A Physical Therapy Guide to Hip Bursitis

Hip bursitis is a condition that can cause pain and stiffness in the hip. This guide will take a closer look at hip bursitis, including its symptoms, causes, diagnosis, and treatment options.

The most common form of hip bursitis, trochanteric bursitis, mainly affects middle-aged women. Although, it can affect people at any age when there is too much strain on local hip tissues.¹

Hip bursitis pain can make it challenging to keep up with daily activities, from going out for a walk to climbing stairs. Working with a CityPT physical therapist can help you effectively manage hip bursitis and get you back to your routine pain-free.

Table of Contents

• Understanding Hip Bursitis
• Causes of Hip Bursitis
• Symptoms of Bursitis
• Diagnosing Hip Bursitis
• What to Expect from Physical Therapy for Hip Bursitis
• Will I Need Surgery for Hip Bursitis?
• How to Prevent Hip Bursitis
• Getting Treatment for Your Hip Pain

Understanding Hip Bursitis

There are fluid-filled sacs, known as bursae, located throughout the body. Their primary function is to act as a cushion between bones, tendons, and ligaments to reduce friction between these tissues. Bursitis occurs when these bursae become inflamed.

Bursitis generally worsens gradually over time. There are several bursae around the hip joint. The most commonly affected bursae are located on the outside of the hip, near the bony protrusion known as the greater trochanter — the area where we generally measure our hip width. These bursae are known as the greater trochanteric bursa.² Other hip bursae include the ischial bursa (where you sit) and iliopsoas bursa (in the front of the hip).

CityPT clinicians and other physical therapists following the latest evidence will refer to greater trochanteric bursitis as greater trochanteric pain syndrome. The latest research indicates that the true cause of lateral hip pain is most often related to the gluteal tendons.³

Causes of Hip Bursitis

The primary causes of hip bursitis are related to excessive friction or pressure on the bursae. This can occur with overuse, direct trauma, or repetitive motions. Other potential causes include arthritis, gout, and infection. However, hip bursitis can also have no known cause.`

Certain risk factors may increase your chances of developing hip bursitis. These include age, gender, and obesity. For example, bursitis is more common in women over 40.

If you have any of the following risk factors, you may be more likely to develop hip bursitis:¹

• Age over 40
• Female gender — particularly with an increased Q-angle (how close the knees are together when standing)
• Obesity
• Arthritis (Osteoarthritis or Rheumatoid arthritis)
• Gout
• Infection
• Overtraining (athletes or other active individuals)
• Chronic inflammatory disease
• Thyroid disease
• Tendinopathy
• Rapidly increasing mileage with running or walking
• Leg length discrepancy (actual or functional)
• Weakness and poor coordination of the hips, core, or ankles
• Excessive stiffness of the IT band (a stiff band of tissue that runs along the outside of the thigh)

Symptoms of Bursitis

The most common symptom of bursitis is pain. The pain is typically localized to the affected area but may radiate down the thigh or cause low back pain in more severe cases. It may feel like a dull ache or a sharp, burning sensation. Hip bursitis pain typically worsens with movement or pressure on the joint.

Other symptoms of bursitis may include:

• Swelling
• Tenderness
• Redness
• Warmth to the touch
• Stiffness
• Limited hip movement (range)
• Painful hip movement with going up stairs or a ladder
• Gait changes (abnormal walking/limping)
• Inability to lie on the affected side
• A snapping sensation in the hip with leg use

Diagnosing Hip Bursitis

Bursitis is usually diagnosed using your medical history and a virtual or in-person physical examination with a healthcare professional. It's important to rule out underlying issues like arthritis, tendinitis, stress fracture, or bacterial infection. If there are concerns like these, your CityPT physical therapist will refer you to a physician for imaging or blood tests if needed.

During your initial evaluation, your physical therapist will ask specific questions about your symptoms. Then, they will complete a comprehensive physical examination, which may include the following:

• Joint range of motion testing
• Palpation (touching) of the affected area
• Strength and flexibility testing
• Specialized tests specific to bursitis and other hip conditions
• Functional assessment to see how your symptoms are affecting your normal activities

What to Expect from Physical Therapy for Hip Bursitis

The primary goal of physical therapy for hip bursitis is to create a comprehensive rehabilitation program to minimize pain and reduce inflammation while improving hip mobility and strength. Once these goals are met, the focus will shift to preventing future flare-ups.

Your individualized physical therapy treatment plan may include:

• Manual therapy techniques: Mobilization of soft tissues and joint mobilization to decrease pain and inflammation with daily activities.
• Exercise: Hip strength and stretching exercises to improve flexibility and coordination, to reduce localized strain on the hip.
• Modalities: Such as heat or ice therapy, electrical stimulation, or ultrasound, to better manage pain and inflammation short term and allow better tolerance of an exercise program.
• Education: Primarily to help you understand the cause of your pain and risk factors for a flare-up. Plus, tips on activity modification and how to best manage your recovery.
• Ergonomic and activity modification: Recommendations to prevent future flare-ups and reduce strain on the hip.
• Biomechanics training: Particularly for athletes, focusing on adequate control of the lower leg with weight-bearing activities will help immensely.

What is the Best Exercise for Hip Bursitis?

There is no one perfect exercise that'll give you relief. The right exercises depend on your symptoms, goals, and more. Examples of hip bursitis exercises you might try under the supervision of a physical therapist include:

• Iliotibial band stretch: In standing, cross the leg you want to stretch in front of the other. Keeping your front leg straight, reach with the same arm overhead toward the opposite shoulder and lean sideways until you feel a gentle stretch in the side of your thigh. You can also try an iliotibial stretch when you lie on your side.
• Hip rotator stretch: Lying on your back with your feet flat and knees bent, you will bring the ankle of the affected leg across and rest it on your opposite thigh. Push your knee away from your body with your hand until you feel a gentle stretch in the butt. Hold for 30 seconds or more.
• Clam shells: To strengthen key hip muscles, lie on your side with the affected side facing up and hip and knees bent. Lift the top leg (knee) toward the ceiling while keeping the ankles together and hips stacked (don't let the hips roll forward or back). Slow lower the leg and repeat for 10 to 15 repetitions if pain-free. Other hip strengthening exercises include hip bridges, and straight leg raises.
• Side-lying hip abduction: As your pain improves, you can lie on your side with the affected side up (bottom knee bent and upper leg straight). Lift your straight leg up toward the ceiling while keeping the knee pointing forward and repeat 10 to 15 times.
• Functional movements: Most importantly, as your pain and coordination improve, your therapist will advise you to get back to your normal activities pain-free.

Will I Need Surgery for Hip Bursitis?

Most cases of bursitis will improve with conservative management, like physical therapy.

In some cases, a steroid injection may be recommended to help reduce hip bursitis pain and inflammation. If the bursa is found to be septic (infected, which is very rare), antibiotics will be required as well. However, surgical options, such as hip preservation surgery, are not needed for bursitis since there is typically no mechanism that needs to be removed or repaired.⁴

How to Prevent Hip Bursitis

You can do several things to prevent hip bursitis or reduce your risk of a flare-up. These include:

• Wearing proper shoes that support your feet and aren't excessively worn out.
• With sports and high-impact activity, focusing on landing "lightly" and with better hip and knee positioning.
• Regular exercise to maintain a good range of motion, and flexibility and improve strength in the hip and surrounding thigh muscles — most importantly, focusing on hip and core strength and stability.
• Avoid sudden increases in mileage or intensity when participating in high-impact activities.
• Modifying your activity level or avoiding certain activities if you have a known risk factor for bursitis or a history of hip pain.
• Sleeping on a good mattress that offers adequate support and isn't too firm, particularly if you lie on your sides.
• Reducing general inflammation in the body with healthy lifestyle choices, including nutrition, sleep, stress management, mental health, etc.
• Weight management to reduce the amount of stress on the hip and promote health overall.

Getting Treatment for Your Hip Pain

Hip pain can be debilitating and make it difficult to participate in even the most basic activities, like stair climbing. If you think you may have hip bursitis, the first step is to seek treatment from a CityPT physical therapist.

Your physical therapist will work with you to create an individualized treatment plan that meets your specific goals and addresses the underlying cause of your pain. Get in touch with a CityPT orthopedic specialist today to get started.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

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