Hip pain has a way of showing up as one vague complaint, even though what’s actually happening underneath can be quite different depending on exactly where it hurts. Hip bursitis and hip flexor strain are two of the most common culprits behind hip pain we see at Clayton Heights 188 St Physiotherapy and Sports Injury Clinic, and while they can feel similar at first, they involve completely different structures with different causes and different recovery paths. Getting the right diagnosis matters here, since the treatment for one won’t necessarily help the other. Let’s break down what’s actually going on with each.
What Is Hip Bursitis?
Bursae are small, fluid-filled sacs that sit between bone and soft tissue to reduce friction during movement. At the hip, the bursa most often implicated sits over the greater trochanter, the bony point on the outside of your hip. Despite how commonly “hip bursitis” gets used as a catch-all label, true isolated inflammation of that bursa is actually uncommon.
One study found that only about two percent of women with lateral hip pain had isolated bursitis, while roughly a quarter had underlying gluteal tendon pathology with an associated bursitis alongside it. In most cases, it’s the gluteus medius and minimus tendons doing the damage, with any bursal involvement along for the ride rather than the primary cause.
This is why the condition is now more accurately referred to as greater trochanteric pain syndrome, or GTPS, and it’s most common in women in their forties through sixties. The label matters less than the outcome, though: whether the tendon or the bursa is the bigger contributor, the pain shows up in the same spot and generally responds to the same treatment approach.
Common symptoms include pain directly over the outer hip, pain that can radiate down the outside of the thigh and sometimes as far as the knee, tenderness when you press on the greater trochanter, and pain that flares with lying on the affected side, prolonged sitting, sitting with your legs crossed, or weight-bearing activities like walking and stair climbing.
What Is a Hip Flexor Strain?
A hip flexor strain is a different injury entirely. Your hip flexors, primarily the iliopsoas and rectus femoris, are the muscles responsible for lifting your knee toward your chest and driving your leg forward. A strain happens when these muscles or their tendons are stretched or loaded beyond their capacity, often during sprinting, kicking, or a sudden change of direction. Strains are graded by severity:
- Grade I involves mild overstretching with minimal fiber damage
- Grade II involves a partial tear with more noticeable pain and weakness
- Grade III involves a complete tear, which is far less common but requires a longer recovery.
Why These Two Conditions Get Confused
Both conditions cause hip pain, which is exactly why they get lumped together, but the location and behavior of the pain usually tell them apart. Hip bursitis produces pain on the outside of the hip, over that bony point, sometimes radiating down the outer thigh, and tends to flare with direct pressure or compression, like lying on that side, sitting with your legs crossed, or sitting for long stretches. A hip flexor strain produces pain at the front of the hip or groin, typically worse with lifting your knee, climbing stairs, or accelerating while running. Paying attention to exactly where the pain sits, and what specific movement or position provokes it, is one of the fastest ways to tell these two apart before you even walk into a clinic.
Common Causes of Hip Bursitis
- Mechanical overload or overuse from repetitive activities like running, cycling, or stair climbing
- Prolonged sitting, sitting with legs crossed, or consistently sleeping on the affected side, all of which compress the area
- Weak hip abductors or poor pelvic control, which is responsible for controlling the hip during single-leg activities like walking
- Gluteus medius or minimus tendon tears, whether gradual or from a specific injury
- Direct trauma to the outer hip, or contributing factors like obesity
Hip osteoarthritis can produce similar lateral hip pain and is worth ruling out, but it’s considered a separate condition your physiotherapist will screen for rather than a direct cause of bursitis itself.
Common Causes of Hip Flexor Strain
- Sudden sprinting, kicking, or an abrupt change of direction, especially without an adequate warm-up
- Tight or under-conditioned hip flexors that are asked to produce force beyond their current capacity
- Sports with repetitive hip flexion under load, such as soccer, martial arts, or sprinting-based sports
- A history of previous hip flexor strain, which raises the risk of re-injury if strength hasn’t fully returned
Physiotherapy Treatment for Hip Bursitis
There’s no single test that definitively confirms hip bursitis or GTPS. Diagnosis is largely clinical, based on where your pain sits and what provokes it, and imaging like ultrasound or MRI is generally reserved for cases where conservative treatment hasn’t helped, the diagnosis is unclear, or a gluteal tendon tear is suspected, not as a first step.
Since the gluteal tendons are usually the main driver of symptoms, treatment focuses there rather than on the bursa itself. This typically includes activity modification to reduce direct pressure on the area, such as adjusting sleep position or reducing high-friction activities temporarily, along with soft tissue work to ease surrounding muscle tension.
From there, progressive gluteal strengthening, particularly of the glute medius and minimus, becomes the core of treatment, since these muscles control hip stability and take pressure off the irritated area. As we remind patients working through this, the tendon heals slowly with progressive loading, so consistency matters more than intensity here.
If you’ve been offered a corticosteroid injection, it’s worth knowing that these tend to provide short-term relief rather than a lasting fix, and NSAIDs are typically better suited to short bursts of acute pain than ongoing use, since they can interfere with tendon healing over time.
Physiotherapy Treatment for Hip Flexor Strain
Diagnosis usually starts with how the injury happened, since a sudden sprint, kick, or forceful hip flexion against resistance is a strong clue. From there, your physiotherapist checks for point tenderness over the muscle, along with pain or weakness when you actively lift your knee against resistance, which helps confirm the strain and gauge its severity. The Thomas Test does have a role here, though not as a way to diagnose the strain itself. It’s a flexibility assessment that measures hip flexor tightness, and it’s useful both for identifying tightness that may have contributed to the injury and for tracking whether your hip flexor length is returning to normal as you progress through rehab.
Early treatment focuses on protecting the healing muscle while managing pain, typically with relative rest from provoking activities, ice in the first few days, and gentle movement within a pain-free range. As pain settles, treatment shifts toward restoring flexibility and gradually reloading the hip flexors, often starting with controlled exercises like band marching before progressing to more dynamic movements. The underlying principle here is straightforward: strength restores the tendon’s capacity, and rushing this process is one of the most common reasons hip flexor strains become recurring problems.
What to Expect During Recovery
Hip bursitis often takes several weeks to meaningfully improve, since the underlying strength deficits that contribute to it take time to address, though pain typically starts easing within the first couple of weeks of consistent treatment. Hip flexor strains vary more by grade: mild Grade I strains often recover within one to two weeks, Grade II strains typically take three to six weeks, and Grade III strains can take several months, particularly for athletes returning to sprinting or kicking sports.
Preventing Recurrence
- Warm up thoroughly before activities that involve sprinting, kicking, or rapid direction changes.
- Build gluteal strength consistently, not just when hip pain flares up, since weak glutes contribute to both conditions.
- Progress training load gradually rather than jumping into high-intensity activity after a period of rest.
- Address sleep position and prolonged sitting habits if hip bursitis has been a recurring issue for you.
Get to the Root of Your Hip Pain
Hip pain can come from more than one source, and getting an accurate diagnosis is the fastest way to a treatment plan that actually works. At Clayton Heights 188 St Physiotherapy and Sports Injury Clinic in Clayton Heights, Surrey, our team assesses exactly what’s driving your hip pain, whether it’s bursitis, a hip flexor strain, or something else entirely, and builds a recovery plan around it. Reach out to book an assessment and let’s get your hip moving the way it should.