Trochanteric Bursitis: Why Does Lying on One Side Hurt?

Pain on the outside of your hip that worsens when you lie on one side can make sleeping uncomfortable and affect your daily activities.

It is often called trochanteric bursitis, but the bursa is not always the main source of pain.

The symptoms may also come from the gluteal tendons, which help stabilize your pelvis when you walk or stand on one leg.

Understanding the difference can help guide appropriate physiotherapy, activity modification, and recovery.

What Is Trochanteric Bursitis?

Trochanteric bursitis refers to irritation or inflammation of a bursa near the greater trochanter, the bony prominence on the outside of the upper thigh bone.

A bursa is a small, fluid-filled sac that helps reduce friction between nearby tissues. Around the hip, bursae allow muscles and tendons to move more smoothly over bony surfaces.

When a bursa becomes irritated, pressure on the outer hip may cause pain and tenderness. This can make sleeping on the affected side, climbing stairs, or walking uncomfortable.

However, trochanteric bursitis is often discussed under the broader term greater trochanteric pain syndrome (GTPS).

GTPS includes bursal irritation, gluteal tendinopathy, and sometimes tears affecting the gluteal tendons.

These problems can coexist, so not every case of outer hip pain should be treated as isolated bursitis. (Pianka et al., 2021)

Why Does Lying on One Side Hurt?

Direct pressure on the outer hip

When you lie on your affected side, your body weight places pressure on the tissues around the greater trochanter.

If the bursa or nearby tendons are sensitive, this pressure can reproduce pain.

The discomfort may begin soon after lying down or gradually increase as you remain in the same position.

Turning over may provide relief, but the pain can return when pressure builds up again.

Compression of the gluteal tendons

The gluteus medius and gluteus minimus muscles help stabilize your pelvis when you walk, climb stairs, and stand on one leg. Their tendons attach around the greater trochanter.

These tendons can become sensitive when repeatedly exposed to excessive loading or compression.

Certain hip positions, including bringing the thigh across the body’s midline, can increase compression around the tendons.

This explains why some people experience pain when lying on either side.

The affected tissues and the position of the hip influence how much pressure is applied. (Grimaldi & Fearon, 2015)

Why can the pain continue at night?

Sensitive tissues may remain under pressure for an extended period while you sleep.

Repeatedly waking to change positions can interrupt sleep and make it harder to feel rested.

Poor sleep can also make pain more difficult to manage the following day.

If hip pain regularly disrupts your sleep, addressing the underlying problem is more useful than relying only on temporary relief.

What Are the Symptoms of Trochanteric Bursitis?

Symptoms can overlap with other causes of outer hip pain.

Common features include:

• Pain or tenderness over the bony prominence on the outside of the hip.
• Discomfort when lying on the affected side.
• Pain when climbing stairs or walking uphill.
• Increased discomfort after prolonged walking or standing.
• Pain when getting up from a chair.
• Tenderness when pressing the outer hip.
• Pain spreading down the outer thigh, sometimes towards the knee.

Some people notice symptoms mainly at night, while others experience them during exercise or everyday activities.

An important distinction: Pain when lying on one side is common in GTPS, but it does not prove that the bursa is inflamed. A clinical assessment helps identify the likely source.

What Causes Trochanteric Bursitis?

Several factors may contribute to irritation around the greater trochanter.

Repeated pressure on the hip

Frequently sleeping on the painful side or holding positions that place pressure on the outer hip may aggravate sensitive tissues. Crossing the legs tightly or standing with most of your weight shifted onto one hip may also increase compression around the gluteal tendons.

Sudden increases in physical activity

Increasing walking distance, running, hill training, or gym intensity too quickly can overload the gluteal tendons and surrounding tissues.

The activity itself is not necessarily harmful. Symptoms may develop when the demands placed on the tissues exceed their current capacity.

Reduced hip muscle capacity

The hip abductor muscles help control pelvic movement during walking and single-leg activities. Reduced strength or endurance may make these tasks more difficult.

However, weakness is not always the original cause of pain. Pain itself can reduce muscle performance, so strengthening should be guided by an individual assessment.

Other contributing factors

Greater trochanteric pain syndrome is reported more frequently in middle-aged adults and women. Previous hip injuries, coexisting hip conditions, and lower-back problems may also influence symptoms.

These factors do not confirm bursitis. Similar symptoms can develop for different reasons, which is why the diagnosis matters.

Is It Trochanteric Bursitis or Gluteal Tendinopathy?

Both conditions can cause outer hip pain, tenderness, and discomfort when lying on the affected side.

Feature	Trochanteric bursitis	Gluteal tendinopathy
Main tissue involved	Bursa near the greater trochanter	Gluteus medius or minimus tendon
Pain when lying on the affected side	Common	Common
Pain with stairs or single-leg activities	Possible	Common
Tenderness over the outer hip	Possible	Common
Can both conditions coexist?	Yes	Yes

These patterns are not definitive diagnostic rules. A person may have more than one contributing condition, and symptoms can overlap with hip osteoarthritis or pain referred from the lower back.

A systematic review found that combining selected clinical tests, including gluteal tendon palpation and resisted hip abduction, can help clinicians assess the likelihood of GTPS. Results still need to be interpreted alongside the person’s history and the rest of the examination. (Kinsella et al., 2024)

How Is Trochanteric Bursitis Diagnosed?

Physiotherapy assessment

A physiotherapist will ask where the pain occurs, how long it has been present, whether it affects sleep, and which activities make it worse.

The examination may include:

• Palpation: Checking whether pressure over the greater trochanter reproduces familiar pain.
• Hip abductor strength testing: Assessing pain and muscle performance during resisted movements.
• Single-leg stance: Observing symptoms and pelvic control while standing on one leg.
• Functional assessment: Checking walking, stair climbing, and other relevant daily activities.
• Hip and lower-back examination: Investigating other conditions that could explain or contribute to the symptoms.

The aim is to identify the likely pain source and understand which activities need to be modified.

Are scans necessary?

Imaging is not always needed to diagnose GTPS. A clinician may recommend further investigations when the diagnosis is unclear, symptoms persist despite appropriate treatment, a significant tendon tear is suspected, or another condition needs to be excluded.

• Ultrasound can assess the bursa and nearby tendons.
• MRI may help evaluate tendon tears and other soft-tissue problems.
• X-rays can help identify certain bone and joint conditions.

Imaging findings must be interpreted alongside the symptoms and clinical examination. Bursal fluid or tendon changes do not automatically mean that the finding is responsible for the pain.

How Can You Sleep With Outer Hip Pain?

Changing your sleeping position may reduce pressure on sensitive tissues and make it easier to rest.

Try these sleeping adjustments

• Sleep on the unaffected side: This can help avoid direct pressure on the painful hip.
• Place a pillow between your knees: Supporting the upper leg may help keep your hips in a more comfortable position.
• Try sleeping on your back: A pillow under your knees may make this position more comfortable.
• Avoid forcing your knees together: Positions that bring the thigh across the body’s midline may aggravate sensitive gluteal tendons.
• Change position when pain builds: You do not need to remain in a painful position throughout the night.

These adjustments can help manage symptoms, but they do not identify or treat every possible cause of hip pain. If pain repeatedly disrupts your sleep, consider a professional assessment.

Physiotherapy Treatment for Trochanteric Bursitis

Treatment depends on whether the main problem involves the bursa, the gluteal tendons, or overlapping conditions. Physiotherapy often focuses on reducing aggravating pressure, improving strength, and gradually restoring comfortable movement.

1. Modify aggravating activities

You may not need to stop all physical activity. Instead, temporarily reduce the duration or intensity of activities that repeatedly worsen your symptoms.

For example, consider shorter walks, flatter routes, and avoiding prolonged standing with most of your weight shifted onto one hip.

The aim is to maintain comfortable movement while allowing irritated tissues to settle.

2. Start appropriate strengthening exercises

When gluteal tendinopathy contributes to the pain, progressive strengthening can help improve the muscles’ ability to manage everyday loads.

Depending on your symptoms, a physiotherapist may introduce:

• Isometric hip abduction: Gently press the outer knee against a wall or fixed resistance without moving the leg.
• Bridges: Lie on your back with your knees bent and lift your pelvis in a controlled movement.
• Standing hip abduction: Hold a stable support and move one leg out to the side without leaning your trunk.
• Resisted side-stepping: Take controlled sideways steps with a resistance band when more demanding exercises are appropriate.

These are examples, not a universal exercise prescription. The starting position, resistance, repetitions, and progression should reflect your symptoms and physical capacity. Stop and seek guidance if an exercise causes sharp or progressively worsening pain.

3. Progress towards everyday activities

As symptoms improve, rehabilitation may progress to step-ups, balance exercises, longer walks, and other activities that matter to you.

The amount of exercise should increase gradually. If pain consistently becomes worse later that day or the following morning, the exercise load may need to be adjusted.

4. What does research say about exercise?

A systematic review and meta-analysis published in 2024 found that exercise can improve pain and physical function in people with GTPS, although the evidence came from a relatively small number of trials. The authors supported exercise as a first-line treatment for clinically diagnosed GTPS. (Kjeldsen et al., 2024)

These findings support structured rehabilitation, particularly when gluteal tendinopathy contributes to the symptoms. They should not be interpreted as proof that every case of isolated bursitis requires the same exercise program.

Do Corticosteroid Injections Help?

A corticosteroid injection may provide short-term relief for selected people, depending on the diagnosis and clinical circumstances. However, it is not a guaranteed cure, and relief may diminish over time.

An injection should be considered by a qualified clinician after assessing the likely pain source, previous treatments, potential benefits and risks, and the person’s goals.

When gluteal tendinopathy contributes to the problem, an injection does not replace the need to address loading, strength, and function. Persistent symptoms may require a review of the diagnosis and treatment plan.

A randomized clinical trial involving people with gluteal tendinopathy found that education about tendon load management combined with structured exercise produced better overall improvement than corticosteroid injection or a wait-and-see approach for key outcomes. (Mellor et al., 2018)

How Long Does Recovery Take?

Recovery depends on the underlying condition, symptom duration, physical demands, and response to treatment. Some people improve over several weeks, while persistent cases may take months.

Signs of progress may include sleeping longer without waking because of hip pain, walking further with less discomfort, climbing stairs more comfortably, and tolerating strengthening exercises with fewer symptoms.

Recovery is not always linear. If progress stalls or symptoms worsen, the diagnosis and rehabilitation plan should be reassessed.

When Should You See a Doctor?

Arrange an assessment if outer hip pain persists, repeatedly disrupts sleep, limits walking, or fails to improve with sensible activity modification.

Seek urgent medical attention if severe hip pain follows a fall or injury, you cannot bear weight, or you develop a hot or markedly swollen area with fever or feel seriously unwell. Sudden severe pain or rapidly worsening symptoms also require prompt evaluation.

Pain accompanied by progressive weakness, numbness, or symptoms that appear to originate in the lower back may indicate another condition that needs assessment.

A Lesser-Known Fact About Trochanteric Bursitis

The bursa is not always the main source of outer hip pain. Gluteal tendon problems are important contributors to what was historically labelled trochanteric bursitis.

This distinction matters because treatment based only on the assumption of inflammation may overlook the need for load management and progressive strengthening. An accurate assessment helps determine which approach is most appropriate.

Conclusion

Trochanteric bursitis can cause pain when lying on one side because pressure irritates sensitive tissues around the outer hip. However, similar symptoms commonly occur with gluteal tendinopathy and other conditions grouped under greater trochanteric pain syndrome.

Physiotherapy can help by modifying aggravating positions, improving hip strength where appropriate, and gradually restoring comfortable movement. Persistent or unusual symptoms deserve assessment so that treatment addresses the actual source of pain.

If lying on one side repeatedly hurts, the most useful next step is to identify which tissues are contributing to the symptoms rather than assuming that every case is bursitis.