Hip Bursitis vs. Gluteal Tendinopathy: How to Tell Which One You Have (Naperville, IL)

If you’ve been searching both of these terms, you’ve already noticed the problem: nobody seems to agree on what’s actually wrong with your hip. One provider says bursitis. An article says tendinopathy. A third source throws out “greater trochanteric pain syndrome” and leaves you more confused than when you started.

Here’s the short version, and then I’ll explain it: in most cases, what gets called “hip bursitis” is really gluteal tendinopathy — and that mix-up is the single biggest reason outer hip pain drags on for months.

I’m Dr. Jennifer Wise, DC, Acupuncturist, and in 26 years of practice in Naperville (since 2000), telling these two apart correctly has been the difference between patients who get better and patients who keep cycling through treatments that don’t last. This page lays out exactly how bursitis and gluteal tendinopathy differ, how to tell which one you’re dealing with, why it changes everything about treatment, and what we do at Synergy Institute Acupuncture & Chiropractic about it.

The Short Answer

Trochanteric bursitis is inflammation of the bursa — a small fluid-filled sac over the bony point of your outer hip. Gluteal tendinopathy is degeneration of the gluteus medius and minimus tendons that attach right next to that bursa. They sit millimeters apart and feel similar, which is why they get confused. But here’s what modern imaging and research have shown: true, isolated bursitis is uncommon, and most lateral hip pain is driven by the tendon, with the bursa irritated only as a secondary effect. That distinction matters enormously, because the two are treated in nearly opposite ways. Bursitis logic says calm the inflammation and rest. Tendinopathy reality says the tendon needs loading and, when it’s stuck, direct tissue repair — which is where SoftWave therapy and shockwave therapy come in.

Synergy Institute Acupuncture & Chiropractic is a lateral hip pain treatment clinic located in Naperville, Illinois. We don’t lead with a device — we lead with an accurate diagnosis, then combine chiropractic care for the mechanics, acupuncturefor pain and healing, a loading program, and regenerative therapy to rebuild the tissue. Getting the diagnosis right is step one, because treating bursitis when the real problem is the tendon is exactly how people end up here after a year of frustration.

Research published in the American Journal of Sports Medicine found that greater trochanteric pain syndrome is often a manifestation of underlying gluteal tendinopathy rather than isolated bursa inflammation — a shift that reshaped how lateral hip pain should be treated (Furia et al., 2009).

The Quick Comparison

What Trochanteric Bursitis Is

A bursa is a small, fluid-filled cushion that reduces friction where tendons and muscles glide over bone. The trochanteric bursa sits over the greater trochanter, the bony bump on the outer side of your hip. When it becomes inflamed, that’s trochanteric bursitis, and it tends to produce sharp, localized pain right over that point — often worse when you press on it or lie directly on it.

For decades, this was the assumed cause of nearly all outer hip pain. It’s an easy diagnosis to reach: the bursa is superficial, it shows up on ultrasound, and “bursitis” is a familiar word. The trouble is that it’s been over-diagnosed for years.

What Gluteal Tendinopathy Is

Your gluteus medius and minimus tendons anchor into that same greater trochanter, and they’re what stabilize your pelvis every time you stand on one leg or take a step. Gluteal tendinopathy is degeneration of those tendons — structural breakdown from a long mismatch between load and repair, not a single injury.

The key word is degeneration, not inflammation. People hear “tendinitis” and assume the “-itis” means inflammation, but true gluteal tendinitis is rare. What we almost always find is tendinosis: the tendon tissue itself has broken down. That’s why I tell patients this isn’t an inflammation problem, it’s a failed healing problem — and it’s the reason anti-inflammatory treatment so often disappoints.

Why the Two Get Confused

Three reasons, really. First, they’re anatomical neighbors — the bursa sits right on top of the tendons, so pain in one area overlaps with the other. Second, the symptoms look nearly identical: outer hip pain, worse lying on that side, worse on stairs. Third, and most important, the two often coexist — a degenerating tendon frequently irritates the bursa sitting above it. So a provider sees an inflamed bursa on ultrasound, calls it bursitis, and treats the inflammation, never realizing the bursa is just the smoke and the tendon is the fire.

Which One Do You Have? A Self-Check

No checklist replaces a proper exam, but at a glance, the patterns tend to split like this:

In practice, more of these lean toward gluteal tendinopathy as the real driver:

• ✅ Pain is load-related — worse with stairs, hills, walking, or standing on one leg
• ✅ It’s worse after sitting a while, then eases as you start moving
• ✅ Stretching the hip or IT band makes it worse, not better
• ✅ Rest helps briefly, then it flares the moment you’re active again
• ✅ A cortisone shot wore off after a few weeks
• ✅ You’ve had it longer than six weeks

Pure, isolated bursitis is more likely when pain is sharply pinpoint over the bony spot, came on after a direct knock or a brief overload, and settles down with a short period of relative rest. But here’s the practical reality: even when the bursa is genuinely inflamed, it’s usually inflamed because of the tendon underneath. Treat only the bursa and the pain comes back.

Why the Distinction Changes Everything

This is the whole point of getting the diagnosis right. The two conditions call for almost opposite approaches.

If it’s truly an inflamed bursa, calming inflammation and a brief rest can settle it. But if it’s gluteal tendinopathy — which it usually is — that same plan backfires. Rest lets the tendon weaken further. Stretching compresses the degenerated tendon against the bone and aggravates it. And cortisone, aimed at inflammation that isn’t really the problem, gives a few weeks of relief before fading, while repeated injections can weaken the very tendon you’re trying to heal. A landmark 2018 trial in The BMJ found that for gluteal tendinopathy, cortisone injection was no better than simply waiting once you reached the one-year mark.

So if you’ve been treated for “bursitis” and nothing held, you didn’t fail the treatment. The treatment was matched to the wrong problem.

How We Treat Lateral Hip Pain at Synergy Institute

Once we know what’s actually driving the pain, the plan follows the cause. Here’s what I tell every patient: the best lateral hip pain treatment in Naperville isn’t about one therapy — it’s about applying the right combination in the right sequence.

• Diagnosis first — confirming whether you’re dealing with hip bursitis, gluteal tendinopathy, or pain referred from the low back or hip joint.
• Unload and correct the mechanics — removing the compressive positions feeding the problem and using chiropractic care to fix the gait and pelvic patterns overloading the tendon.
• Regenerate the tissue — SoftWave or shockwave to restart repair in a degenerated tendon. We were the first clinic in Naperville to offer SoftWave, using the TRT OrthoGold 100 system.
• Calm the pain and reload — acupuncture to settle pain signaling, plus a progressive loading program to rebuild the tendon to full strength.

Each of those condition pages goes deeper on its specific treatment path. This page exists to make sure you’re pointed at the right one.

🚨 When to seek urgent care: Outer hip pain is rarely an emergency, but get evaluated right away if you have fever or chills with a hot, red, swollen hip (possible infection), if you can’t bear weight after a fall (possible fracture, especially with osteoporosis), or if hip pain comes with unexplained weight loss or night pain unrelieved by rest. These need imaging and a medical doctor’s evaluation first.

Honest Assessment

I’ll always tell you what we find, even when it’s not what either of us hoped. Some lateral hip pain turns out to be hip joint arthritis, a labral tear, or a full-thickness tendon tear that needs a surgeon — and if I don’t think we can help you, I’ll tell you directly. I’d rather refer you to someone who can help than waste your time and money. Most outer hip pain, though, responds well once it’s correctly identified and treated at the cause.

Frequently Asked Questions

Is hip bursitis the same as gluteal tendinopathy?

No, but they’re closely linked and constantly confused. Bursitis is inflammation of the fluid-filled bursa over the outer hip. Gluteal tendinopathy is degeneration of the gluteal tendons that attach right beside it. They sit millimeters apart and feel similar. Research now shows most lateral hip pain is driven by the tendon, with the bursa irritated as a secondary effect. Both fall under the umbrella term greater trochanteric pain syndrome.

Can you have both at the same time?

Yes, and you often do. A degenerating gluteal tendon frequently inflames the bursa sitting on top of it, so the two coexist. That’s exactly why they get confused. The important point is which one is the driver — and in most cases it’s the tendon. Treat only the bursa and the pain tends to return, because the underlying cause is untouched.

How can I tell which one I have?

A few patterns point toward gluteal tendinopathy as the driver: pain that’s worse with stairs and standing on one leg, worse after sitting then easing as you move, made worse by stretching, and not lasting in its response to rest or cortisone. Pinpoint pain over the bony spot that settles with brief rest leans more toward isolated bursitis. A proper exam with clinical tests is the only way to be sure, which is why we diagnose before we treat.

Why does it matter what it’s called?

Because the two are treated in nearly opposite ways. Bursitis responds to calming inflammation; tendinopathy needs loading and tissue repair, and is often made worse by the rest and stretching that bursitis tolerates. If your pain is tendinopathy but it’s being treated as bursitis, the treatment can actually perpetuate the problem. Correct diagnosis is what makes correct treatment possible.

Why didn’t my cortisone shot for bursitis work?

Most likely because the real problem was the tendon, not the bursa. Cortisone targets inflammation, so it can quiet things for a few weeks, but it does nothing for tendon degeneration underneath. Once it wears off, the pain returns. Repeated cortisone can also weaken the tendon, which is a real concern when degeneration is already the issue.

Does shockwave therapy work for this kind of hip pain?

Yes, and it’s one of the better-supported options for the tendon problem driving most lateral hip pain. Randomized trials show shockwave outperforming both cortisone and home exercise, with results that last, and an MRI-documented study showed tendon improvement holding at long-term follow-up. It works by stimulating new blood vessel growth and a genuine repair response in the degenerated tendon.

Is stretching good or bad for outer hip pain?

If the cause is gluteal tendinopathy, aggressive hip and IT-band stretching usually makes it worse. Those stretches move the hip into adduction, which compresses the degenerated tendon against the bone — the exact load it can’t tolerate. Removing compressive positions, rather than stretching into them, is one of the first changes we make.

Will rest make it better?

For a genuinely inflamed bursa, a short rest can help. For gluteal tendinopathy, pure rest usually backfires — the tendon weakens, then flares again as soon as you’re active. Tendons heal through the right kind of progressive loading, not by being left alone. This is another reason the correct diagnosis changes the whole plan.

Who gets gluteal tendinopathy most often?

It’s far more common in women over 40, especially after menopause, when hormonal changes appear to reduce tendon resilience. Runners, people who suddenly increase their activity, and those with low back pain are also at higher risk. It’s a known pattern, not a sign you did anything wrong, and it responds well to the right approach.

Where can I get this treated in Naperville?

Our clinic treats both conditions and, more importantly, sorts out which one is actually driving your pain before starting treatment. Your first visit is a thorough evaluation, and if we don’t think we can help, we’ll tell you and point you in the right direction. We offer a no-cost initial consultation so you can get answers first. Call or text us to get scheduled.

Stop Guessing — Get the Right Diagnosis First

If you’ve been bounced between “bursitis” and “tendinopathy” with no lasting relief, the fix starts with knowing which one you actually have. As Naperville’s cause-based clinic for lateral hip pain, Synergy Institute Acupuncture & Chiropractic will pinpoint the real driver and treat it at the source.

Claim your free Pain Relief consultation today. Call or text (630) 454-1300, or call our office directly at (630) 355-8022.

Synergy Institute Acupuncture & Chiropractic 4931 Illinois Rte 59, Suite 121 Naperville, IL 60564 (at 111th Street)synergypainrelief.com

References

1. Furia JP, Rompe JD, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med. 2009;37(9):1806-1813. https://journals.sagepub.com/doi/abs/10.1177/0363546509333014
2. Cleveland Clinic. Gluteal tendinopathy: symptoms, causes and treatment. https://my.clevelandclinic.org/health/diseases/22960-gluteal-tendinopathy
3. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. https://pubmed.ncbi.nlm.nih.gov/29720374/
4. Grimaldi A, Mellor R, Nicolson P, et al. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. Br J Sports Med. 2017;51(6):519-524. https://pubmed.ncbi.nlm.nih.gov/27474385/
5. Seo KH, Lee JY, Yoon K, et al. Long-term outcome of low-energy extracorporeal shockwave therapy on gluteal tendinopathy documented by magnetic resonance imaging. PLoS One. 2018;13(7):e0197460. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197460
6. Rompe JD, Segal NA, Cacchio A, et al. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 2009;37(10):1981-1990. https://journals.sagepub.com/doi/10.1177/0363546509334374
7. Ramon S, Russo S, Santoboni F, et al. Focused shockwave treatment for greater trochanteric pain syndrome: a multicenter, randomized, controlled clinical trial. J Bone Joint Surg Am. 2020;102(15):1305-1311. https://pubmed.ncbi.nlm.nih.gov/32769596/
8. Harding L, et al. Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis. Musculoskeletal Care. 2024. https://onlinelibrary.wiley.com/doi/abs/10.1002/msc.1892
9. Notarnicola A, Ladisa I, Lanzilotta P, et al. Shock waves and therapeutic exercise in greater trochanteric pain syndrome: a prospective randomized clinical trial with cross-over. J Pers Med. 2023;13(6):976. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10301141/

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Medical Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Individual results vary. Always consult a qualified healthcare provider regarding any medical condition or before beginning any new treatment. No treatment outcome is guaranteed.

Reviewed by Dr. Jennifer Wise, DC, Acupuncturist — June 2026