Hip Bursitis — When Lying on Your Side Hurts

Some people wake up at night because the outside of the hip throbs whenever they roll onto the painful side. If the outside of the hip also feels tight when walking and worsens with stairs, trochanteric bursitis of the hip should be considered.

What is a bursa?

A bursa is a small fluid-filled sac located between bone and tendon or muscle that acts as a cushion to reduce friction. When the bursa over the greater trochanter (the outer bony prominence of the femur) becomes inflamed, the condition is called trochanteric bursitis.

Main symptoms

• Tenderness on the outer hip (over the greater trochanter)
• Pain that worsens when lying on the affected side (sleep disturbance)
• Increased pain with prolonged walking or climbing stairs
• Stiffness on the outer hip when standing up from a chair
• Pain may radiate down the outer thigh toward the knee

Why does it happen?

• Repetitive friction — Walking and running cause the iliotibial (IT) band to repeatedly rub over the greater trochanter
• Muscle imbalance — Weakness of the gluteus medius (the muscle on the side of the hip) overloads the bursa
• Postural problems — Crossing the legs or habitually leaning to one side
• Excess body weight — Increased load on the hip joint
• Degenerative changes — Age-related fragility of the bursa

Treatment and management

With appropriate treatment and lifestyle correction, bursitis usually improves.

• Acupuncture and pharmacopuncture to directly reduce bursal inflammation
• Stretching the IT band to lessen friction at the greater trochanter
• Strengthening the gluteus medius (side-lying leg raises, clamshells)
• Placing a pillow between the knees while sleeping to distribute pressure
• Avoiding lying on a hard floor on your side

Hip pain has many possible causes, so rather than self-diagnosing, it is important to be evaluated by a specialist who can distinguish bursitis from intra-articular hip problems or referred pain from the lower back.