What is Bursitis?
Near our joints, we have small, fluid-filled sacs called “bursa”. When the bursa become inflamed, it is called “bursitis.”
Bursitis most commonly occurs in the shoulder, elbow, and hip, but it also may occur in the heel, knee, or base of the big toe. 1
Hip bursitis, which is also referred to as “Trochanteric bursitis” is the most common type of bursitis for older adults, as well as women and middle-aged individuals.2
In this article, we will focus on treating hip bursitis.
What are the Symptoms of Bursitis?
Symptoms of bursitis include the following:
*Achiness or stiffness in the area that’s impacted
*Pain with movement
*Pain with pressure on the joint
*Decreased motion
*Redness and/or swelling at the affected area
With hip/trochanteric bursitis, activities like walking, standing, sitting, and sleeping can be difficult.1,2 This makes hip bursitis very frustrating as it can feel difficult- if not impossible- to find relief.
What Causes Hip Bursitis?
Inflammation occurs within the bursa, or the surrounding musculature, which causes pain.
Typically, this inflammation is caused by an injury to the area or overuse of the joint. It could also be caused by an infection.
Additionally, spinal abnormalities, arthritis, or surgery may also lead to developing bursitis.
Other conditions, such as diabetes, gout, tendonitis, and thyroid disease may be associated with it as well. 2
How is Bursitis Diagnosed?
Generally, your doctor will diagnose bursitis based on your symptoms, medical history, and physical exam.
Imaging (like X-ray, ultrasound, MRI) may be ordered as well. An X-ray will not show inflammation in the bursa, but it may be used to help rule out other conditions. Ultrasound or MRI may be used if physical exam alone isn’t conclusive.
Lab work may also be performed, which may possibly include removing fluid from the bursa itself.1,2
Is All Hip Bursitis Treated the Same?
There are two types of bursitis- Aseptic and Septic- which can impact how it’s treated.
Aseptic bursitis means that the tissue around the joint/bursa is inflamed, but not the fluid within the bursa itself. This is the type we will focus on for treatment from a PT perspective.
Septic bursitis indicates the bursa itself is infected. This will likely require antibiotic treatment, as well as removal of the infected fluid (aspiration), and possibly surgical drainage and/or removal of the bursa (bursectomy).2
It’s important to consult with your doctor so she/he/they can determine the appropriate course of action for your specific type of bursitis.
How is Aseptic Hip Bursitis Treated?
Although bursitis can be very painful and frustrating at times, there are ways to treat this condition at home and with the help of a physical therapist.
Generally treatment for hip bursitis includes the following:
*Resting (especially from repetitive activities. This is not to say stop moving at all. Resting means taking more frequent breaks during the day, and taking an extended break from an activity that’s causing pain until the inflammation subsides, so you can return to that activity).
*Ice (When people are in pain, many turn to heat. This tends to promote inflammation, as heat opens up our blood vessels. Ice, on the other hand, constricts our vessels, forcing inflammation out of the area. Icing the affected joint after activity can help reduce inflammation).
*Physical Therapy (Seeing a physical therapist is very helpful for trochanteric bursitis. Your PT will be able to develop a plan that is customized to your activity level and what you enjoy doing to help you return to function as soon as possible. In this article, I will demonstrate the exercises I would generally provide to my client with hip bursitis).
**Possibly a corticosteroid injection to decrease the inflammation** (If resting, icing, and completing the program prescribed by your physical therapist is not working, your doctor may recommend a steroid injection to help with the inflammation/pain. However, it’s important to note that these injections address the symptoms, but not always the cause, so continuing with your prescribed exercise routine will likely provide you continued benefit in the long run. Once again, consult with your doctor and physical therapist on what’s best for you).
Can I Prevent Bursitis? If So, How?
1. Warm up before activities and/or exercise.
2. Begin new exercise routines or sports slowly to allow your body to adjust gradually to new demands placed on it.
3. Take breaks when doing repetitive tasks.
4. Cushion joints (wear knee pads when gardening, for example).
5. Stop an activity if it’s causing you pain. This may be an indicator that you need to rest. It doesn’t mean you’ll never be able to return to this activity- it’s important to listen to your body though!
6. Practice good posture (see my article on posture). Our bodies will respond better to the demands placed on them if they’re in the proper position to do so. 2
7 Exercises for Hip Bursitis
Here’s a workout video where I do these exercises with you!
Please note! These exercises are to be completed after you are cleared to exercise by your physical therapist or doctor. When it comes to treating true hip bursitis, REST is the #1 treatment!
Keeping our hips and core muscles strong is key to decreasing pain, and even preventing bursitis from happening. These muscles help stabilize our pelvis/hip bones. When they’re strong, the muscles can properly take on the demand of the activity, without causing strain and/or inflammation.
1. IT Band Stretch
IT stands for iliotibial band. It runs from the top of your hip, down the side of your leg, and attaches just below the knee. Due to it’s location, when it, and the muscles around it get tight, pressure increases on the bursa of the hip.
Fun fact: You can’t actually “stretch” your IT band, because it is so thick. What we’re really doing is stretching the muscles around it. Yet, it’s still called the “IT Band Stretch”.
When we are performing this stretch, we’re actually stretching gluteus maximus, biceps femoris (hamstring muscle), and vastus lateralis (quadricep muscle).3
**NOTE: Many people teach this stretch as crossing one foot in front of the other, then bending over. I typically don’t like this approach for most older adults as that is a lot of back flexion, which can be dangerous for those with osteoporosis. It’s not wrong to do it that way, however, for older adults, I recommend the approach outlined below.**
1. Stand with injured leg closest to wall.
2. Cross non-injured leg in front.
3. Bend front knee slightly.
4. Shift hips towards the wall.
5. Hold for 1 minute, breathing.
6. Repeat 2-3x on each side.
2. Figure 4 Stretch
This stretch is used to stretch our piriformis muscle (found it our buttocks region). Overall, this stretch helps decrease stiffness in our hips, which may help decrease pain.
1. Lay on your back with both knees bent, feet flat on the floor/mat/bed.
2. Cross the ankle of your injured leg over your knee of your non-injured leg.
3. You should feel a stretch in the back of your hip. If you don’t, press down gently on the knee of your top leg. Or, slide the foot on your supporting leg closer to your bottom.
4. Hold for 1 minute, breathing.
5. Repeat 2-3x on each side.
3. Hip abduction (Standing or Side lying)
None of us strengthen our hips enough! What’s interesting, though, is that our hip strength impacts not only our hips, but our knees and back as well.
The stronger your hips, the less likely you are to have pain in any of those regions!
This exercise primarily works the gluteus medius with some work done by the tensor fasciae latae.
It is usually most effective lying on your side, but if lying on your injured side is painful, you can do this standing. Or, you can try placing a towel or small pillow under your hip to pad it.
If you don’t have pain lying on your side, then perform in side lying.
Side Lying Hip Abduction
1. Lay on your non-injured side.
2. Bend your bottom knee.
3. Lift your top leg about 6 inches off of the floor/mat/bed (focus on lifting from your glutes. You should feel your glutes working!).
4. Lower your leg to starting position.
5. Repeat 10-12 times.
6. Rest for 1-3 minutes.
7. Perform 3 sets.
8. Repeat on other side.
Standing Hip Abduction
1. Stand on injured leg, holding on to counter/stable surface for balance.
2. Bend knee of standing leg slightly.
3. Kick injured leg out to the side (once again, about 6 inches, it doesn’t need to/shouldn’t be high)
4. Lower your leg to starting position.
5. Repeat 10-12 times.
6. Perform on other side.
7. Perform 3 sets on each leg.
4. Bridges
Bridges are an excellent exercise that work a lot of muscles at once. These will help increase our core strength and lower body strength, to help stabilize our pelvis/hips.
1. Lay on your back with your feet flat on surface, about hip-distance apart.
2. Brace your belly so your abdominals are engaged.
3. Using your glute muscles, lift your buttocks up.
4. Hold for 3 seconds
5. Lower buttocks slowly to surface.
6. Repeat 10-12 times.
7. Rest for 1-3 minutes.
8. Perform 3 sets total.
5. Plank
Planks are an excellent exercise to strengthen our core muscles to help with overall stability.
Planks really strengthen A LOT of muscles- muscles of upper and lower body, as well as the core. Since we are focusing on this exercise as a core workout, the primary core muscles being worked are shown above.
Another added benefit of this exercise for hip bursitis is that it doesn’t put any pressure on the injure area.
Planks are definitely a challenging exercise, so it’s 100% okay if you need to start on your knees and work up to completing them on your toes as you get stronger!
1. Start on your hands and knees. Hands should be under the shoulders, knees under the hips.
2. Brace your abdominals.
3. Keeping your abs braced and back flat, straighten one leg back and then the other. (If you want to do a kneeling plank, walk knees backwards, so your body is at about a 45 degree angle)
4. Hold for 10-30 seconds (increase your time as you get stronger).
5. Lower down to your knees (if you’re not already there).
6. Return to starting position and rest for 1-3 minutes.
7. Repeat 3 times.
6. Supine Marches
This exercise is seemingly simple, but is very beneficial for our lower abdominals, which is important to stabilizing our hips.
When done correctly, you will really feel your abdominals (rectus abdominis and transverse abdominis) kick on.
1. Lay on your back with your feet flat on surface, about hip-distance apart.
2. Brace your belly so your abdominals are engaged.
3. Lift one foot off of the floor/mat/bed.
4. Return foot to floor.
5. Lift opposite foot.
6. Alternate until you’ve done 10 reps on each side.
7. Rest for 1-3 minutes.
8. Perform 3 sets total.
7. Leg Circles
Another hip exercise! By now, you can probably tell how important how hip strength is.
This exercise really targets stability as you are working inner thigh (adductor group), front of the leg (quadriceps), back of the leg (hamstrings and gluteal muscles).
If lying on your injured side is painful, only perform on one side. You can try placing a towel or small pillow under your hip to pad it.
If you don’t have pain lying on your side, then perform on both sides.
1. Lay on your non-injured side.
2. Bend your bottom knee.
3. Lift your top leg about 6 inches off of the floor/mat/bed (focus on lifting from your glutes. You should feel your glutes working!).
4. Hold your leg in line with your body, draw a circle in the air with your foot (about the size of a dinner plate).
5. Perform 4 circles.
6. Reverse the direction for 4 circles.
7. Rest for 1-3 minutes.
8. Perform 3 sets.
9. Perform on other side if it’s not painful to lay on your injured side.
Sources:
- https://www.mayoclinic.org/diseases-conditions/bursitis/symptoms-causes/syc-20353242#:~:text=Bursitis%20(bur%2DSY%2Dtis,the%20shoulder%2C%20elbow%20and%20hip.
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/bursitis#:~:text=Hip%20bursitis.,middle%2Daged%20and%20older%20people.
- Liebman, H. (2014). Anatomy of exercise encyclopedia. New York: Firefly.
- All pictures taken from photos with Creative and Common Licenses on Google Images and Canva.com