You feel a dull ache in your hip. It's worse in the morning. Moving around eventually helps — or maybe it doesn't. You wonder: is this arthritis? Bursitis? Something else entirely?
These two conditions are the most common causes of hip pain in adults over 45, and they're frequently confused. But they have different origins, different patterns, and importantly, different treatments. Getting it right makes a real difference to how well you manage your pain.
What Is Hip Bursitis?
Bursae are small, fluid-filled sacs that cushion bones, tendons, and muscles near joints. Your hip has two major bursae. When one becomes inflamed — usually from repetitive motion, prolonged pressure, or a sudden injury — you have bursitis.
The most common type is trochanteric bursitis, affecting the bursa on the outer side of the hip (over the greater trochanter). It's more common in women and in people who walk with an abnormal gait.
What Is Hip Arthritis?
Osteoarthritis of the hip is a degenerative condition in which the cartilage that cushions the ball-and-socket joint gradually wears down. As the cushioning thins, the bones increasingly rub against each other, causing pain, stiffness, and eventually changes to the shape of the joint itself.
Hip arthritis typically worsens over time and is more likely in people over 60, those who are overweight, and those with a history of hip injury.
Side-by-Side Comparison
| Feature | Hip Bursitis | Hip Arthritis |
|---|---|---|
| Pain location | Outer hip / side of thigh | Groin / front of hip / buttock |
| Morning stiffness | Mild; eases quickly | Significant; can last 30+ min |
| Pain with pressure | Tender to touch on outer hip | Not usually tender to touch |
| Worse with activity | Yes (walking, stairs, lying on side) | Yes, especially after rest |
| Nighttime pain | Often severe when lying on affected side | Moderate; can disrupt sleep |
| X-ray findings | Usually normal | Narrowed joint space, bone spurs |
| Age of onset | 40–60, often active individuals | Usually 55+, progressive |
| Treatment focus | Anti-inflammatory, rest, PT | Mobility, weight management, PT |
Key Diagnostic Clues
Where exactly does it hurt?
This is the most reliable distinguishing question. Bursitis pain is typically on the outer side of the hip — the part that touches the bed when you lie on your side. It may radiate down the outer thigh. Arthritis pain is usually felt in the groin, the front of the hip, or deep in the buttock. If your hip pain is mostly in the groin, think arthritis first.
Is the hip tender to the touch?
Press firmly on the outer bony prominence of your hip (the greater trochanter). If this produces sharp pain, that's a strong indicator of trochanteric bursitis. Hip arthritis rarely causes external tenderness.
How does it behave after rest?
Arthritis is classically worse after periods of inactivity — sitting for a long time, sleeping — and then improves somewhat with gentle movement. Bursitis can also be worse after rest, but it tends to be more consistently aggravated by weight-bearing activity and lying on the affected side.
The FABER test: Lie on your back. Place your ankle on the opposite knee (figure-4 position). If this causes groin pain, it suggests arthritis. If it causes outer hip pain, bursitis is more likely. This isn't diagnostic, but it's a useful indicator.
Can You Have Both?
Yes — and it's not uncommon. Hip arthritis can change your gait in ways that put extra stress on the bursa, causing secondary bursitis. If you have widespread hip pain both in the groin and on the outer hip, you may have both conditions contributing. Your doctor can order an X-ray and, if needed, an MRI to clarify.
Treatment Approaches
For Bursitis
- Activity modification to reduce repetitive hip motion
- NSAIDs (ibuprofen) or topical anti-inflammatories
- Ice for 15 min several times daily during flare-ups
- Physical therapy targeting hip abductors and IT band flexibility
- Corticosteroid injection if conservative measures fail
For Arthritis
- Low-impact exercise (swimming, cycling, walking) to maintain cartilage health
- Weight management to reduce joint load
- Acetaminophen or NSAIDs for pain management
- Physical therapy focusing on hip strengthening and range of motion
- Hip replacement surgery in advanced cases
For Both Conditions
Compression support during daily activity — like a hip brace — can help stabilise the joint, reduce swelling, and give the affected structures a chance to recover. It's particularly useful for people who need to stay active despite pain.
See your doctor if: Your pain is severe, worsening over weeks, accompanied by fever or swelling, or if you can't bear weight on the leg. These need professional evaluation before self-management.
Daily Support While You Manage Hip Pain
The ODOFIT Hip Brace provides targeted compression across the hip flexor, groin, and thigh — helping you move more comfortably on days when bursitis or arthritis is flaring. Not a treatment, but a practical tool for managing daily activity.
Learn About the Hip Brace