Part of Greater trochanteric pain syndrome
Hip bursitis or sciatica: telling outer hip pain from nerve pain
Warning signs, and when to get help
Hip bursitis or sciatica: what is the difference?
The outer hip problem is a tendon complaint. The gluteus medius and gluteus minimus tendons attach to the bony point at the top of the thigh bone. They are now regarded as a main local source of pain in that spot, so clinicians use the name greater trochanteric pain syndrome or gluteal tendinopathy rather than trochanteric bursitis (Grimaldi and colleagues, 2015). The greater trochanteric pain syndrome program is the treatment page, and why the word bursitis is on its way out answers the terminology question in full.
Sciatica is a nerve, irritated where it leaves the lower back. The NHS describes it as pain in the bottom and the back of one leg that often runs into the foot and toes, with burning pain, tingling, numbness or weakness, and pain that can be worse when you move, sneeze or cough. Sciatica covers its causes, its course and its treatment, and how long sciatica lasts answers the question people ask next.
Two tissues, two places, and an overlap in the middle of the thigh. The overlap is what makes this hard to call, and the rest of the page is about separating them there.
Hip bursitis vs sciatica: three checks that sort the hip from the nerve
None of these is a test a clinician would stake a diagnosis on. They are the questions that get asked first, and having your answers ready makes the appointment shorter.
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Can you find it with a thumb? Press firmly over the bony point at the side of the hip, and just above and below it, and compare the two sides. Reproducing your own pain there is a point for the tendons, because those structures sit close enough to the skin to be reached. Nerve pain generated in the lower back is not produced at that spot. Keep the limits in view: the ISHA physiotherapy agreement records that pressing there is not specific, and that no test or cluster of tests identifies which structure is involved (Disantis and colleagues, 2023).
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Does the pain pass the knee? The outer hip descriptions stop in the thigh. OrthoInfo takes the pain from the point of the hip to the outside of the thigh and no further. The NHS takes sciatica into the foot and toes. So pain below the knee, especially with pins and needles, numbness or weakness, shifts the weight toward the back, and it has its own timing on the warning list at the end of this page.
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What does lying on that side do? This is the most useful of the three in practice. Lying on the painful hip presses the tendons against the bone, and the top leg drops across the body unless a pillow holds it apart, which is the compressed position the condition revolves around (Grimaldi and colleagues, 2015). OrthoInfo lists pain worse at night and worse lying on the affected hip. Nerve pain is less fussy about which side you are on, and more responsive to what the spine is doing.
One more in the same vein: standing with your weight hung on one hip, and sitting with your legs crossed, are tendon triggers and not nerve ones, for the same mechanical reason. Sitting and crossing your legs with outer hip pain sets that out properly.
Can hip bursitis cause pain down the leg?
Yes, and this single fact causes most of the confusion on this page. Pain from the gluteal tendons does not stay politely over the bony point. It travels down the outside of the thigh, often as a band or a stripe, and a reader who has only ever heard the phrase referred pain assumes a nerve must be involved.
The useful distinction is the route and the end point. Tendon pain takes the outside of the thigh and stops in the thigh. Nerve pain from the lower back more often takes the buttock and the back of the leg and keeps going, and it brings the sensory symptoms with it, which tendon pain does not. Where outer hip pain is felt and where it travels maps that out in detail.
Numbness and weakness are not features of a sore tendon. If you have them, they belong in a conversation with a clinician, not in a self-assessment, and the list at the end of this page says how fast.
What if you have both, and the exercises have not helped?
Having both at once is the situation that gets left out of the comparison, and it is not rare. In a US study of 3,026 adults aged 50 to 79 who had knee osteoarthritis or were at high risk of it, outer hip pain kept company with low back pain as well as with iliotibial band tenderness and knee osteoarthritis (Segal and colleagues, 2007). That was a knee study rather than a hip one, so read it for the company this condition keeps rather than as a count of how common anything is. The ISHA agreement names overlapping conditions as common and lists lumbosacral spine disorders among the things to screen for in anyone with this presentation (Disantis and colleagues, 2023).
That explains a story that turns up often in clinic. Someone is given a program for one problem, does it properly for two months and gets nowhere, because half their pain was never going to answer to it.
A clinician works out which problem is driving today's symptoms, treats that first, and brings in the other afterwards. Your part is to stop treating a mixed picture as one puzzle with one answer, and to say plainly at the appointment that two patterns seem to be present. Outer hip pain and sciatica pain when sitting are both reasonable things to read in the meantime, and neither replaces the assessment.
Does the treatment differ, and where does it clash?
Plenty of it is shared. Neither usually needs surgery. Both are built on strengthening instead of resting, both are judged on how things are the following morning, and both are measured in months.
Where they pull against each other is the stretches. The movements commonly offered for buttock and leg pain, the piriformis stretch and the lying figure 4 stretch among them, pull the thigh across the body. That is exactly the position that presses the gluteal tendons against the bone (Grimaldi and colleagues, 2015), the trial program for the tendon condition deliberately left those stretches out (Mellor and colleagues, 2016), and the Cambridge University Hospitals leaflet advises against stretching while symptoms are settling. So a person with both problems can be handed a stretch that is reasonable for one half of their pain and counterproductive for the other.
Nights are the other place they separate. The tendon condition has a position rule, which is to keep off the sore side and keep the knees apart. Nerve pain does not follow that rule, and why outer hip pain is worse at night explains the mechanism behind the hip version.
What else gets mistaken for both
The sacroiliac joint sits at the back of the pelvis, not at the side of the hip, and it is the third corner of this confusion. Sacroiliac joint pain has the pattern.
The hip joint itself puts its pain in the groin, with stiffness instead of a tender spot on the outside. Hip osteoarthritis is the program, and groin pain with a stiff hip is on the warning list below.
Behind a lot of sciatica sit the specific spinal diagnoses: lumbar disc herniation, spinal stenosis and piriformis syndrome. Which of them applies is a job for an examination, not a symptom list.
When to see a physio or doctor, and what needs help today
Book a routine appointment with a doctor or physio if the pain is stopping you sleeping or doing what you normally do, if it keeps coming back, or if it has not improved after 2 weeks of looking after it at home (NHS). Go sooner if you cannot tell which of these you have, because the two plans differ enough that guessing wastes months. If you have already done a program properly for 6 to 8 weeks and nothing has changed, ask for the diagnosis to be rechecked rather than doing more of the same.
Some leg symptoms are not a sorting problem. Numbness or weakness in both legs, numbness around your genitals or bottom, a new problem with your bladder or bowels, or loss of feeling in one leg means emergency care straight away. A foot that drags, catches or slaps down when you walk means medical advice the same day, and faster if it is worsening by the hour. Both are in the warning list below in full, with the rest of the timings.
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
Is my pain hip bursitis or sciatica?
Start with three questions. Does pressing firmly on the bony point at the side of your hip reproduce the pain you came here about? Does the pain carry on below the knee, with burning, tingling, numbness or weakness? And what happens when you lie on that side in bed? A pain you can find with a thumb, that stops in the outer thigh and bites when you lie on it, behaves like the hip tendons. A pain that runs from the buttock into the calf or foot and takes no notice of which side you lie on behaves like a nerve. Neither answer is a diagnosis, and both can be true at once.
Can hip bursitis cause pain down the leg?
Yes, as far as the outer thigh, which is why it gets mistaken for a nerve so often. OrthoInfo describes the pain at the point of the hip usually extending to the outside of the thigh. What it does not do in those descriptions is carry on past the knee. Pain below the knee, especially with pins and needles or numbness in the leg or foot, is on the warning list on this page with a timing attached.
Can you have hip bursitis and sciatica at the same time?
Often enough that clinicians expect it. In a US study of 3,026 adults aged 50 to 79 who had knee osteoarthritis or were at high risk of it, pain over the outer hip went along with low back pain as well as with iliotibial band tenderness and knee osteoarthritis (Segal and colleagues, 2007), and the 2022 ISHA physiotherapy agreement names overlapping conditions as common, lumbosacral spine disorders included (Disantis and colleagues, 2023). If you have both and you have been following advice written for one of them, that is usually why nothing has shifted.
Does sciatica hurt when you press the side of your hip?
Not usually in the way the tendons do. Pressing the bony point at the side of the hip is close enough to the surface to reach the structures that sit there, and nerve pain coming from the lower back is not generated at that spot. Treat a positive answer as a point in favor of the tendons rather than as proof: the ISHA agreement notes that pressing there is not specific and that no test or group of tests identifies which structure is responsible (Disantis and colleagues, 2023).
Which one hurts more when you lie on that side?
The hip tendons, characteristically. Body weight presses them against the bony point, and the top leg drops across the body unless something holds it apart, which is the position the whole condition revolves around (Grimaldi and colleagues, 2015). OrthoInfo lists pain that is worse at night and worse lying on the affected hip. Nerve pain from the back is less tied to which side you are on and more tied to what your spine is doing, and the NHS notes sciatica pain can be worse when you move, sneeze or cough.
Could it be the sacroiliac joint instead?
It is a reasonable third option and it is a common three-way confusion. Pain centered at the back of the pelvis, just inside the dimple above the buttock, rather than at the side of the hip or down the back of the leg, is the pattern that raises it. Nothing you can do at home separates these three reliably, so the sacroiliac joint pain page is there for the pattern and an assessment is what settles it.
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
- 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
- Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC. Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation. 2007;88(8):988-992. https://www.archives-pmr.org/article/S0003-9993(07)00302-4/abstract
- 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
- American Academy of Orthopaedic Surgeons. Hip bursitis. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/hip-bursitis/
- Cambridge University Hospitals NHS Foundation Trust. Gluteal tendinopathy. Patient information. Approved 14 January 2025. https://www.cuh.nhs.uk/patient-information/gluteal-tendinopathy/
- NHS. Sciatica. Page last reviewed 3 December 2024. https://www.nhs.uk/conditions/sciatica/
- 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.