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. 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

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

No accuracy study

30-Second Single Leg Stance

Procedure

Patient stands on the affected leg with the other knee lifted, a fingertip on the wall for balance, and holds for up to 30 seconds. Watch the pelvis and ask about pain.

Positive Finding

Reproduction of the lateral hip pain within 30 seconds, and/or the pelvis drops on the side of the lifted leg.

Sensitivity / Specificity

100% (17 patients)/—

Interpretation

Pain reproduction supports a gluteal tendon source. Pelvic drop shows weak hip abductors and guides strengthening. From one small study of 17 patients with long-standing lateral hip pain, all with gluteal tendon changes or bursitis on MRI (Lequesne 2008). Only sensitivity is shown: the comparison group had no hip pain, which makes specificity look better than it is in clinic.

Sources

No accuracy study

FABER Test

Procedure

Patient supine. Place the foot of the tested leg on the opposite knee, then let the knee fall outwards with gentle overpressure.

Positive Finding

Pain at the lateral hip, or groin or buttock pain.

Interpretation

Lateral hip pain in this position can come from gluteal tendon compression. Groin pain points to the hip joint; buttock pain to the sacroiliac joint. Not specific.

Sources

No accuracy study

Resisted External Derotation Test

Procedure

Patient supine with the hip and knee bent to 90° and the hip turned out. Ask the patient to push the foot back towards the midline (turning the hip in) against your resistance at the ankle.

Positive Finding

Reproduction of the lateral hip pain.

Sensitivity / Specificity

88% (17 patients)/—

Interpretation

Loads the gluteus medius and minimus tendons in a position that also compresses them. Pain supports a gluteal tendon source of lateral hip pain. From one small study of 17 patients with long-standing lateral hip pain, all with gluteal tendon changes or bursitis on MRI (Lequesne 2008). Only sensitivity is shown: the comparison group had no hip pain, which makes specificity look better than it is in clinic. Figure is for the test done lying on the back with the hip bent to 90°.

Sources

No accuracy study

Palpation of the Greater Trochanter and Bursa

Procedure

Patient lies on the unaffected side. Palpate over the greater trochanter and just above and behind it, comparing with the other side.

Positive Finding

Tenderness over the greater trochanter that reproduces the patient's pain.

Interpretation

Supports greater trochanteric pain syndrome. Most lateral hip pain comes from the gluteal tendons rather than the bursa alone, and palpation cannot separate them. Heat, redness and fever suggest an infected bursa and need medical assessment.

Sources

No accuracy study

Ober Test

Procedure

Patient lies on the unaffected side with the bottom hip and knee bent. Hold the pelvis steady, bring the top leg into abduction and slight extension, then let it lower towards the plinth.

Positive Finding

The leg stays up, or lateral hip pain is reproduced as it lowers.

Interpretation

Tests tensor fasciae latae and iliotibial band tightness. Lateral hip pain in adduction suggests compression of the gluteal tendons and bursa. Not diagnostic.

Sources

No accuracy study

Resisted Hip Abduction (Isometric Strength Test)

Procedure

Patient lies on the unaffected side, top leg slightly lifted. Ask the patient to hold against your resistance at the knee or ankle for a few seconds. Compare with the other side.

Positive Finding

Reproduction of the lateral hip pain, or weakness.

Interpretation

Loads the gluteal tendons. Pain supports a gluteal tendon source; weakness guides strengthening.

Sources

⚠ 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

No trials of osteopathic or manual techniques for gluteal bursitis were found. For gluteal tendinopathy (see GTPS), education with exercise beat a steroid injection and wait-and-see in the LEAP trial.

Region

Gluteal and deep hip muscles

Technique

Soft tissue, lumbar and glutealNo trials found

Rationale

Eases tension in the gluteal and deep hip muscles. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Hands-on soft-tissue work (kneading, stretching and sustained pressure) to the lumbar paraspinals, quadratus lumborum and gluteal muscles, usually prone or side-lying.

Cautions

Only minor side effects have been reported in trials.

Evidence in Gluteal Bursitis

Searched 24 Oct 2026: no trials of gluteal soft tissue technique in gluteal bursitis.

Sources

Region

Tensor fasciae latae and iliotibial band

Technique

Soft tissue, hip and thighNo trials found

Rationale

Eases tension in the hip and thigh muscles. Not tested in trials for this condition.

How it's done & evidence

How it's done

Hands-on kneading, stretching and sustained pressure to the muscles around the hip and thigh: the hip flexors, adductors and hamstrings, and tensor fasciae latae with the iliotibial band.

Evidence in Gluteal Bursitis

Searched 24 Oct 2026: no trials of TFL and ITB soft tissue technique in gluteal bursitis.

Sources

Region

Hip joint

Technique

Articulation, hipNo trials found

Rationale

Gentle, rhythmic movement of the hip joint within its range to ease stiffness. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Rhythmic, low-velocity passive movement of the hip joint within its range, with no thrust, usually with the patient supine. In hip osteoarthritis trials it was given as a course of about 9–10 sessions over 5–12 weeks.

Cautions

Side effects are usually mild and short-lived. In one hip osteoarthritis trial, 41% of the active group (manual therapy plus exercise) reported mild side effects, against 14% with sham.

Evidence in Gluteal Bursitis

Searched 24 Oct 2026: no trials of hip mobilisation in gluteal bursitis.

Region

Psoas and iliacus

Technique

Muscle energy, psoasNo trials found

Rationale

Low-force MET or counterstrain to ease a tight, tender psoas. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

The hip is taken into extension to the barrier (prone, or supine with the leg off the table). The patient pulls the hip toward flexion for 3–5 seconds against equal resistance, relaxes, and the hip is taken further into extension. Repeat 3–5 times, then re-check.

Cautions

Do not use with a fracture in the area, an unstable pelvis or hip, recent surgery, or a patient who cannot contract on request or follow directions.

Evidence in Gluteal Bursitis

Searched 24 Oct 2026: no trials of hip flexor MET in gluteal bursitis.

Region

Lumbar spine and sacroiliac joints

Technique

Articulation, lumbarNo trials found

Rationale

Gentle mobilisation of the lower back and sacroiliac region. Not tested in trials for this condition.

How it's done, cautions & evidence

How it's done

Rhythmic, low-velocity movement of restricted lumbar segments within their passive range, with no thrust, usually side-lying or prone. The amplitude can vary.

Cautions

Side effects reported in trials were mild and short-lived: soreness, tiredness or a flare of existing symptoms.

Evidence in Gluteal Bursitis

Searched 24 Oct 2026: no trials of lumbar or sacroiliac mobilisation in gluteal bursitis.

Sources

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