Hip bursitis — the diagnosis given to pain on the bony outside of the hip, worse lying on that side at night, worse getting up from a chair, worse on stairs — has had a quiet revision over the last decade. The bursa, the small fluid-filled cushion over the hip bone, is rarely the real problem. In most cases the pain comes from the gluteal tendons underneath it, which have become irritated and weakened, and clinicians increasingly call it gluteal tendinopathy or greater trochanteric pain syndrome. That matters enormously for exercise, because tendons do not want rest and they do not want stretching. They want to be loaded, gradually and without compression. Pilates, done the right way, is one of the best ways to do that — and done the wrong way, it is one of the most common reasons the pain never leaves.
Key takeaway: Pilates is good for hip bursitis when it strengthens the gluteal tendons without compressing the side of the hip. Most “hip bursitis” is gluteal tendinopathy, so the priorities are isometric holds, bridges, hip hitches and sit-to-stands — and strict avoidance of compressive stretches: crossing the legs, figure-four, pigeon, side-lying on the sore side and hanging on one hip. Expect three to six months of steady work.
Pilates is good for hip bursitis when it is adapted to what the condition really is: most lateral hip pain diagnosed as trochanteric bursitis is gluteal tendinopathy, an irritated and weakened gluteus medius and minimus tendon rather than an inflamed bursa. The helpful Pilates exercises load those tendons gradually — isometric side-lying abduction holds, glute bridges, standing hip hitches, sit-to-stands and step-ups — while keeping the hip in a neutral, uncompressed position. The exercises to avoid are compressive stretches such as figure-four, pigeon, crossing the legs and lying on the painful side. Sophie Mercer, PMA-certified clinical Pilates instructor, designed a 12-week Hip Replacement Recovery protocol of 44 exercises built on this same progressive, compression-free gluteal loading.
Hip bursitis or gluteal tendinopathy? Why the name changes the treatment
The gluteus medius and minimus tendons wrap around the greater trochanter — the bony point on the side of your hip — and the bursa sits on top as a cushion. When those tendons are weak and repeatedly compressed against the bone, they become painful, and the bursa may become irritated as a bystander. Imaging studies of people with “bursitis” typically show tendon changes far more often than an inflamed bursa, which is why the modern names are gluteal tendinopathy or lateral hip pain.
Why does this matter? Because the two diagnoses suggest opposite treatments. Bursitis suggests rest, ice and anti-inflammatories. Tendinopathy calls for progressive loading — strengthening the tendon so it tolerates more — combined with removing compression. Rest alone lets the tendon get weaker; stretching, which most people instinctively reach for, compresses the tendon against the bone and makes it worse. Almost everyone I see with long-standing hip bursitis has been faithfully doing the figure-four stretch for months.
What exercises should I avoid with hip bursitis?
This list is more important than the exercise list, because removing compression is often what allows the tendon to finally settle. Avoid, at least until the pain has calmed for several weeks:
- Crossing your legs when sitting — the single most common aggravator
- Figure-four, pigeon, and any stretch that pulls the knee across the body — these compress the gluteal tendons against the trochanter
- Lying on the painful side — use a pillow between the knees and lie on the other side or your back; if you must lie on the sore side, a thick mattress topper helps
- Hanging on one hip when you stand — the “hip out to the side” posture that shifts the pelvis sideways
- Deep side-bends and wide-legged stretches
- High-repetition clams and side-lying leg lifts early on — the classic Pilates “hip series” is done in exactly the side-lying position that compresses the tendon, and clams in particular can flare it; introduce them later, in small doses, with a pillow under the waist to keep the hip neutral
- Sitting in low, soft chairs with the knees higher than the hips
- Hills, stairs and long walks during a flare
A useful way to think about it: keep the thigh in line with the body or slightly out to the side, never across the midline. Most of what aggravates hip bursitis involves the knee drifting inward.
What is the best exercise for hip bursitis?
Loading the tendon progressively, without compression, in this order. Start with the isometric holds for one to two weeks, add the strengthening as the pain allows, and expect some mild discomfort during exercise that settles within 24 hours — that is acceptable; pain that is worse the next morning means you did too much.
- Isometric side-lying abduction hold — lie on the unaffected side with a pillow between the knees, or on your back with a band around the knees. Press the affected leg gently outward against the resistance without moving it. Hold 30-45 seconds, 5 reps. Feel: the side of the hip working with no sharp pain. Avoid: any position where the sore hip is pressed into the floor.
- Standing isometric wall push — stand side-on to a wall, affected hip nearest the wall, and press the outside of the knee sideways into the wall. Hold 30-45 seconds, 5 reps. Tendons calm down well with these holds.
- Glute bridge — knees bent, feet hip-width, lift to a straight line and squeeze for 2-3 seconds. 10-12 reps. Feel: glutes. Avoid: the knees falling inward.
- Standing hip hitch — stand on the affected leg on a step, the other foot hanging free. Let the free hip drop slightly, then lift it back to level using the standing hip. 10 slow reps. Feel: the side of the standing hip. This is the exercise that most directly retrains the gluteal tendon.
- Sit-to-stand — from a firm chair, stand up and sit down slowly without using the hands, knees tracking over the toes. 10-12 reps. Progress to a lower chair over time.
- Step-up — step onto a low step with the affected leg, keeping the pelvis level, and lower slowly. 8-10 reps. Avoid: the pelvis dropping on the free side.
- Side-lying leg lift (modified) — only once the above are comfortable. Lie on the unaffected side with a pillow under the waist so the top hip stays neutral, top leg in line with the body, lift 20-30 cm and lower for 3 counts. 8-10 reps. Avoid: the leg drifting forward or the pelvis rolling back.
- Supine band abduction — on your back, knees bent, band around the knees, press the knees outward and hold 2 seconds. 12-15 reps. A safe way to load the abductors without any side-lying.
Progress by adding a second set, then slower tempos, then a light weight on the hip for bridges and step-ups. The wider hip-strength picture is covered in glute strengthening exercises.
Should you walk a lot with hip bursitis?
Walking is good for you and I would never take it away entirely, but “a lot” is where people go wrong. Every step loads the gluteal tendons, and long walks, hills, stairs and cambered pavements load them repeatedly in a position that compresses the tendon. The approach that works is to find the distance that leaves your hip no worse the following morning — often 15-20 minutes on the flat — and hold that level while the strengthening builds tolerance, adding a few minutes each week. Walk with a slightly quicker, shorter stride and an upright pelvis rather than a long stride that lets the hip drop. If walking is currently unbearable, a stationary bike keeps you moving without the side-to-side pelvic loading.
How long does it take for an inflamed hip bursa to heal?
Honest answer: longer than most people expect. Where the bursa itself is irritated and the compressing habits are removed, pain can settle within a few weeks. Where the underlying problem is gluteal tendinopathy — which is most cases — three to six months of consistent, progressive loading is a realistic timeframe, and progress tends to come in steps rather than a smooth line. Pain that has been present for over a year still responds, but the loading needs to be more gradual and the patience greater. A corticosteroid injection can quieten severe pain in the short term, but on its own it does not fix the tendon, so it works best as a window in which to start the strengthening.
Hip bursitis in older adults and after hip replacement
Lateral hip pain is especially common in women over 50 and in the months after a hip replacement, where the gluteal tendons have been disturbed by surgery and weakened by the time before it. The principles are the same — remove compression, load the tendon gradually — but with even more emphasis on standing, functional exercises like sit-to-stands and step-ups and even less on side-lying work. Anyone over 60 will find the gentler progressions in chair Pilates for seniors a comfortable place to start, and post-surgical readers should follow Pilates after hip replacement alongside their surgeon’s precautions. Because tight hips and lateral hip pain can look alike, it is also worth reading Pilates for tight hips — but note that the figure-four stretch recommended there is exactly the one to skip if your pain is on the outside of the hip.
When to see a clinician
See a doctor or physiotherapist if the pain followed a fall, if you cannot bear weight, if there is redness, heat or swelling over the hip, if you have a fever, or if the pain is in the groin rather than the outside of the hip (which points to the joint itself). Pain that radiates down the leg with numbness or tingling suggests a nerve rather than a tendon and needs a different assessment.
How the Hip Replacement Recovery protocol helps
Sophie’s 12-Week Hip Replacement Recovery Program is built on exactly the compression-free, progressive gluteal loading that hip bursitis and gluteal tendinopathy need — 44 exercises across twelve weeks that move from isometric holds and supine band work through bridges, hip hitches, sit-to-stands and step-ups, with the pelvis kept level and the thigh kept out of the compressed, cross-midline positions throughout. It is written for the post-surgical hip, but the same careful progression suits a painful lateral hip that has not had surgery. For older adults, the 8-Week Pilates for Seniors (Over 60) programme offers a gentler standing and chair-based route, and if the hip pain comes with a sore lower back, the 8-Week Lower Back Pain programme addresses both.
This article is for informational purposes only and does not constitute medical advice. Lateral hip pain has several possible causes; if your pain followed an injury, involves the groin, comes with swelling, fever or inability to bear weight, or radiates down the leg with numbness, please consult a physiotherapist or doctor before beginning or continuing an exercise programme.