi A, Ganderton C, Nasser A. Gluteal tendinopathy masterclass: Refuting the myths and engaging with the evidence. Musculoskeletal Science and Practice. 2025;76:103253. https://doi.org/10.1016/j.msksp.2025.103253
- Kjeldsen T, Hvidt KJ, Bohn MB, Mygind-Klavsen B, Lind M, Semciw AI, Mechlenburg I. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy. 2024;123:69-80. https://doi.org/10.1016/j.physio.2024.01.001
- Disantis A, Andrade AJ, Baillou A, et al. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. Journal of Hip Preservation Surgery. 2023;10(1):48-56. https://doi.org/10.1093/jhps/hnac050
- Cambridge University Hospitals NHS Foundation Trust. Gluteal tendinopathy. Patient information. Approved 14 January 2025. https://www.cuh.nhs.uk/patient-information/gluteal-tendinopathy/
- Kingston and Richmond NHS Foundation Trust. Greater trochanteric pain syndrome. Patient leaflet. Last updated 9 December 2024. https://www.kingstonandrichmond.nhs.uk/patients-and-families/patient-leaflets/greater-trochanteric-pain-syndrome
- NHS. Hip pain in adults. Page last reviewed 20 November 2025. https://www.nhs.uk/symptoms/hip-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-17.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.