A Physical Therapy Guide to Hip Bursitis
Hip bursitis is a condition that can cause pain and stiffness in the hip. In this guide, we 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
- 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
There are 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 we generally measure our hip width from. 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.4
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 years of age.
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)
- Overtraining (athletes)
- Chronic inflammatory disease
- 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)
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. The pain typically worsens with movement or pressure on the joint.
Other symptoms of bursitis may include:
- Warmth to the touch
- Limited range of motion
- Pain with going up stairs or a ladder
- Inability to lie on the affected side
- A snapping sensation in the hip with leg use
Bursitis is usually diagnosed using your medical history and a virtual or in-person physical examination. It's important to rule out underlying issues like arthritis, tendinitis, stress fracture, or bacterial infection. If there are concerns such as 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:
- 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 daily activities
The primary goal of physical therapy for hip bursitis is to create a comprehensive rehabilitation program to reduce pain and inflammation while improving hip range of motion 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: Such as soft tissue mobilization and joint mobilization, to reduce pain and inflammation with daily activities.
- Exercise: To improve hip range of motion, flexibility, strength, and coordination, all with the goal of reducing localized strain on the hip.
- Modalities: Such as heat or ice therapy, electrical stimulation, or ultrasound, to reduce 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, a focus on adequate control of the lower leg with weight-bearing activities will help immensely.
Most cases of bursitis will improve with conservative management like physical therapy. During your course of treatment, your physical therapist will modify your exercise prescription until the pain is reduced or resolved.
In some cases, a corticosteroid injection may be recommended to help reduce pain and inflammation. If the bursa is found to be septic (infected, which is very rare), antibiotics will be required as well. However, surgery is not needed for bursitis since there is typically no mechanism that needs to be removed or repaired.3
There are several things you can do 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, flexibility, and strength in the hip joint and surrounding 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 joint.
Hip pain can be debilitating and make it difficult to participate in even the most basic of activities, like going up a flight of stairs. 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.
- Seidman AJ, Varacallo M. Trochanteric Bursitis. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. https://www.ncbi.nlm.nih.gov/↩
- Physiopedia. Trochanteric Bursitis. Physiopedia.com. Accessed August 15, 2022. https://www.physio-pedia.com/↩
- Grimaldi, Alison. Diagnosing gluteal tendinopathy in clinical practice. Accessed September 1, 2022. https://dralisongrimaldi.com/ ↩
- Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. New York: Springer and Arthritis Foundation, 2008.↩