Hip Bursitis Not Getting Better? It May Not Actually Be Bursitis

Many patients are told they have hip or pelvic bursitis after developing pain around the hip. They may receive cortisone injections, take anti-inflammatory medications like ibuprofen, and still experience persistent symptoms. If this sounds familiar, the first question to ask is: Is it really bursitis?

What Is Bursitis?

Bursae are small fluid-filled sacs that act as cushions between tendons and bones. Their purpose is to reduce friction and protect surrounding tissues during movement.

When a bursa becomes irritated, it can fill with fluid and become inflamed, leading to pain and tenderness. This condition is known as bursitis.

The Most Important Question: Is It True Bursitis?

A true diagnosis of bursitis should be confirmed with imaging studies such as ultrasound or MRI.

When bursitis is present, imaging often reveals a fluid-filled sac that can sometimes be aspirated and analyzed to determine the cause of inflammation.

However, many patients diagnosed with bursitis do not actually have an inflamed bursa.

Hip Bursitis vs Tendonitis: A Common Misdiagnosis

One of the most common reasons patients fail to improve after a steroid injection is that the underlying problem is not bursitis at all.

Instead, the pain may be caused by:

• Gluteal tendinopathy
• Tendonitis
• Partial tendon tears
• Tendon weakness
• Ligament instability

These conditions can closely mimic the symptoms of hip bursitis and are frequently mistaken for one another.

Because steroid injections do not directly address tendon weakness or degeneration, symptom relief may be incomplete or temporary.

Three Common Areas Where Bursitis Can Occur Around the Pelvis

Bursitis can develop in several locations around the pelvis and hip, including:

1. Side of the Hip (Greater Trochanteric Bursa)

This is the most common location and often causes pain when lying on the affected side.

2. Front of the Hip

Inflammation of the iliopsoas bursa can create discomfort in the groin or front hip region.

3. Sit Bone Area

The ischial bursa near the sitting bones can become irritated, especially in individuals who spend prolonged periods sitting.

When Hip Pain Is Coming From Somewhere Else

Not all hip pain originates in the hip.

Pain that feels like bursitis may actually be referred from:

Sacroiliac (SI) Joint Dysfunction

Irritation of the SI joint or surrounding ligaments can create pain along the outer hip and pelvis.

Lower Back Conditions

Pinched nerves, disc issues, and spinal arthritis can refer pain into the hip region.

Pelvic Instability

Weakness within the pelvic stabilizing structures can contribute to ongoing pain and dysfunction.

If these underlying conditions are not identified, treatments focused only on the bursa may fail.

The Importance of Core and Hip Strengthening

For many patients, the first-line treatment should focus on improving stability through targeted strengthening exercises.

A comprehensive rehabilitation program should address:

• Core strength
• Hip stabilizer muscles
• Gluteal strength
• Pelvic control
• Functional movement patterns

Improved stability often reduces stress on tendons, ligaments, and surrounding structures.

When Additional Imaging Is Needed

If symptoms persist despite conservative treatment, advanced imaging may help identify the true source of pain.

Your physician may recommend:

• Ultrasound evaluation
• MRI imaging
• Lower back assessment
• SI joint evaluation

The goal is to determine whether tendon injury, ligament dysfunction, nerve irritation, or another condition is contributing to symptoms.

Regenerative Medicine Options for Persistent Hip Pain

When appropriate strengthening and rehabilitation have not provided sufficient relief, regenerative medicine treatments may be considered.

Potential options include:

Prolotherapy

Prolotherapy stimulates the body’s healing response and may help strengthen weakened ligaments and connective tissues.

Platelet-Rich Plasma (PRP)

PRP uses concentrated platelets from the patient’s own blood to support healing in injured tendons, ligaments, and other soft tissues.

These treatments may be beneficial for carefully selected patients whose symptoms are related to tendon or ligament pathology rather than simple inflammation.

The Bottom Line

If your hip or pelvic bursitis is not improving after cortisone injections and anti-inflammatory medications, it may be time to reconsider the diagnosis.

Many cases of so-called bursitis are actually caused by tendon injuries, SI joint dysfunction, ligament instability, or referred pain from the lower back.

Accurate diagnosis, appropriate imaging, targeted strengthening, and regenerative treatment options such as prolotherapy or PRP may help address the true source of pain and provide longer-lasting relief.

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