Physical Therapist's Guide to
Hip bursitis is a painful condition that affects 15% of women and 8.5% of men of all ages in the United States. The condition tends to develop more in middle-aged and elderly individuals. Hip bursitis can have many causes, but the most common is a repetitive activity, such as walking or running on an uneven surface, which creates friction in the hip area. Athletes often develop hip bursitis after running up and down hills repetitively. The condition can also be caused by abnormal walking, such as limping, due to an uneven leg length, or arthritis in the back, hip, knee, or other joints in the leg. It can also occur without any specific cause. Physical therapy can be an effective treatment for hip bursitis to reduce pain, swelling, stiffness, and any associated weakness in the hip, back, or lower extremity.
What is Hip Bursitis?
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:
- Repetitive motions (running up and down hills or stairs)
- Muscle weakness
- Incorrect posture
- Direct trauma (being hit or falling on the side of the hip)
- Differences in the length of each leg
- Hip surgery or replacement
- Bone spurs in the hip
- Diseases, such as rheumatoid arthritis, gout, psoriasis, or thyroid disease
- Muscles or tendons in the hip area rubbing the bursa and causing irritation
How Does it Feel?
With hip bursitis, you may experience:
- Pain on the outer side of the hip, thigh, buttock, or outside of the leg.
- Pain when you push on the outer side of the hip with your fingers.
- Pain when lying on the affected hip.
- Pain when climbing stairs.
- Pain that worsens when getting up from sitting, such as from a low chair or car seat.
- Pain when walking or running.
- Pain when lifting the leg up to the side.
- Pain when sitting with legs crossed.
How Is It Diagnosed?
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:
- How and when did you notice the pain?
- Have you been performing any repetitive activity?
- Did you receive a direct hit to the hip or fall on it?
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.
How Can a Physical Therapist Help?
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:
- Rest the area by avoiding walking or any activity that causes pain.
- Apply ice packs to the area for 15 to 20 minutes every 2 hours.
- Consult with a physician for further services, such as medication or diagnostic tests.
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.
Can this Injury or Condition be Prevented?
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:
- Follow a consistent flexibility and strengthening exercise program, especially for the hip muscles, to maintain good physical conditioning, even in a sport's off-season.
- Always warm up before starting a sport or heavy physical activity.
- Gradually increase any athletic activity, rather than suddenly increasing the activity amount or intensity.
- Obtain a professionally fitted shoe insert, if your legs are different lengths.
- Learn and maintain correct posture.
Real Life Experiences
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.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat hip bursitis. However, you may want to consider:
- A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
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):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider. The following articles provide some of the best scientific evidence related to physical therapy treatment of hip bursitis. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Haviv B. Update on trochanteric bursitis of the hip. OA Orthopaedics. 2013;1(1):10. Article summary not available.
Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011;21(5):447–453. Free Article.
Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88(8):988–992. Free Article.
Jones DL, Erhard RE. Diagnosis of trochanteric bursitis versus femoral neck stress fracture. Phys Ther. 1997;77(1):58–67. Free Article.
Butcher JD, Salzman KL, Lillegard WA. Lower extremity bursitis [erratum in: Am Fam Physician. 1996;54(2):468]. Am Fam Physician. 1996;53(7):2317–2324.
Hammer WI. The use of transverse friction massage in the management of chronic bursitis of the hip or shoulder. J Manipulative Physiol Ther. 1993;16(2):107–111. Article Summary in PubMed.
Sears B. Physical therapy for hip pain. About.com website. Accessed December 9, 2014.
Physical therapy management of trochanteric bursitis. Morphopedics website. Accessed December 9, 2014.
Trochanteric bursitis. Cleveland Clinic website. Accessed December 9, 2014.
University of Washington Orthopedics and Sports Medicine. Bursitis, tendinitis, and other soft tissue rheumatic syndromes. Accessed December 9, 2014.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the editorial board.