Sciatica and bursitis, but is it really?
by Dr. Sarah Joy White, PT, DPT, CD
So many people with hip pain are told they have sciatica or bursitis. They’re common diagnoses, but what do they really tell you?
Sciatica is really common, with about 40% of people experiencing this pain in their lifetime. But is all pain in the low back or down the leg sciatica? No! The sciatic nerve is made up of a bundle of nerve roots that come from your low back, levels L4-S3. This nerve runs behind your sacroiliac joint, under (or through) your piriformis muscle, and then down the back of your thigh before branching off into smaller nerves. If that nerve is being pinched or irritated anywhere along that route, it can cause pain at the place of irritation and extend anywhere down along the path of the nerve. But if the point of irritation is higher, as with lumbar stenosis or a bulging disc, then the proper term would be lumbar radiculopathy, even if the pain is in the same area. And if the pain is a result of muscle tension or strain in the back of the hip or thigh but the sciatic nerve isn’t being irritated, then it’s not sciatica either. This is all important, because it affects how we treat it. If a physical therapist hears you have sciatica and starts treating you before assessing your low back, hips, muscles, and sciatic nerve, RUN! A thorough treatment plan includes a full evaluation, and treating the root cause of the issue. Sometimes this looks like releasing muscle tension, sometimes it’s stabilization exercises, sometimes it’s nerve glides, sometimes it’s addressing an issue in the foot! This is why a one-size-fits-all approach works for a few people, but not for everyone and it can make some people feel worse. So your best bet to get rid of the pain is to see a physical therapist and get an evaluation and personalized plan.
Hip bursitis is another condition that is often over-diagnosed, blaming the bursa for pain at the side of the hip that’s likely the fault of another structure. The more over-arching term for this type of pain is greater trochanteric pain syndrome. It’s currently thought that it affects about 15% of women and 8% of men. Bursitis is thought to be inflammation of the bursa (fluid-filled sac) that sits between the greater trochanter at the side of the femur, and the IT band. So how do we know that the bursa is blamed too often? There are many structures that intersect in the same area, including the IT band and gluteal tendons. One study took bursa samples from people with bursitis-type lateral hip pain, and while there was gluteal tendon thinning in 20% of the patients, there was NO bursa inflammation in any of the samples. So instead of blaming the bursa and going right to surgical removal, a better move would be to get a thorough assessment from a physical therapist, who will check the muscles, tendons, and nerves in that region, as well as the hip joint itself. Then they’ll give you a personalized plan to address the root issue and resolve your pain.
If you’re dealing with pain at the back or side of your hip, or going down your leg, we can help! Book a free discovery call to chat with a doctor of physical therapy about how we can help.
References
Berg S. What doctors want patients to know about sciatica. American Medical Association. November 15, 2024. https://www.ama-assn.org/public-health/prevention-wellness/what-doctors-want-patients-know-about-sciatica.
Gomez LP. Greater trochanteric pain syndrome (greater trochanteric bursitis). StatPearls [Internet]. February 25, 2024. Accessed August 19, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557433/.
Board TN, Hughes SJ, Freemont AJ. Trochanteric bursitis: The last great misnomer. HIP International. 2014;24(6):610-615. doi:10.5301/hipint.5000154
