Hip Burstitis

What is bursitis of the hip?

A bursa is a small sack of fluid which is usually positioned in between a bone and a muscle or tendon. The function of a bursa is to prevent friction between the bone and overlying soft tissue. There are several bursas around the hip joint, including:

Trochanteric bursa – on the outside of the hip between the greater trochanter and the attachments of the gluteal muscles.

Gluteus medius bursa – a smaller bursa, between the gluteus medius muscle and the greater trochanter, just medial to the trochanteric bursa.

Iliopsoas bursa – between the iliopsoas muscle at the front of the hip joint and the underlying bone (bursitis in this area is also known as Iliopectineal bursitis).

Ischial bursa – Between the hamstring tendons and the base of the pelvis.

By far, the most common type of hip bursitis is from the trochanteric bursa. This can be injured in one of two ways, through a direct impact to the bursa, such as a fall onto the outer hip, which is known as traumatic bursitis,  or through repetitive friction from the overlying muscles and tendons, usually during running. This repeated friction results in the bursa becoming inflamed and swollen. Every time the tendons then rub over the bursa, this causes pain.

Bursitis of the hip can be caused by a number of factors including a fall onto the side of the hip can cause traumatic bursitis. Most cases of bursitis are overuse injuries due to biomechanical abnormalities. If you overpronate then you are more susceptible to this injury as the knee falls inwards which increases the angle at the hip. Weakness in the hip abductors, especially gluteus medius has the same effect.

Tight structures surrounding the hip such as the iliotibial band, hip flexors, and hamstrings. A bone spur which is a small excess growth of bone which can aggravate the bursa.

Hip bursitis symptoms

• Symptoms include pain on the outside of the hip which is worse during activities such as running, climbing stairs or getting out of a car.
• The pain will gradually get worse and the area on the outside of the hip is tender when pressing in.
• Pain may also radiate down the outside of the thigh.

Hip bursitis exercises

If muscles surrounding the hip joint are tight then these must be stretched to reduce pressure on the bursa. Stretches for the outer hip, gluteal muscles, hip flexors, and hamstrings are important. Strengthening exercises more commonly need to be done for the muscles on the outside of the hip rather than the adductor muscles or hamstrings.

Reducing pain and inflammation

Hip bursitis pain can be reduced by applying a cold pack to the hip. Cold can be applied for 10 minutes every hour initially, particularly if the injury is very painful. This will help reduce the inflammation in the bursa and other local tissues if necessary. A simple reusable ice pack is ideal but should never be applied directly to the skin in case it burns the skin. Always wrap in a wet tea towel or use an integrated cold wrap to avoid burning.

Rest is also an important element for reducing pain. Continuing to train with an inflamed bursa may make it worse and will most likely stop it healing. A chronic or long term injury is always more difficult to cure than a recent one so rest now to avoid being out for longer later.

Orthotic insoles

If overpronation or rolling in of the foot is a problem then this can be corrected with Orthotic insoles. See a podiatrist or other medical professional who specializes in foot biomechanics for an accurate diagnosis and best results. Off the shelf orthotic insoles are also available and suitable for most patients

The orthotic will correct the motion of the foot providing a sound foundation for the rest of the body and preventing the lower leg turning inwards which in turn causes the tip to twist when running and walking.

Hip bursitis stretching

If the muscles surrounding the hip joint are tight then gentle stretching exercises are recommended. Stretching should be performed regularly, on a daily basis and ideally up to 5 times a day for the maximum benefit.

Stretches should be held for 20-30 seconds and should be repeated twice each time. Take the stretch to the point where a gentle pull in the muscle is felt and hold. Do not bounce or try and force the stretch as this could be counterproductive or damage the muscle. If, during your 30 seconds, the stretch fades away, move a little further into it until you can feel the pull again.