Hip Bursitis

Other names for hip bursitis

• Trochanteric bursitis
• Trochanteric tendinobursopathy
• Greater trochanter pain syndrome

What is hip bursitis?

Hip bursitis is an inflammation of the trochanteric bursa, a small fluid-filled cushion located on the side of your hip. This bursa allows tendons and muscles to glide smoothly during movement.

A bursa is like a small, thin sac filled with fluid found in several joints of the body. This small sac acts as a cushion in the joint and lubricates structures exposed to increased friction.

At the hip, the trochanteric bursa is located on the side, near the greater trochanter (the bony protrusion you can feel on the side of your hip). When this bursa becomes inflamed or irritated, it is called trochanteric bursitis.

It is important to note that recent research suggests that several cases of lateral hip pain also involve the tendons of the gluteal muscles. This is why professionals now often refer to "greater trochanter pain syndrome" to encompass bursitis and the tendinopathies that frequently accompany it.

What causes hip bursitis?

Hip bursitis is often caused by repetitive movements that are poorly controlled or direct trauma. Irritation occurs when the bursa is compressed or rubbed excessively.

Irritation of the bursa can be caused mainly by:

• Repetitive hip movements that are poorly controlled (running, mountain hiking, leg exercises)
• Direct trauma to the side of the hip (falling on the side, being struck)
• Too rapid an increase in training volume
• Muscle imbalances in the glutes

A classic example is someone who starts running a lot without properly pacing their progress. The body does not have time to adapt to the new demands, and the bursa becomes irritated.

More rarely, bursitis can be caused by infection or rheumatoid arthritis.

What are the risk factors for developing hip bursitis?

Certain groups of people are more likely to develop trochanteric bursitis. Age, gender, and level of physical activity all play a role.

Hip bursitis is more common in the following groups:

• Women are more affected than men (particularly those between the ages of 40 and 60).
• People who participate in sports involving repetitive leg movements (running, cycling, dancing)
• Athletes in sports involving jumping and changes of direction (volleyball, basketball, hockey)
• People who have weak hip stabilizing muscles
• Those who have recently increased their level of physical activity

What are the symptoms of hip bursitis?

The main symptom of trochanteric bursitis is pain on the side of the hip. This pain is usually localized and may radiate to the thigh.

The most common symptoms are:

• Pain on the outer side of the hip (not in the groin)
• Sensitivity to touch on the greater trochanter
• Pain that may radiate to the outer thigh
• Pain worsened when lying on the affected side

Pain is generally increased by:

• Walking, especially long distances
• Climbing stairs or hiking
• Running or cycling
• Standing on one leg
• Lying on the painful side
• Sit cross-legged
• Getting up from a prolonged sitting position

How is hip bursitis diagnosed?

Trochanteric bursitis is mainly diagnosed based on your symptoms and a clinical examination. Imaging tests are rarely necessary.

Your physical therapist or doctor will ask questions about:

• The exact location of your pain
• Movements or activities that aggravate it
• How long have you been in pain?
• Your recent sports or professional activities

The physical examination includes specific tests to reproduce your pain and assess the strength of your hip stabilizing muscles.

For older adults who have fallen, an X-ray may be recommended to rule out a hip fracture, especially in those with osteoporosis.

When should you see a physical therapist for hip bursitis?

You should consult a physical therapist if you experience the symptoms described above or if your doctor has already ruled out other possible causes of your pain.

You do not need to see a doctor before consulting a physical therapist. If your condition requires medical attention, your physical therapist will be able to advise you and refer you to a doctor.

Consult quickly if:

• Pain limits your daily activities
• You have difficulty walking normally
• The pain is keeping you awake.
• Symptoms have lasted for more than 2 weeks without improvement.

What are the physical therapy treatments for hip bursitis?

Treatment for trochanteric bursitis focuses primarily on load management and strengthening the hip stabilizing muscles. Your physical therapist will create a personalized program tailored to your needs.

Your physical therapist will first conduct a comprehensive assessment to determine the factors contributing to your bursitis. This assessment includes:

• Your joint mobility
• The quality of your movements
• Your muscle strength and stability
• Your walking pattern
• Your physical activity habits

Based on the results of the assessment, your physical therapist will be able to:

• Give you specific exercises to strengthen your glutes and stabilizing muscles
• Teaching you how to modify your activities to reduce irritation
• Move your hip if necessary to reduce pain.
• Helping you gradually ease back into activities
• Advise you on positions to avoid and favor

Strengthening the gluteal muscles is often key to treatment. These muscles stabilize your hip, and when they are strong, they reduce stress on the trochanteric bursa.

What can you do at home for hip bursitis?

A few simple adjustments can help relieve your symptoms and speed up your recovery. The goal is to reduce irritation of the bursa while remaining active.

• Swimming
• Stationary bike (well-adjusted seat)
• Moderate walking on flat terrain

• Standing with your hips swaying (putting your weight on one hip)
• Sit with your legs crossed
• Sleep on the painful side. If you sleep on your side, place a pillow between your thighs.
• Stretching the iliotibial band (this can worsen compression)

• Incorporate walking breaks into your runs
• Temporarily reduce your mileage
• Avoid sloping or uneven surfaces.
• Do glute strengthening exercises regularly.

If you see no improvement after 10 to 14 days of modifying your activities, consult a physical therapist.

If your bursitis is caused by direct trauma (fall, blow), follow the PEACE & LOVE protocol for managing acute injuries.

How long does it take for hip bursitis to heal?

Most people with trochanteric bursitis see significant improvement within 6 to 8 weeks with appropriate treatment. Healing time varies depending on severity and individual factors.

Factors that influence healing time:

• How long have you had symptoms?
• Your level of physical activity
• Your adherence to the exercises and recommendations
• The presence of modifiable risk factors

With early treatment and an appropriate strengthening program, the vast majority of hip bursitis cases resolve without more invasive intervention.

Sources

• Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. J Orthop Sports Phys Ther. 2015;45(11):910-922.
• Dubois B. The Runner's Clinic: Health Through Running. Mons Eds. 2019.