Part of Hip osteoarthritis
Hip arthritis or bursitis: how to tell them apart
Warning signs, and when to get help
Hip arthritis or bursitis: what is the difference?
Hip arthritis is wear in the ball and socket joint. That joint sits deep inside the pelvis, behind the crease at the top of your thigh. Nothing you do with your fingers from outside reaches it, and that single fact does most of the sorting on this page.
The outer hip problem is at the other end of the scale for depth. The bony lump you can feel on the side of your hip is the greater trochanter, the top of the thigh bone, roughly a hand's width out from the joint itself, and it is where the muscles at the side of the hip attach by tendons. A bursa, a small fluid-filled sac, sits under those tendons to let them glide. All of that is close to the surface, and all of it can be pressed on.
So the two produce different maps. Joint pain is reported deep, in the groin and across the front of the thigh, sometimes reaching the knee: where hip arthritis pain is felt covers that pattern in full. Outer hip pain sits over the bony point and often spreads down the outer thigh, and the greater trochanteric pain syndrome program is its treatment page, with outer hip pain covering the wider list of causes in that spot.
There is one thing to unlearn first, because the quick comparisons reduce all this to a timing rule: arthritis is worst in the morning, bursitis is worst at night, and bursitis clears up in a few weeks. All three of those claims are shaky, and the next sections say why.
How do you tell them apart at home?
Find the bony lump on the side of your hip, press firmly over it and just above and below it, and compare the two sides. Reproducing your pain there points at the outer hip structures. Finding nothing points away from them, because a tender tendon or bursa is tender to touch.
Then there are the positions that set it off. Lying on that side is the classic complaint of the outer hip problem, and so is standing with your weight hung on one hip or sitting with your legs crossed, all three of which bring the thigh toward or across the midline of the body and press the tendons against the bone. Hip joint pain is provoked more by movement than by position: deep bending, turning the leg inward, getting out of a low seat, standing up after sitting still.
Turning the leg inward is often the first range lost in a hip joint, and the outer hip problem does not take it away. If you cannot get your foot across comfortably to reach the other knee, and the end of that movement feels blocked rather than sore, that is the joint speaking.
Osteoarthritis stiffness is at its worst first thing and after sitting still, and loosens with movement. In its advice on diagnosing it without an X-ray from age 45, NICE accepts either no morning stiffness at all or morning stiffness that clears inside 30 minutes. The outer hip problem is more often stiff and sore for the first few steps after lying on it, which is a different trigger.
Stairs sort them as well, because going up stairs, a slope or a high step loads one hip at a time and tends to provoke the outer hip tendons, where a low seat and a deep squat load the joint. None of these checks is a diagnosis; they are what a clinician gathers in the first two minutes, and having the answers ready makes the appointment faster.
If pain is running down the leg past the knee with pins and needles, numbness or weakness, neither of these is the first suspect: sciatica covers that, and the warning list below gives the timings.
Why bursitis is usually the wrong word now
There is a bursa on the outside of the hip and it can be involved, so bursitis is not nonsense, and it may well be the word a clinician used with you. What has changed is which structure takes the lead. The tendons of the muscles at the side of the hip are now recognized as the primary local source of lateral hip pain, which is why the umbrella term greater trochanteric pain syndrome is used in place of trochanteric bursitis (Grimaldi and Fearon, 2015). The NHS leaflet from Kingston and Richmond uses both names and describes the problem as affecting the muscles and tendons on the outside of the hip.
That matters for your treatment, not just your vocabulary. The word bursitis points toward inflammation and therefore toward resting and settling something down. A tendon problem points the other way, toward graded loading.
The LEAP trial tested exactly that. It randomized 204 adults with gluteal tendinopathy to education plus exercise, a single steroid injection, or a wait and see approach. The education and exercise group did better than both at 8 weeks, and still had better overall improvement than the injection group at 1 year (Mellor and colleagues, 2018). If you have been told you have bursitis and rested it for three months without improvement, that trial is the reason to ask about a loading program.
Bursitis gets described as a few weeks of trouble, and that timeframe needs correcting too. The Kingston and Richmond leaflet, setting out activity changes and daily strengthening exercises, says symptoms usually improve within 3 to 6 months. That is months, not weeks, it assumes the loading work is being done, and it is the normal course rather than a bad outcome.
The greater trochanteric pain syndrome page has the staged version, and whether an injection suits you is a decision for your doctor, not something this page can set out.
Can you have both at once?
Yes, and once a hip has been stiff for a few years it is common. Think about what the muscles at the side of the hip are doing. Their job is to keep your pelvis level while you stand on one leg, which is most of walking. A hip joint that has lost range makes them work in positions they were not designed for, and a limp changes their load with every step. So tendon pain on the outside of a worn hip is a routine finding, not a coincidence that needs explaining away.
What this page will not say is that the arthritis caused it. Nobody has shown that, and the sources here do not claim it. The reasonable position is that the two often occur together, that a mechanical link is plausible, and that which one is producing today's pain is a question for an examination.
Practically, if you have both, the one that is irritable right now sets the plan. A hip with deep groin pain and a stiff blocked rotation gets the joint program. A hip that cannot bear being lain on and is tender over the bony point gets the tendon program first. Then they merge, because the strengthening overlaps.
Do they need different exercises?
The shared part is bigger than people expect: strengthening the muscles around the hip and thigh, progressed gradually, judged on how the hip feels the next morning, and kept going for months rather than weeks.
For the outer hip problem, positions and movements that take the thigh across the midline come out early, because they squeeze the tendon against the bone. That means not crossing the legs, not standing hung on one hip, cutting down on lying on the sore side, and leaving out the outer hip and buttock stretches that pull the leg across the body. Two exercises that sit in the hip arthritis program come out early in a tendon program for their own reasons: side lying hip abduction loads the tendon hard, and the hip hike lets the pelvis drop on one side, which moves the standing hip into the compressed position. Physios often bring both in later, once the hip has settled.
For hip arthritis, those stretches are not usually the irritant. What flares an arthritic hip is more often deep bending, long spells in low chairs and a sudden jump in walking distance. The hip osteoarthritis program is built around that, and seated and standing exercises for older adults is the gentler entry point.
If nights are the main problem, the set-up differs between the two as well, so sleeping positions and night pain with hip arthritis and hip pain at night are separate pages.
What else it could be if neither fits
The lower back can produce all of this. Pain in the buttock and down the leg, worse with certain spinal positions, often with pins and needles, is the back's pattern and not the hip's. Sciatica covers it, and pain spreading below the knee with numbness or tingling has its own timing on the warning list below.
The rim of the socket and the shape of the joint matter more in younger and more active hips. A pinching catch at the front of the hip on deep bending, clicking, or a feeling of the hip giving way fits hip impingement or a hip labral tear better than either option on this page.
Diagnosis in this area is genuinely hard. For the outer hip problem, Grimaldi and Fearon work from a battery of provocation tests, not one, and say plainly that high-quality studies of diagnostic testing in this condition are still lacking (Grimaldi and Fearon, 2015). For the joint, the X-ray matches the pain poorly in both directions (Kim and colleagues, 2015). So a clinician works from the whole picture, and so should you: the pattern, not one test.
When to see a physio or doctor
Book a routine appointment with a doctor or physio if hip 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 are not sure which of these you have, because the two plans differ enough that guessing costs you time. If you have already been given a label and 6 to 8 weeks of doing the program has changed nothing, ask for the diagnosis to be rechecked rather than doing more of the same.
Where it hurts, whether pressing on the bony point reproduces it, which positions set it off, and what the hip can no longer do: those four answers are most of what the first part of an examination is after, and you can bring them with you.
Some signs need help faster, from an emergency visit to a doctor within a few days. They are listed under the warning signs below.
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, or the skin over 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 or groin pain that is worse at night or does not ease with rest, 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 or groin pain that is worse at night or does not ease with rest, 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 or groin pain that is worse at night or does not ease with rest, and keeps getting worse. See your doctor within a few days.
- Within a few days: new groin or hip pain 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.
Common questions
How do I know if I have hip arthritis or bursitis?
Put a thumb on the bony lump at the side of your hip and press. If that is your pain, the outer hip structures are the likely source. If pressing there does nothing and the ache sits deep in the groin or the front of the thigh, the joint is the likely source. Then check what provokes it: deep bending and turning the leg in point at the joint, while lying on that side and standing hung on one hip point at the outer hip.
What is the difference between hip arthritis and hip bursitis?
Different structures in different places. Hip arthritis is wear in the ball and socket joint, buried deep in the pelvis. The outer hip problem involves the tendons of the muscles at the side of the hip where they attach to the bony point, along with a bursa that sits under them, a hand's width away from the joint. One is inside and unreachable, the other is right under the skin.
Can you have hip arthritis and bursitis at the same time?
Often. In a hip that has been stiff for years we would expect it. The muscles at the side of the hip are working around a joint that has lost movement, and they take more strain for it. Nothing on this page should be read as choosing one and ruling the other out, and an examination is worth more than a self-test.
Which one hurts more at night?
Both can, which is why the night pain shortcut you will read elsewhere does not work. Pain lying on that specific side, coming on after you settle, is characteristic of the outer hip problem. Hip arthritis also starts turning up at rest and at night as time goes on, which AAOS describes directly. So night pain tells you to look at which position provokes it, not which diagnosis you have.
Does bursitis show up on an X-ray?
No. An X-ray shows bone, so it can show the changes of joint arthritis and it cannot show a tendon or a bursa. It is also a weaker test for arthritis than people assume: among hips with frequent pain, most showed no arthritis on the film in two large cohorts (Kim and colleagues, 2015). NICE advises that from age 45 osteoarthritis can usually be diagnosed without an X-ray when the joint aches with activity and there is either no morning stiffness at all or morning stiffness lasting no longer than 30 minutes.
Can hip arthritis cause bursitis?
Nobody has shown that it causes it, and the sources on this page do not claim it. What is reasonable to say is that a stiff hip changes how the muscles at the side of it work, and that the two problems keep company. Treat that as a mechanism worth raising with a clinician rather than a settled fact.
Do they need different exercises?
The strengthening overlaps and the load advice does not. For the outer hip problem, positions that pull the thigh across the body squeeze the tendon against the bone, so crossing the legs, standing with your weight hung on one hip and the outer hip stretches come out early. For hip arthritis, those are not usually the problem, and deep bending and sudden jumps in walking distance are the common irritants instead.
References
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic and Sports Physical Therapy. 2015;45(11):910-922. https://doi.org/10.2519/jospt.2015.5829
- Mellor R, Bennell K, Grimaldi A, et al. 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
- Kim C, Nevitt MC, Niu J, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983. https://doi.org/10.1136/bmj.h5983
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. https://www.nice.org.uk/guidance/ng226
- American Academy of Orthopaedic Surgeons. Osteoarthritis of the hip. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/osteoarthritis-of-the-hip/
- Kingston and Richmond NHS Foundation Trust. Greater trochanteric pain syndrome. Patient leaflet. https://www.kingstonandrichmond.nhs.uk/patients-and-families/patient-leaflets/greater-trochanteric-pain-syndrome
- NHS. Hip pain in adults. https://www.nhs.uk/symptoms/hip-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.