Hip Bursitis: The Lower Back Connection You May Be Missing

By Grant Frost · Physiotherapist • Last clinically reviewed: 21 September 2026

If you're struggling with persistent hip bursitis, you may understandably be focusing most of your attention on the hip itself.

But what if the real source of the problem is not entirely local to the painful area?

As a physiotherapist, I have consistently found that lower-back dysfunction can be an important, yet often overlooked, contributor to persistent lateral hip pain in some patients.

This can be surprising, particularly if you don't have any back pain. However, the lower spine, the nerves supplying the hip and the muscles responsible for hip movement and stability are functionally connected.

In this guide, I'll explain the connection I observe clinically, show you a simple test-and-retest approach I use to assess whether the back may be influencing hip function, and explain the treatment approach I use when those findings are present.

For a visual overview, some of the structures commonly discussed in relation to lateral hip pain include the trochanteric bursa, gluteal muscles and gluteal tendons.

Pain around the outside of the hip is a common presentation. However, pain in this location does not automatically mean that the bursa is the only structure involved. Lateral hip pain can involve several tissues around the greater trochanter, which is why I believe a broader clinical assessment can be valuable.

The Clinical Finding That Changed How I Approach Hip Bursitis

One of the most useful things I have learned clinically is that the painful area is not always the only area that needs to be assessed.

When treating patients with persistent lateral hip pain, I began noticing something that repeatedly caught my attention: changing the movement or mobility of the lower back would consistently produce an immediate change in the way the hip muscles felt and performed.

In some patients, the hip became stronger. In others, their pain changed. In some, both happened.

These responses were not simply theoretical. They were observable changes during the re-assessment itself.

That led me to start asking a different question when treating persistent hip pain:

I believe this test-and-retest approach has revealed a clinically important relationship that can be missed when treatment focuses exclusively on the painful hip.

Importantly, this is my clinical observation and treatment approach. I am not claiming that every case of hip bursitis originates in the lower back, or that this relationship has been definitively established as the primary cause of hip bursitis - but it's seemingly important one way or another.

I believe the repeated clinical response is significant enough that the lower back deserves consideration when someone has persistent or recurrent lateral hip pain, particularly when conventional local treatment has not produced the expected result.

Could Your Lower Back Be Causing or Contributing to Hip Bursitis?

It may seem strange to look at your back when you're dealing with a hip problem, particularly if your back doesn't hurt.

However, the nerves involved in hip movement and muscle function have connections with spinal nerve roots in the lower spine. This provides one possible reason why changes around the lumbar spine could influence how muscles around the hip perform.

This image shows dermatomal patterns - areas of skin associated with particular spinal nerve roots. While a dermatome map does not by itself prove that a particular hip problem originates from the spine, it illustrates the broader neurological relationship between the lower spine and the lower limb.

From my clinical perspective, the more important question is not simply where the nerves originate. It is whether changing the function of the lower back changes what happens at the hip.

This is where the test-and-retest approach becomes particularly interesting.

If a patient has measurable weakness or pain around the hip, and a targeted lower-back intervention immediately changes that finding, I consider that a useful clinical clue that the lower back may be contributing to the presentation.

I sometimes describe this clinically as a "kink in the hose". The analogy is not intended to suggest that the spine literally switches the blood supply or nerve supply to the hip on and off. It is simply a way of explaining the idea that altered function somewhere along a connected system may influence what happens further down the chain.

This is one of the most important connections I believe can be missed when treating persistent lateral hip pain.

Simple Test: Is Your Back Affecting Your Hip?

This video demonstrates a simple clinical test-and-retest approach that I use to investigate whether the lower back may be influencing hip muscle performance.

The process is straightforward:

1. Test the relevant hip movement or muscle performance.
2. Apply an appropriate lower-back mobility intervention.
3. Re-test the same movement or muscle performance.
4. Compare what has changed.

If you notice an immediate improvement in strength or a reduction in pain after changing the movement or mobility of your lower back, I consider that a useful clinical clue that the back may be an important contributor.

What it provides is something I find extremely valuable clinically: a way to test a hypothesis in real time.

Rather than simply assuming that the painful hip is the entire problem, we can make a targeted change and observe whether the patient's symptoms or muscle performance change with it.

That immediate response can help guide treatment.

My Hip Bursitis Treatment Approach

If you've been dealing with lateral hip pain for a while, it can be frustrating to keep treating the same painful area without getting lasting results.

My approach is not to ignore the hip. Instead, I look at the hip and the factors that may be influencing how it functions.

Depending on the individual assessment, this may include:

• Relative rest: Reduce or modify activities that significantly aggravate symptoms while maintaining appropriate movement and activity.
• Symptom management: Strategies such as ice or medication may have a role in managing symptoms, particularly when pain is limiting normal activity. They should not be viewed as the entire treatment strategy.
• Breathing and pain management: Slow, controlled breathing can be useful for relaxation and may help some people manage pain and muscle tension.
• Hip mobility and strength: Restore appropriate movement and progressively build the capacity of the muscles around the hip.
• Lower-back assessment: Where the clinical findings suggest a contribution from the lumbar spine, assess and address relevant mobility, movement and control deficits.

The goal is not simply to make the hip feel better temporarily. It is to understand why the hip is struggling in the first place and address the factors that appear relevant in that individual.

Step 1: Improve Hip Mobility and Strength

The fact that I believe the lower back can be an important contributor does not mean the hip should be ignored.

Once the relevant contributing factors have been identified, the hip still needs to develop the mobility, strength and load tolerance required for normal activity.

Hip Mobility Drills

Use a lacrosse ball to work on areas of gluteal tightness, followed by appropriate hip mobility exercises. A resistance band can be incorporated into some mobility drills where appropriate.

The aim is to improve movement while preparing the surrounding muscles to work effectively.

Hip Strength Exercises

Strengthening should generally be progressed according to the individual's symptoms, capacity and response rather than following one fixed program for everyone.

• Side-Lying Hip Abduction: 3 sets of 12 reps.
• Clamshells: 3 sets of 12 reps.
• Squats and Lunges: 3 sets of 10-15 reps, progressing according to tolerance.

The exact exercises are less important than progressively restoring the hip's ability to tolerate the movements and loads required in everyday life.

Step 2: Assess and Treat the Underlying Back Dysfunction

This is the part of my approach that I believe is most often overlooked.

If the lower back is contributing to the way the hip muscles function, strengthening the hip without assessing the back may leave an important piece of the clinical picture untouched.

Again, this does not mean that every person with hip bursitis needs lower-back treatment. The clinical finding is what matters.

If changing the lower back changes the hip, that gives me a reason to include the lower back in the treatment plan.

• Mobilise the lower back: Where appropriate, use gentle mobility techniques to address areas that appear restricted during assessment. The specific technique and intensity should be appropriate for the individual.
• Build trunk and core capacity: Exercises can be used to improve the ability to control the spine during movement.
  • Planks: 5 sets of 15-30 second holds.
  • Fit Ball Roll-Outs: 3 sets of 10 reps.
• Consider everyday movement habits: Rather than focusing on a single "perfect" posture, look at how the person moves, sits and loads their body throughout the day and whether these behaviours appear relevant to their symptoms.

The broader goal is to restore appropriate movement and control through the lower back while simultaneously building the strength and capacity of the hip.

What Does This Mean If Your Hip Bursitis Keeps Coming Back?

If you've repeatedly treated the painful area and your symptoms keep returning, I think it is reasonable to broaden the assessment.

That does not mean assuming that your lower back is the cause - although my clinical experience suggests that it might be.

Instead, it means asking whether the lower back, hip, pelvis, neural system, muscle function, movement patterns or loading history may be contributing to the problem.

In my clinical practice, the lower back has repeatedly proved to be an important piece of this puzzle in some patients who present with persistent lateral hip pain.

The most useful finding is often not what an anatomy textbook says should happen. It is what happens when you make a change and re-test the patient in front of you.

Living With Persistent Pain?

If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our hip pain physiotherapy services in Port Macquarie.

Want personalised guidance?

If you'd like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.

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