In this article you will find out about all the best hip bursitis exercises and the most effective ways to prevent it from returning.
Hip Bursitis, which may also be referred to as Trochanteric Bursitis, Greater Trochanteric bursitis, or greater trochanteric pain syndrome, is a frequently encountered condition that causes lateral hip pain. It is characterized by inflammation of the bursa, which are small fluid-filled sacs that act as lubricating agents for the gluteal tendons. This allows these tendons to move without friction and slide over, allowing a greater range of motion. The burs which are affected in hip bursitis are the trochanteric bursa, which is located on the lateral aspect of the hips. These lie superficially to the hip flexors and deeper to the iliotibial band. This specific location of the bursa, which makes it closer to the large tendons, causes it to become inflamed easily, as is a common cause of hip pain and lower back pain.
Hip bursitis is proposed to be caused by repetitive microtraumas, which may be facilitated by running, and excessive physical activity. It may also be facilitated by tendinopathy, defects in the surrounding musculature, or disorder of the soft tissues. The diagnosis is usually made based on detailed history and physical examination. Health physicians may also recommend plain film x-rays to rule out any other causes causing hip pain. (1)
What Causes Hip Bursitis?
The most common causes of Hip Bursitis are blunt trauma, injury, and repetitive microtraumas due to physical activity. In some cases, hip bursitis is also idiopathic in nature. By overusing the muscles surrounding the hip joint, the individual may be at a greater risk for tendinopathies affecting the gluteus medius and gluteus minimus. Physical exercises that involve repetitive abduction of the hip, as seen during climbing stairs or cycling, can also accelerate the inflammation of the bursa.
The hip bursitis caused by a direct blow or blunt trauma to the hip is most commonly seen in the elderly population, which are at a greater risk of falling. Injury to the surrounding musculature and soft tissues can lead to inflammation and eventually Bursitis of the hip. (2)
How is Hip Bursitis Diagnosed?
Hip Bursitis may be diagnosed on the basis of the patient presenting complaints, detailed history, and examination. The majority of the patients with hip Bursitis complain of unilateral lateral hip pain, back pain, and limited range of motion. The low back pain usually has a gradual onset, and patients report this pain to be improved by taking over-the-counter pain killers or anti-inflammatory medications. The hip bursitis pain may also be located by the patient to be limited to the greater trochanteric of the proximal femur. (3)
Treatment of Hip Bursitis
The hip bursitis treatment may be of conservative and surgical nature. While it is usually recommended to start with non-operative management strategies, the healthcare professional may suggest a surgical approach if they do not work.
The most common form of medication recommended for Hip Bursitis includes Non-steroidal anti-inflammatory drugs as they help control the inflammatory activity in the bursa and its surrounding structures. However, before recommending NSAIDs, the doctor may first make sure the patient does not have any contraindications for these medications.
Individuals who find over-the-counter drugs to be effective at improving their symptoms may then be recommended corticosteroid injections. Thes injections help deliver a known dose of cortisone to the inflamed Bursitis. This may also be given in combination with lidocaine or Marcaine in some cases to provide even better pain relief. Thes injections are usually given by experts who have specialized in orthopedics. (4)
PRP stands for Platelet-rich plasma, which is extracted from the own individual blood. These injections have gained popularity and have been a topic of interest amongst wellness experts worldwide. (5) The effectiveness of PRP for Bursitis of the hip has been investigated in numerous studies. One such study, conducted as a review of the clinical trials investigating the subject matter, found improvement in individuals at the 3 and 12 months follow-up. (6) However, due to the availability of other more suited treatment modalities, PRP is not considered the gold standard for the treatment of hip bursitis
The effectiveness of orthotics for hip bursitis has been studied in numerous studies. One such study conducted by Ferrari included 68 individuals who were either given customized foot orthotics to corticosteroid injections for their trochanteric Bursitis. They were asked to continue this for at least three months. After four months, when the individual was assessed to note their improvement, the orthotics groups were found to have superior results. (7)
Physical therapy is one of the most popular management forms for hip bursitis. The physical therapist may encourage numerous strengthening exercises, ischial tibial band stretching, and quadriceps stretching exercises. They may also help the individual initiate hip abduction exercises aimed at strengthening and stretching the gluteus medius and minimus. (8) (9)
What are the Recommended Hip Bursitis Exercises?
Rotator Hip Stretches
To practice the hip rotator stretches, the individual may adopt a starting position of lying down on their back. Their knees should be bent, and their feet flat against the floor. They may then raise the leg with the inflamed Bursitis so that the ankle is touching the other leg. The individual is then required to gently use their hands to push their knee away from their body until they feel a stretch in their hips. They are then required to hold this position for at least 15 seconds. Some may also opt for 30 seconds. This may be repeated 2 to 4 times.
Stretching of Iliotibial Band
The iliotibial band stretch also referred to as the band stretch, involves the individual taking a starting position with their body leaning sideways against a wall. Next, the leg with the affected hip should be closer to the wall and is used to stand. This is followed by raising the other leg and crossing it in front of the affected leg. Next, the affected hip is allowed to drop out to the side and against the wall, and the individual must lean away from it until they feel a stretch. This should be held for 15 to 30 seconds and repeated 2 to 4 times.
Outwards Straight-Leg Raises
The individual may start by lying on their side on the floor, with the inflamed bursa on top. First, the muscles of the top leg must be tightened while the top knee is straight. Then the top leg is raised at least 30 centimeters off the floor and held for 6 seconds. This should be repeated at least eight times.
Clamshell involves the individual lying on their side, with the affected bursa on top. The feet and knees of both legs should be kept joined to each other, and the knees bent. After this, the top knee is raised. This allows the legs to open up like Clamshell, and this position should be held at least for 6 seconds. After lowering the knee, the individual can take a rest for 10 seconds, after which the individual may continue with its repetitions.
Frequently Asked Questions
What is the Fastest Way to Heal Bursitis of the Hip?
Amongst the most efficient and safer ways to treat hip Bursitis is by icing the affected area, at least for the first two days. The individual may also take an over-the-counter anti-inflammatory medication to help control the inflammation.
Is Walking Good for Bursitis of the Hip?
Walking is considered a safer choice for Bursitis of the hip in comparison to more intense physical activities like jumping, weight lifting, and running.
Does Bursitis of the Hip Ever Go Away?
Bursitis of the hip may take a recovery time of at least six weeks to properly heal. Some individuals with more severe forms of Bursitis may require a longer healing period of 12 weeks. If chronic Bursitis is not treated, it may lead to eventual thickening of the bursa, leading to long-term symptoms of discomfort and difficulty in hip movements.
What Activities Make Hip Bursitis Worse?
The activities that might worsen hip Bursitis include lying down for a long time, as seen in sedated patients, and sitting in one position for a long, as seen in office workers. It may also be worsened by overuse of the muscles, as seen in athletes and boy builders.
How Should I Seep with Hip Bursitis?
Sleep may also play an important role in worsening or improving one’s hip bursitis. It is recommended to sleep on the side to ensure a proper alignment of the spinal cord and involved structures. The individual should also make sure the mattress they are using is even and does not include any structures or shape irregularities.
What Can be Mistaken for Bursitis?
The conditions that may be mistaken for Bursitis include fractures of the trochanteric and the femoral neck. Injury causing hamstring avulsion, muscle sprain, or snapping hip syndrome.
- Seidman AJ, Varacallo M. Trochanteric Bursitis. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538503/
- Pumarejo Gomez L, Childress JM. Greater Trochanteric Syndrome. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557433/
- Speers CJ, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2017;67(663):479-480. doi:10.3399/bjgp17X693041
- Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H., & Vicenzino, B. (2018). Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. British journal of sports medicine, 52(22), 1464–1472. https://doi.org/10.1136/bjsports-2018-k1662rep
- Mathew, J., Sankar, P., & Varacallo, M. (2021). Physiology, Blood Plasma. In StatPearls. StatPearls Publishing.
- Ali, M., Oderuth, E., Atchia, I., & Malviya, A. (2018). The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review. Journal of hip preservation surgery, 5(3), 209–219. https://doi.org/10.1093/jhps/hny027
- Ferrari, Robert. “A cohort-controlled trial of customized foot orthotics in trochanteric bursitis.” JPO: Journal of Prosthetics and Orthotics 24.3 (2012): 107-110.
- Ganderton, C., Semciw, A., Cook, J., Moreira, E., & Pizzari, T. (2018). Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial. Journal of women’s health (2002), 27(6), 815–829. https://doi.org/10.1089/jwh.2017.6729
- Attum, B., & Varacallo, M. (2021). Anatomy, Bony Pelvis and Lower Limb, Thigh Muscles. In StatPearls. StatPearls Publishing.