Hip bursitis

Other names for hip bursitis

• Trochanteric bursitis
• Trochanteric tendinobursopathy
• Greater Trochanteric 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 your movements.

A bursa is like a small, very thin fluid-filled sac found in several joints throughout the body. This small sac acts as a cushion within the joint and lubricates structures exposed to more friction.

In the hip, the trochanteric bursa is located on the side, near the greater trochanter (the bony prominence 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 trochanteric pain syndrome" to encompass bursitis and the tendinopathies that frequently accompany it.

What causes hip bursitis?

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

Bursa irritation can be primarily caused by:

• Poorly managed repetitive hip movements (running, mountain hiking, leg exercises)
• Direct trauma to the side of the hip (falling on your side, receiving a blow)
• Increasing your training volume too quickly
• Muscle imbalances in the glutes

A common example is someone who starts running frequently without gradually increasing their activity. The body doesn't have enough time to adapt to the new demands, leading to irritation of the bursa.

More rarely, bursitis can be caused by an 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 (especially between 40 and 60 years old)
• People who participate in sports involving repetitive leg movements (running, cycling, dancing)
• Athletes in sports with jumping and changes of direction (volleyball, basketball, hockey)
• Individuals with weakness in their hip stabilizing muscles
• Those who have recently increased their physical activity level

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 can spread down the thigh.

The most common symptoms are:

• Pain on the outer side of the hip (not in the groin)
• Tenderness to the touch over the greater trochanter
• Pain that can radiate down the outer thigh
• Pain that worsens when lying on the affected side

Pain is generally increased by:

• Walking, especially over long distances
• Climbing stairs or hiking
• Running or cycling
• Standing on one leg
• Lying on the painful side
• Sitting with crossed legs
• Getting up from a prolonged sitting position

How is hip bursitis diagnosed?

Trochanteric bursitis is primarily diagnosed based on your symptom history and a clinical examination. Imaging tests are rarely needed.

Your physiotherapist or doctor will ask about:

• The exact location of your pain
• Movements or activities that make it worse
• How long you've had pain
• Your recent sports or work activities

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

For elderly individuals who have fallen, an X-ray may be recommended to rule out a hip fracture, especially for those with osteoporosis.

When should you consult a physiotherapist for hip bursitis?

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

You do not need to see a doctor before consulting a physiotherapist. If your condition requires seeing a doctor, your physiotherapist will be able to inform you and provide a referral.

Consult quickly if:

• Pain limits your daily activities
• You have difficulty walking normally
• Pain keeps you from sleeping
• Symptoms have lasted for more than 2 weeks without improvement

What are the physiotherapy treatments for hip bursitis?

Treatment for trochanteric bursitis primarily focuses on managing the load on the hip and strengthening the muscles that stabilize it. Your physiotherapist will create a personalized program tailored to your needs.

Your physiotherapist will first conduct a complete assessment to identify 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 assessment results, your physiotherapist will be able to:

• Providing you with specific exercises to strengthen your gluteal and stabilizing muscles
• Teaching you how to modify your activities to reduce irritation
• Mobilizing your hip if necessary to reduce pain
• Helping you gradually increase your return to activities
• Advising you on positions to avoid and to favor

Strengthening your 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 (with a well-adjusted seat)
• Moderate walking on flat ground

• Standing with your weight shifted to one hip
• Sitting with your legs crossed
• Sleeping 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 running sessions
• Temporarily reduce your mileage
• Avoid sloped or uneven surfaces
• Do glute strengthening exercises regularly

If you don't see any improvement after 10 to 14 days of modifying your activities, consult a physiotherapist.

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

What is the recovery time for hip bursitis?

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

Factors that influence healing time:

• How long you have had symptoms
• Your Physical Activity Level
• Your adherence to exercises and recommendations
• The presence of modifiable risk factors

With early intervention and a suitable strengthening program, the vast majority of hip bursitis cases resolve without more invasive procedures.

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. La clinique du coureur: la santé par la course à pied. Mons Eds. 2019.