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:
With hip bursitis, you may experience:
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:
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.
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:
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.
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:
John is a 30-year-old dentist who enjoys running, biking, and triathlon training. He recently decided to add CrossFit training to his exercise routine, and joined an aggressive CrossFit gym. After running stairs intensely during 1 session, John felt pain developing on the outside of his right hip a few hours later. He realized that he was limping. By the end of the day, he was having trouble climbing stairs because of the hip pain. He contacted his physical therapist.
John's physical therapist asked him how and when he felt the pain. She observed him walking, and noted his limp. She gently touched the soft tissues on the outside of his hip, and noted the tenderness he felt when she pushed right over the bony spot on the outer side of the hip. She tested the strength and flexibility in his hip and back. She concluded that his hip bursa was irritated and inflamed, and that he had some tight and weak muscles in the area. She diagnosed hip bursitis. She asked John about his goals, which he said were to get rid of the pain, walk normally, and return to his previous level of exercising as well as his CrossFit club activities.
John's physical therapist began his treatment by gently stretching the muscles she had found were tight. Next, she applied ice and electrical stimulation to the area to help halt and reverse the inflammation process. She discussed with John the importance of “relative rest” for the hip area, meaning he should avoid activities like stair running, lunges, and squats for a few days, until his pain subsided.
When John returned for his next treatment, he was already feeling less pain. His physical therapist noted that his limp was almost gone. She started teaching John strengthening exercises for the muscle weakness she had found in his hip and back muscles. Only light weights were used to avoid causing new pain. As John improved, the weights were steadily increased.
Two weeks later, John's physical therapist added light jogging to John’s program, which he was able to do without increasing his pain. During the third week, John was improved enough to add lunges. By the fourth week, he was able to begin jogging up stairs in short sessions.
By the fifth week, John was able to rejoin his CrossFit club, although he was mindful to increase his workouts slowly and gradually, especially when it came to running stairs. He learned from his physical therapist to avoid any sudden increases in exercise. John also incorporated some of the special strengthening exercises he learned from his physical therapist into his warm-up and workout.
When he met his physical therapist at the store 6 months later, John was happy to report he was functioning at his top fitness level, and by following the advice he learned from her, he had prevented any recurrence of hip bursitis.
All physical therapists are prepared through education and experience to treat hip bursitis. However, you may want to consider:
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):