Intro: What is Hip Bursitis?
Hip bursitis (aka trochanteric bursitis) is a very, very common injury so it’s important we break down what it is. For all I know, you, yes you, could be in excruciating pain right this moment because of it. So I want to do all I can to provide value and relief for you.
Before we get into the details, what the heck is a bursa anyways? Think of it as a pillow or cushion covering your joints to reduce friction. Without bursa, simple tasks that apply pressure to your joints like lying on your side, leaning on your elbow, or repetitive throwing would cause us more issues than they do. Think about it. Sit on a wooden chair for 8 hours straight and your tushy is going to be uncomfortable, right? But sit on a chair with a few inches of padding and it won’t be as bad. Bursa supports our joints!
Now that you know what a bursa is, let’s focus on the hip specifically.
As you can see in the photo below, the hip bone on the side that you can feel is called the greater trochanter and surrounding that are 3 small bursa to pad it. They’re located where each of the 3 glute muscles attach in at the trochanter.
If I had to wrap-up what hip bursitis is into one sentence it would be this:
Hip bursitis is inflammation of the fluid-filled sacs (bursas) at the outer hip due to repetitive motion or prolonged pressure.
Symptoms of Hip Bursitis
If you’re still reading, you probably already know what hip pain feels like. But what does hip bursitis specifically feel like?
Common symptoms of hip bursitis:
-Pain with pressure
-Pain with movement
As a Physical therapist, the most common symptoms I heard from patients with this diagnosis was pain in side-lying. Anytime they slept on their side for long periods of time, the symptoms would increase.
Another common complaint was that sitting in their car seat hurt - why? Because many car seats are extremely narrow and curve up on the left and right side causing excess pressure on the hips.
Common Causes of Hip Bursitis
Hip bursitis is caused by two things: repetitive pressure or repetitive movement. I mentioned some examples of repetitive pressure above like lying on your side. The other common cause is repeated movement - doing the same movement over and over again.
Examples of repetitive movement at the hips that could aggravate the bursitis include running, jumping, cycling, kneeling (like for gardening), or walking.
The older we get and the more overweight we are, the more prone we are to bursitis issues. Changes in our walking style (gait) could also contribute to new hip bursitis issues.
Testing for Hip Bursitis
You can visit your Physician or Physical therapist to have imaging done and an MRI or Ultrasound would be able to show inflammation of the bursa(s).
In the clinic, the most common test is to apply pressure just outside the greater trochanter of the hip and if there’s pain, bursitis is possible.
Besides that, there’s no real accurate test which is why this is often misdiagnosed and hard to differentiate between a tendon injury like a tendinitis/tendinosis/tendinopathy (an injury when the tendon’s capacity to tolerate load is exceeded). The main difference is that a tendon injury would be caused from an increase in physical activity to more than your body could handle. So if there’s been no increase in activity, then perhaps it’s purely bursitis.
Conservative Treatment for Hip Bursitis
Disclaimer: The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Most of the time, hip bursitis issues can be resolved with Physical therapy alone. However if conservative treatment does not resolve it, the next step is to get imaging done to determine if there is more going on like a tendinopathy, tear, fracture, etc.. Since the glutes attach to the greater trochanter, it’s common to get the diagnosis of bursitis when there’s a tendinopathy going on instead or at the same time. Regardless, treatment for both is similar.
Physical therapy for bursitis is hugely successful to help with mobilizing the guarded muscles, strengthening the weakened muscles, and lengthening the restrictions.
If not successful, an injection may be done to reduce inflammation and pain.
Treatments for Hip Bursitis (from basic to advanced):
Reduce the activity (or prolonged pressure) that may be aggravating it
Joint mobilization of the hip (level depends on stage of injury & restrictions)
Range of motion exercise (within a pain-free range)
Stretching (plus contract-relax technique)
Strengthening exercise (including isometrics and neuromuscular stimulation) to load the ligaments and muscles progressively
Cardio (to help vascularization or bring blood flow to the area for healing)
Functional exercise (form training for unilateral exercises especially)
Manual/Massage: soft tissue massage (especially of the guarded muscles which are often TFL, glutes, and piriformis surrounding that greater trochanter - must be careful directly over that trochanter though)
Below are some Amazon links to hip pain related products that may be helpful:
Physical Therapy Exercises for Hip Bursitis
Watch the video below for some of the best Mobility exercise ideas for hip bursitis.
Watch the video below for some of the best strengthening exercise ideas for hip bursitis.
Mission: Mobilize, Modify, Move
It’s my goal to ensure you learn three things with every blog post: how to mobilize your body, how to modify exercise, and how to optimize your movement.
Above I shared a video for hip mobility and strengthening exercises. Strengthening the glutes helps stimulate blood flow to the muscles and tendons and also improves stability around the hip joint.
Now, let’s cover some ideas for how to modify exercise if you have hip pain:
Modify your sleeping position by sleeping on your back instead of sides. Or sleep on your unaffected/non-painful side with a pillow between your knees.
Modifying sitting for long periods by using a taller chair that is more cushioned. Also try not to sit with the legs crossed.
Modify standing by trying to stand with your weight even between left and right side instead of shifting off to one side
Consider adjusting your workout split to focus more on the upper body and core more often - temporarily until your hip feels better.
Modify lower body exercises by working within a comfortable range of motion, using lighter loads, & slowing things down. For example, if you’re doing a squat try these things:
Don’t go down as deep
Do it bodyweight or lighter load than usual
Go slower so you can really focus on form
Consider doing it in front of a mirror so you can watch your knee alignment
Try out different stances: narrow, wide, wider, toes forward, toes more turned outward
Prioritizing unilateral, single-leg exercises that really target the gluteus medius and TFL to build up strength near that greater trochanter.
Finally, let’s talk about how to move better throughout the day without flaring up your hip pain. Throughout the day, modify any of the repetitive movements you make as that’s possibly the true cause of the inflammation. Or take more breaks while doing them. If you’re using the stairs and have discomfort maybe use the escalator or elevator temporarily as that could cause a flare-up. Maybe instead of a 3 mile jog you do a 1-2 mile walk until you feel better. And always, always wear high quality shoes made for the sport you love doing!
Hip pain is very common, so if you’re experiencing any please go see your doctor or Physical therapist for an evaluation and customized treatment plan for you.
I hope you get feeling better soon!
Thanks for reading!
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