Gluteal Bursitis

Lower Limb

Overview

Gluteal bursitis is inflammation of one or more bursae in the gluteal region, most commonly affecting the trochanteric bursa located between the greater trochanter and gluteal muscles. The condition presents with lateral hip pain, typically aggravated by prolonged sitting, lying on the affected side, or activities requiring hip abduction. It is a common source of lower limb disability that responds well to conservative management including manual therapy and targeted rehabilitation.

Pathophysiology

Bursae are fluid-filled sacs that reduce friction between tendons, muscles, and bone surfaces. Gluteal bursitis develops through repetitive microtrauma, direct compression (prolonged sitting), hip biomechanical dysfunction, or muscle imbalances causing altered movement patterns. Inflammation leads to increased fluid production, bursal distension, and pain with movement. Contributing factors include hip weakness, excessive hip adduction, tight hip flexors and tensor fasciae latae, and altered motor control of hip stabilisers. The condition may develop secondary to hip osteoarthritis, IT band tightness, or abnormal gait mechanics.

Patient Education

Gluteal bursitis improves significantly with activity modification, strengthening the hip stabiliser muscles (particularly the gluteus medius), stretching tight structures, and addressing postural habits like prolonged sitting on the affected side.

Typical Presentation

Site

Lateral hip and upper lateral thigh, often localised to the region over the greater trochanter; may radiate distally along the IT band

Quality

Sharp, aching, or burning pain; may feel like a deep throbbing sensation

Intensity

Mild to moderate (3-7/10), often worse in the morning or after activity

Aggravating

Lying on the affected side, prolonged sitting (especially cross-legged), climbing stairs, standing on one leg, hip adduction movements, walking on uneven surfaces, sudden changes in activity intensity

Relieving

Rest, avoiding aggravating positions, ice application, lying on the unaffected side, gentle movement and mobilisation

Associated

Limping gait, reduced hip abduction strength, tightness in hip flexors and IT band, possible pain on internal hip rotation, stiffness after periods of inactivity

Orthopaedic Tests

Palpation of the Greater Trochanter and Bursa

Procedure

Patient lies supine or sidelying on the unaffected side. Palpate the lateral aspect of the greater trochanter with direct pressure, assessing for tenderness and swelling over the bursal region.

Positive Finding

Acute tenderness, swelling, or warmth over the greater trochanteric bursa region; pain reproduction on direct palpation

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Direct palpation is a basic screening tool; positive findings support clinically suspected bursitis but lack specificity for differentiating bursal inflammation from other lateral hip pathology (e.g., GTPS, tendinopathy)

Single-Leg Stance (Modified Trendelenburg)

Procedure

Patient stands on one leg for 30 seconds while examiner observes pelvic stability from behind. Note any pelvic drop on the contralateral side or increased difficulty.

Positive Finding

Pelvis tilts downward on the opposite (non-stance) side; difficulty maintaining upright posture; reproduction of lateral hip/gluteal pain

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Positive result suggests gluteal weakness or inhibition due to pain; correlates with functional impairment and pain during weight-bearing activities common in bursitis

Patrick's Test (FABER: Flexion-Abduction-External Rotation)

Procedure

Patient supine; examiner flexes, abducts, and externally rotates the hip, placing the ankle on the opposite knee. Gentle overpressure applied; observe for pain or restriction.

Positive Finding

Lateral hip or gluteal pain; positive test if pain occurs before or at end-range with overpressure; may reproduce bursitis-related discomfort

Sensitivity / Specificity

See current literature / See current literature

Interpretation

Assesses hip mobility and intra-articular vs. extra-articular pain patterns; positive results may indicate bursal irritation or hip joint involvement but is non-specific and commonly positive in multiple hip conditions

Ober Test (Hip Abduction Contracture Assessment)

Procedure

Patient sidelying on unaffected side; examiner flexes the bottom hip for stability, abducts and extends the top hip, then slowly lowers it toward the table while observing hip position.

Positive Finding

Hip remains abducted (does not adduct past midline) or cannot lower to table level; reproduction of lateral hip or gluteal pain

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Positive result suggests iliotibial band (ITB) tightness or hip abductor contracture, which commonly co-occurs with or contributes to greater trochanteric bursal irritation and lateral hip pain

Resisted Hip Abduction (Isometric Strength Test)

Procedure

Patient sidelying on unaffected side or standing; examiner applies resistance to abduction at the hip while patient maintains isometric contraction for 5 seconds.

Positive Finding

Pain or weakness with resisted abduction; reproduction of gluteal/lateral hip pain; reduced strength compared to contralateral side

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Assesses gluteal medius and minimus function; pain during testing suggests muscular inhibition or bursal inflammation. Weakness may reflect pain avoidance or true gluteal pathology

Palpation During Active Hip Abduction (Resisted Abduction with Palpation)

Procedure

Patient standing or sidelying; examiner palpates the greater trochanteric bursa region while patient actively abducts the hip against gentle resistance.

Positive Finding

Tenderness, swelling, or crepitus felt over the bursa during active movement; pain with contraction of abductors

Sensitivity / Specificity

Unknown / Unknown

Interpretation

Combines palpation with dynamic assessment; positive findings indicate bursal inflammation worsened or provoked by gluteal muscle activity, supporting clinically suspected bursitis

⚠ Red Flags

  • •Acute severe swelling with signs of infection (warmth, redness, systemic fever)
  • •Unexplained weight loss with chronic hip pain
  • •Night pain that disturbs sleep despite analgesia
  • •Progressive neurological symptoms (numbness, tingling in lower limb distribution)
  • •History of malignancy with new-onset hip pain
  • •Signs of systemic inflammatory arthropathy (polyarticular involvement, morning stiffness >1 hour)
  • •Inability to bear weight due to acute pain

⚡ Yellow Flags

  • •High pain catastrophising or fear-avoidance behaviours
  • •Chronicity >3 months with minimal improvement despite conservative care
  • •Significant functional disability affecting work or leisure activities
  • •Poor sleep quality related to pain
  • •Psychological distress or depression secondary to chronic pain
  • •Overtraining or exercise addiction contributing to persistence
  • •Sedentary lifestyle with significant sitting demands
  • •Low health literacy or poor engagement with rehabilitation

Osteopathic Techniques

Region

Gluteal region and hip

Technique

Soft Tissue

Rationale

Soft tissue techniques applied to gluteus medius, minimus, and maximus reduce muscular tension, improve local circulation, and promote tissue healing. Reducing muscle guarding facilitates more effective stretching and corrects compensatory patterns.

Region

Iliotibial band and tensor fasciae latae

Technique

Soft Tissue

Rationale

Direct soft tissue release of the IT band and TFL addresses tightness that contributes to abnormal hip biomechanics and lateral hip compression. Reducing IT band tension decreases friction on the bursa.

Region

Hip joint and pelvis

Technique

Articulation

Rationale

Gentle articulation and mobilisation of the hip joint improve synovial fluid distribution, reduce pain-free range of motion, and restore normal arthrokinematics. This addresses secondary hip stiffness and movement restrictions.

Region

Lumbar spine and sacroiliac joint

Technique

Articulation

Rationale

Addressing lumbar and pelvic mobility improves hip biomechanics and reduces compensatory stress on the gluteal region. Hip dysfunction is often secondary to sacroiliac joint or lumbar spine restrictions.

Region

Hip flexors (psoas major, rectus femoris)

Technique

MET

Rationale

Muscle energy technique applied to hip flexors releases tightness that contributes to anterior pelvic tilt and altered hip mechanics. Improved hip extensor flexibility reduces gluteal overload.

Region

Gluteal musculature and bursa

Technique

Lymphatic

Rationale

Gentle lymphatic drainage techniques reduce bursal swelling and inflammation, promoting fluid reabsorption and pain relief. This technique is particularly useful in acute inflammatory presentations.

Add-On Approaches

Chinese Medicine

Acupuncture and moxibustion applied to points in the Gallbladder meridian (GB29-GB34) addressing stagnation in the hip region; herbal formulas such as Du Huo Ji Sheng Tang may reduce pain and inflammation

Chiropractic

Sacroiliac joint adjustments to correct pelvic mechanics; hip and lumbar spine manipulation to address compensatory restrictions affecting hip biomechanics

Physiotherapy

Progressive hip strengthening (especially gluteus medius and hip abductors), gait retraining, modalities such as ultrasound or transcutaneous electrical nerve stimulation, and movement control exercises

Remedial Massage

Remedial massage to gluteal muscles, IT band, and hip musculature to reduce tension, improve circulation, and break down muscular trigger points contributing to pain and dysfunction

Rehabilitation Exercises

Pigeon Pose (Hip External Rotator Stretch)

StretchingBeginner

Supine Figure-Four Stretch

StretchingBeginner

Lunging Hip Flexor Stretch

StretchingBeginner

Clamshells (Gluteus Medius Activation)

StrengtheningBeginner

Side-Lying Hip Abduction

StrengtheningBeginner

Glute Bridges

StrengtheningBeginner

Single-Leg Glute Bridge (Unilateral Loading)

StrengtheningIntermediate

Monster Walks with Resistance Band

StrengtheningIntermediate

Step-Ups (Forward and Lateral)

StrengtheningIntermediate

Pelvic Tilt and Core Stability

PosturalBeginner

Single-Leg Standing Balance

BalanceIntermediate

Hip Circles and Mobilisation

Range of MotionBeginner

Referral Criteria

  • •Persistent symptoms >8 weeks despite optimal conservative management
  • •Significant functional impairment affecting work or activities of daily living
  • •Suspected bursal infection (fever, severe swelling, redness)
  • •Imaging findings suggestive of hip osteoarthritis requiring specialist assessment
  • •Presentation consistent with hip labral pathology (catching, locking, mechanical symptoms)
  • •Neurological symptoms suggesting nerve compression (buttock pain with radiation, numbness)
  • •Failure to progress with manual therapy and rehabilitation after 6 weeks
  • •Patient preference for or candidacy for injection therapy or advanced imaging
  • •Underlying systemic inflammatory condition requiring rheumatological review