Physical Therapist's Guide to Hip Bursitis

Hip bursitis is a painful condition that affects 15% of women and 8.5% of men of all ages in the United States. The condition tends to develop more in middle-aged and elderly individuals. Hip bursitis can have many causes, but the most common is a repetitive activity, such as walking or running on an uneven surface, which creates friction in the hip area. Athletes often develop hip bursitis after running up and down hills repetitively. The condition can also be caused by abnormal walking, such as limping, due to an uneven leg length, or arthritis in the back, hip, knee, or other joints in the leg. It can also occur without any specific cause. Physical therapy can be an effective treatment for hip bursitis to reduce pain, swelling, stiffness, and any associated weakness in the hip, back, or lower extremity.

What is Hip Bursitis

Hip bursitis (also called trochanteric bursitis) occurs when one or both of the 2 bursae (fluid-filled sacs on the side of the hip) become damaged, irritated, or inflamed. Bursitis (“-itis” means “inflammation of”) means the bursa has become irritated and inflamed, usually causing pain. Normally, the bursa acts as a cushion for muscles and tendons that are close to it. Certain positions, motions, or disease processes can cause constant friction or stress on the bursa, leading to the development of bursitis. When the bursa becomes injured, those muscles and tendons don’t glide smoothly over it, and they can become painful.

Hip bursitis can be caused by:

- Repetitive motions (running up and down hills or stairs)

- Muscle weakness

- Incorrect posture

- Direct trauma (being hit or falling on the side of the hip)

- Differences in the length of each leg

- Hip surgery or replacement

- Bone spurs in the hip

- Infection

- Diseases, such as rheumatoid arthritis, gout, psoriasis, or thyroid disease

- Muscles or tendons in the hip area rubbing the bursa and causing irritation

How Does it Feel?

With hip bursitis, you may experience:

- Pain on the outer side of the hip, thigh, buttock, or outside of the leg.

- Pain when you push on the outer side of the hip with your fingers.

- Pain when lying on the affected hip.

- Pain when climbing stairs.

- Pain that worsens when getting up from sitting, such as from a low chair or car seat.

- Pain when walking or running.

- Pain when lifting the leg up to the side.

- Pain when sitting with legs crossed.

How Is It Diagnosed?

If you see your physical therapist first, the physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist also will ask you detailed questions about your condition, such as:

How and when did you notice the pain?

Have you been performing any repetitive activity?

Did you receive a direct hit to the hip or fall on it?

Your physical therapist will perform special tests to help determine the likelihood that you have hip bursitis. Your physical therapist will gently press on the outer side of the hip to see if it is painful to the touch, and may use additional tests to determine if other parts of your hip are injured. Your physical therapist also will observe how you are walking.

Your physical therapist will test and screen for other, more serious conditions that could cause lateral hip pain. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests (eg, an x-ray) to confirm the diagnosis and rule out other damage to the hip, such as a fracture.

How Can A Physical Therapist Help?

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but results can be achieved in 2 to 8 weeks or less, when a proper stretching and strengthening program is implemented.

During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:

- Rest the area by avoiding walking or any activity that causes pain.

- Apply ice packs to the area for 15 to 20 minutes every 2 hours.

- Consult with a physician for further services, such as medication or diagnostic tests.

Your physical therapist will work with you to:

Reduce Pain and Swelling. If repetitive activities have caused the hip bursitis, your physical therapist will help you understand how to avoid or modify your activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and hands-on therapy, such as specialized massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the hip and leg. These might begin with "passive" motions that the physical therapist performs for you to gently move your hip joint, and progress to active exercises and stretches that you do yourself.

Improve Flexibility. Your physical therapist will determine if any leg or spinal muscles are tight, help you to stretch them, and teach you how to stretch them.

Improve Strength. Hip bursitis is often related to weak or injured hip muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to steadily restore your strength and agility. These may include using cuff weights, stretch bands, weight-lifting equipment, and cardio-exercise equipment, such as treadmills or stationary bicycles.

Improve Balance. Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance skills.

Learn a Home-Exercise Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.

Return to Activities. Your physical therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills that match your lifestyle.

Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

If Surgery Is Necessary. Surgery is not commonly required for hip bursitis. However, if surgery is needed, you will follow a recovery program over several weeks guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.

Can this Injury or Condition be Prevented?

Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your knee, upper leg, and abdomen to help prevent future injury. These may include strength and flexibility exercises for the leg, knee, and core muscles.

To help prevent a recurrence of the injury, your physical therapist may advise you to:

- Follow a consistent flexibility and strengthening exercise program, especially for the hip muscles, to maintain good physical conditioning, even in a sport's off-season.

- Always warm up before starting a sport or heavy physical activity.

- Gradually increase any athletic activity, rather than suddenly increasing the activity amount or intensity.

- Obtain a professionally fitted shoe insert, if your legs are different lengths.