Hip Bursitis vs. Hip Arthritis: What Is the Difference?

Hip pain can interfere with nearly every part of your day.

It may hurt to walk, climb stairs, stand from a chair, exercise, put on your shoes, or sleep comfortably. When people begin looking for answers, two terms commonly appear: hip bursitis and hip arthritis.

These conditions can both cause pain around the hip, but they are not the same.

Hip bursitis generally involves irritation of a small cushioning sac outside the hip joint. Hip arthritis affects the joint itself. The location of the pain, the movements that trigger it, and the type of stiffness you experience may provide clues about which condition is more likely.

However, symptoms can overlap. Some people may have more than one contributing issue at the same time. For example, a person with hip arthritis may change the way they walk, which could place additional stress on the tissues along the outside of the hip.

A professional evaluation is the most reliable way to understand what is contributing to your symptoms.

This guide explains the difference between hip bursitis and hip arthritis, common symptoms of each condition, and how physical therapy may help you move more comfortably.

Understanding the Hip

The hip is a ball-and-socket joint.

The rounded top of the thighbone forms the ball, and a section of the pelvis forms the socket. Cartilage helps the joint surfaces move smoothly, while muscles, tendons, ligaments, and other tissues provide strength and stability.

Outside the joint are small fluid-filled sacs called bursae. Their purpose is to reduce friction where muscles and tendons move near bones.

Because the hip includes many closely connected structures, pain in the region may come from:

• The hip joint
• Muscles
• Tendons
• Bursae
• Ligaments
• The lower back
• Nerves
• Nearby areas such as the pelvis or knee

The hip is also a weight-bearing joint. It must support the body while allowing enough mobility for walking, sitting, bending, climbing, and turning.

Understanding whether pain appears to come from inside the joint or from the surrounding tissues is an important part of an evaluation.

What Is Hip Bursitis?

Hip bursitis occurs when a bursa around the hip becomes irritated.

The bursa most commonly associated with outer hip pain is located near the greater trochanter, the bony point on the outside of the upper thigh. This condition is often called trochanteric bursitis.

The main symptom is pain over the outside of the hip. It may extend down the outside of the thigh. In the early stages, the pain may feel sharp or intense and later become a broader ache. develop following repeated stress, a direct impact, changes in activity, or irritation from nearby muscles and tendons.

However, healthcare professionals now recognize that outer hip pain does not always come from an isolated bursa. The gluteal tendons may also be involved. The broader term greater trochanteric pain syndrome, or GTPS, is often used to describe pain involving the outer-hip soft tissues. p Arthritis?

Arthritis is a general term for conditions that affect a joint.

There are many forms of arthritis, but osteoarthritis is one of the most common types affecting the hip. Hip osteoarthritis involves changes in the joint tissues, including the cartilage that covers the ends of the bones.

Symptoms often develop gradually. Pain and stiffness may be worse after sitting, resting, or waking in the morning. Over time, the hip may not move as freely as it once did. frequently causes pain in the groin or front of the thigh. It may also cause discomfort in the buttock, knee, or other parts of the hip region.

Although age can increase the likelihood of osteoarthritis, symptoms should not simply be dismissed as “getting older.” Many factors affect how arthritis influences movement, pain, and daily function.

Hip Bursitis vs. Hip Arthritis: The Main Difference

The main difference is the structure involved.

Hip bursitis affects a bursa outside the joint.

Hip arthritis affects the hip joint itself.

This difference often influences the location and behavior of the pain.

Hip bursitis commonly causes tenderness on the outer side of the hip. Direct pressure, such as lying on the affected side, may be uncomfortable.

Hip arthritis more commonly causes deeper groin-centered pain, joint stiffness, and difficulty with activities requiring greater hip movement.

These patterns are helpful, but they are not absolute. Arthritis can cause pain outside the hip, and bursitis-related pain may spread into surrounding areas.

Quick Comparison: Hip Bursitis and Hip Arthritis

Hip bursitis is more likely to involve:

• Pain over the outside of the hip
• Tenderness when pressing on the side of the hip
• Pain when lying on the affected side
• Pain that spreads down the outside of the thigh
• Symptoms with walking, stairs, or prolonged standing
• Pain after an activity increase
• Irritation following a direct impact

Hip arthritis is more likely to involve:

• Deep pain in the groin
• Pain in the front of the thigh
• Stiffness after sitting or resting
• Reduced hip movement
• Difficulty putting on shoes or socks
• Difficulty getting in and out of a vehicle
• Pain during walking or weight-bearing
• Gradual changes in daily function
• Symptoms that become more frequent over time

A person may not fit perfectly into either list. A complete evaluation considers the full pattern rather than one symptom.

Where Does Hip Bursitis Hurt?

Hip bursitis typically causes pain at the outer point of the hip.

The area may feel sore or tender when touched. The pain can travel down the outside of the thigh but usually remains centered around the lateral hip.

Symptoms may be worse when:

• Lying on the painful side
• Climbing stairs
• Walking for longer distances
• Standing for extended periods
• Rising from a low chair
• Standing on one leg
• Running or performing repetitive activity
• Pressing directly over the outer hip

Bursitis in other areas of the body may involve warmth, swelling, or tenderness. Hip bursitis can be more difficult to see because the affected structures are located beneath layers of tissue. Hip Arthritis Hurt?

Hip arthritis often causes pain deeper in the joint.

The groin is one of the most common locations. Pain may also be felt in the front of the thigh, buttock, or knee. Some people are surprised to learn that knee pain may occasionally be related to the hip. be worse during:

• Walking
• Standing
• Climbing stairs
• Getting up after sitting
• Bending to put on shoes
• Getting into or out of a car
• Turning or pivoting
• Activities requiring a wider range of hip motion

As arthritis progresses, pain may occur more frequently and may sometimes be present during rest or at night. Night Bursitis or Arthritis?

Both conditions may cause pain at night, but the pattern may differ.

Hip bursitis commonly hurts when lying directly on the affected side. The pressure of the mattress against the outer hip may irritate sensitive tissues.

Some people also feel pain when lying on the opposite side because the top leg falls inward and places stress on the outer-hip tissues.

Hip arthritis may cause a deeper ache. The discomfort may be related to stiffness after remaining in one position or may become more persistent as the condition progresses.

Nighttime pain alone cannot determine the cause. The location, sleeping position, daytime symptoms, movement restrictions, and medical history also matter.

Severe or unexplained nighttime pain that continues regardless of position should be discussed with a healthcare professional.

Is Hip Stiffness More Common With Bursitis or Arthritis?

Significant joint stiffness is more characteristic of hip arthritis.

People with hip osteoarthritis often report stiffness after waking or after sitting for an extended period. They may notice reduced ability to rotate or bend the hip. Activities such as reaching the foot, putting on socks, crossing the legs, or getting into a car may become difficult.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that hip osteoarthritis can cause pain and stiffness in the joint, groin, inner thigh, or buttocks, with a gradual reduction in hip movement over time. may cause a person to move cautiously because of pain, but it does not usually create the same deep joint restriction.

However, pain can make any area feel stiff. A physical examination can help determine whether movement is truly restricted or simply uncomfortable.

What Causes Hip Bursitis?

Hip bursitis may be associated with repeated stress or friction around the outer hip.

Possible contributing factors include:

• A sudden increase in walking or running
• Repetitive stair climbing
• Standing for longer periods
• A fall onto the side of the hip
• Direct pressure on the outer hip
• Changes in walking mechanics
• Weakness around the hip or pelvis
• Differences in leg or lower-extremity function
• Returning to activity too quickly
• Repetitive work or sports demands

Physical therapists also consider whether the gluteal tendons are involved. Because these tendons sit close to the bursa, the symptoms may overlap.

Hip bursitis should not automatically be blamed on one tight muscle or one “bad” movement. Usually, the therapist examines how several factors combine to influence the painful tissues.

What Causes Hip Arthritis?

Hip osteoarthritis develops through changes within the joint over time.

Age is one risk factor, but it is not the only one. Previous hip injuries, joint structure, genetics, body weight, occupational demands, muscle function, and other health factors may contribute.

The condition does not affect every person in the same way. Two people with similar X-ray findings may report very different levels of pain and activity limitation.

This is why treatment decisions should not be based only on an image. Symptoms, goals, strength, mobility, and function must also be considered.

An X-ray may help identify changes associated with arthritis, but a healthcare provider interprets those findings alongside the clinical examination.

Can You Have Hip Bursitis and Arthritis at the Same Time?

Yes.

A person with hip arthritis may have stiffness or weakness that changes how they walk. This may increase demand on the tendons and bursae around the outer hip.

Likewise, a person with outer-hip pain may begin avoiding the painful side, taking shorter steps, or leaning while walking. These changes can affect the joint and surrounding muscles.

When more than one factor is present, treating only the most painful spot may not fully address the problem.

A physical therapist evaluates the whole movement system, including the lower back, pelvis, hip, knee, ankle, balance, and walking mechanics.

Which Condition Causes Pain When Walking?

Both conditions can cause pain during walking.

With hip bursitis or greater trochanteric pain syndrome, walking repeatedly loads the muscles and tendons that stabilize the pelvis. Pain may worsen as distance, speed, hills, or fatigue increase.

With hip arthritis, weight-bearing and joint movement may cause groin pain, stiffness, or a shortened stride. The person may have difficulty extending the hip behind the body or rotating it comfortably.

The way the pain changes during walking provides helpful information.

For example:

• Does it begin immediately or after a certain distance?
• Is the pain on the outside or deep in the groin?
• Does the person limp?
• Does walking uphill feel different from walking on flat ground?
• Does the hip feel weak, stiff, or unstable?
• Does the pain improve after warming up?
• Are symptoms worse later that day?

These details help guide the examination.

How Are Hip Bursitis and Hip Arthritis Evaluated?

The evaluation begins with a conversation about your symptoms.

Your healthcare professional may ask:

• Where is the pain located?
• When did it begin?
• Was there an injury?
• What activities make it worse?
• Does it hurt when you lie on your side?
• Do you feel stiff after sitting?
• Does pain travel down your leg?
• Have you experienced numbness or tingling?
• Has your walking changed?
• Do you have difficulty putting on shoes?
• Have you recently increased your activity?

A physical therapist may then examine:

• Hip range of motion
• Strength
• Balance
• Walking
• Stair movement
• Pelvic control
• Tenderness
• Functional activities
• Lower-back movement
• Knee and ankle function

Hip bursitis is often associated with localized outer-hip tenderness and pain during certain loading activities.

Hip arthritis is more likely to involve restricted joint movement, stiffness, and groin-centered pain.

Imaging is not always necessary for outer-hip soft-tissue pain. X-rays are more commonly used when arthritis, a fracture, or another joint condition is suspected. A medical provider determines whether imaging is appropriate.

How Can Physical Therapy Help Hip Bursitis?

Physical therapy for hip bursitis or greater trochanteric pain syndrome is personalized to the findings of the evaluation.

A licensed physical therapist may help by:

• Identifying activities that repeatedly aggravate the hip
• Improving strength around the pelvis and lower extremity
• Improving movement control
• Addressing walking or stair mechanics
• Gradually increasing tissue tolerance
• Restoring comfortable mobility
• Helping the patient return to work or recreation
• Providing education to reduce repeated flare-ups

Physical therapists may also examine the lower back, knee, and ankle because limitations in those regions can affect the hip.

The American Physical Therapy Association’s ChoosePT resource notes that physical therapists help people with hip bursitis reduce pain and irritation, address related weakness, and return to everyday activities. ingle exercise or treatment that is appropriate for every patient. The care plan should be based on individual symptoms, movement, health history, and goals.

How Can Physical Therapy Help Hip Arthritis?

Physical therapy can be an important part of conservative care for people with hip osteoarthritis.

The goals may include:

• Maintaining or improving joint mobility
• Strengthening the muscles that support the hip
• Improving walking
• Improving balance
• Increasing activity tolerance
• Reducing difficulty with daily tasks
• Helping the patient stay active safely
• Preparing for or recovering from surgery when needed

Exercise is commonly included in the management of osteoarthritis because it can improve flexibility, strength, endurance, pain, and function. The specific program should be selected with a healthcare professional and adjusted to the person’s ability and health needs. cal therapy clinical guidance for hip osteoarthritis supports individualized rehabilitation based on the patient’s symptoms, mobility, strength, and functional limitations. apy cannot reverse structural joint changes. However, improving strength, mobility, movement efficiency, and confidence may help a person function better despite those changes.

Does Hip Arthritis Always Require Surgery?

No.

Many people manage hip arthritis with nonsurgical care, particularly when symptoms are mild or moderate.

Management may involve education, physical therapy, appropriate physical activity, weight management when relevant, medication discussions with a medical provider, and other conservative options.

Surgery may be considered when pain and loss of function become severe and nonsurgical care is no longer providing adequate relief.

The decision is individual. Imaging findings alone do not determine whether surgery is needed. The person’s pain, function, goals, overall health, and response to conservative care must also be considered.

The American Academy of Orthopaedic Surgeons includes physical therapy among the nonsurgical options considered for symptomatic hip osteoarthritis. ursitis Require an Injection?

Not necessarily.

Many people begin with conservative care, including activity adjustments and rehabilitation. A medical provider may discuss medication or injections when appropriate, but these decisions depend on the person’s health and examination.

Because outer hip pain may involve the gluteal tendons rather than only the bursa, it is important to identify the broader movement and loading factors contributing to the condition.

An injection may reduce symptoms for some people, but it does not automatically correct weakness, movement limitations, activity demands, or other contributing factors.

A coordinated plan may provide a more complete approach.

Should You Exercise With Hip Bursitis or Arthritis?

Movement is often an important part of managing both conditions, but the appropriate type and amount vary.

With bursitis or outer-hip tendon pain, repeated activities that sharply increase symptoms may need to be temporarily adjusted. The tissues are then gradually prepared to handle more activity.

With arthritis, regular joint-friendly physical activity may help maintain mobility, strength, and function. The Centers for Disease Control and Prevention lists activities such as walking, cycling, swimming, water exercise, dancing, gardening, and tai chi as joint-friendly options for many adults with arthritis. mean every activity is appropriate for every person.

A patient who has severe pain, recent injury, balance problems, heart or lung conditions, or other medical concerns should speak with an appropriate healthcare professional before beginning a new program.

Physical therapy can help identify a starting point and build a plan around the person’s needs.

When Should You Seek Help?

Consider scheduling an evaluation when hip pain:

• Interferes with sleep
• Limits walking or standing
• Makes stairs difficult
• Causes a limp
• Prevents exercise or recreation
• Makes it difficult to put on shoes
• Continues to return
• Is gradually becoming worse
• Has not improved with reasonable activity changes
• Causes concern or uncertainty

You do not have to wait until you can barely walk before seeking help.

An early evaluation may help identify limitations and create a plan before the pain affects more areas of your daily life.

When Is Hip Pain Urgent?

Seek prompt medical care for:

• Severe pain after a fall or accident
• Inability to bear weight
• A visibly deformed hip or leg
• A hot, swollen, or red hip
• Hip pain with fever or chills
• Sudden significant weakness
• New numbness with loss of function
• Loss of bladder or bowel control
• Rapidly worsening symptoms
• Severe unexplained pain

A hot and swollen hip accompanied by fever or feeling unwell requires urgent medical assessment because infection is one possible cause. Asked Questions About Hip Bursitis and Hip Arthritis

How can I tell whether I have hip bursitis or arthritis?

Pain over the outer hip that is tender to touch and worse when lying on that side is more consistent with bursitis or greater trochanteric pain syndrome. Deep groin pain, stiffness, and reduced joint movement are more consistent with arthritis. However, only an appropriate healthcare professional can determine the likely cause.

Does hip bursitis show up on an X-ray?

An X-ray primarily shows bones and joint alignment. It may help rule out arthritis, a fracture, or another bone-related issue, but it does not provide a complete view of all soft tissues. A healthcare provider decides which imaging, if any, is appropriate.

Can hip arthritis hurt on the outside of the hip?

Yes. Although groin pain is more typical, arthritis symptoms can be felt in the thigh, buttock, knee, or outer hip. Arthritis may also change walking mechanics and contribute to irritation of the outer-hip tissues.

Why does my hip hurt when I lie on it?

Direct pressure can irritate the tissues near the greater trochanter. This symptom is commonly associated with lateral hip pain or hip bursitis, but it should be considered together with your other symptoms.

Which condition causes more stiffness?

Hip arthritis is more likely to cause significant joint stiffness and reduced movement, particularly after sleeping or sitting. Bursitis may make movement painful, but it does not usually limit the joint in the same way.

Can physical therapy help both conditions?

Yes. Physical therapy may help address pain, weakness, movement limitations, balance, walking, and difficulty with daily activities. The care plan will differ depending on whether the main issue involves the joint, surrounding soft tissues, or both.

Can bursitis turn into arthritis?

Bursitis does not turn into arthritis. They affect different structures. However, a person may have both conditions at the same time.

Is walking good for hip arthritis?

Walking may be a helpful form of activity for many people with arthritis, but the distance, speed, surface, and frequency should match the person’s current ability. A physical therapist can help determine an appropriate starting point.

How long does hip bursitis take to improve?

The timeline varies based on the tissues involved, how long symptoms have been present, activity demands, overall health, and consistency with the care plan. Persistent symptoms should be evaluated rather than repeatedly managed through guesswork.

Do arthritis symptoms always match the X-ray?

No. Imaging is only one part of the picture. A healthcare professional also considers pain, stiffness, strength, mobility, daily function, and personal goals.

Get a Personalized Hip Evaluation

It can be difficult to determine whether hip pain is coming from a bursa, tendon, joint, lower back, or a combination of areas.

You do not need to figure it out alone.

At Hohman Rehab & Sports Therapy, a licensed physical therapist will perform a detailed evaluation and create a personalized plan based on your movement, symptoms, health history, and goals.

Our team provides personalized, one-on-one care to help you:

• Better understand your hip pain
• Improve mobility and strength
• Walk with greater confidence
• Return to meaningful activities
• Build strategies for long-term independence

To schedule an evaluation, visit www.hohmanrehab.com or contact the clinic nearest you:

Clermont
236 Mohawk Rd., Clermont, FL 34715
(352) 404-6908

Ocoee
11095 W. Colonial Dr., Ocoee, FL 34761
(407) 347-8936

Apopka
125 S. Park Ave., Apopka, FL 32703
(407) 410-3200

Our team is here to help you on your path to wellness.

This article provides general educational information and is not intended to diagnose a condition or replace medical advice from a qualified healthcare professional.

Written By:

Dr. Katie Hohman, PT, DPT, CLT

Physical Therapist, Certified Lymphedema Therapist, Founder

Topics:

Hip