Physical Therapy for Hip Bursitis
Hip bursitis involves inflammation of the bursae, the small fluid-filled sacs that provide cushioning between the hip bones and the soft tissue of the hip (muscles, tendons, and ligaments). Hip bursitis is most common among middle-aged and older adults and affects women more than men. Physical therapy can effectively treat hip bursitis, reducing pain, addressing muscle-related weakness, and helping patients return to daily activities and sports safely. A physical therapist treats hip bursitis with a combination of stretching, strengthening, and movement retraining to decrease irritation in the hip, improve strength and range of motion, resolve pain, and restore normal function.
Anatomy of the Hip
The hip is a ball and socket joint made up of the acetabulum (the socket) and the head of the femur (the ball). The hip socket is housed in the pelvic bone and is lined by a ring of cartilage (the labrum) that stabilizes the hip joint. The head of the femur is a spherical structure that fits flush into the hip socket.
Ligaments connect the femoral head to the socket, stabilizing the hip and forming the joint capsule. The hip joint is surrounded by muscles that support the hip and enable movement, including the gluteal muscles, abductor muscles, hip flexors, quadriceps, and hamstrings.
The joint is lubricated by synovium fluid and bursae. Bursae are fluid-filled sacs that provide cushioning between the hip bones and muscles, tendons, and ligaments. Bursae allow soft tissues to slide and glide freely over bony prominences. The trochanteric bursa is located on the outside of the hip and the iliopsoas bursa is located on the inner part of the hip.
What is Hip Bursitis?
Hip bursitis involves inflammation of the bursae, the small fluid-filled sacs that provide cushioning between the soft tissues of the hip and the hip bones. Hip bursitis is more common among middle-aged and older adults and affects women more often than men.
Greater trochanteric bursitis (GTB) is the most common type of hip bursitis. The greater trochanteric bursa is located at the top of the greater trochanter, a bony prominence on the outside of the hip bone. GTB is most often the result of repetitive friction to the bursa due to a combination of muscle weakness and tightness affecting the outer hip or due to repetitive microtrauma to the bursa from running and exercise or a fall that directly compresses the bursa.
Common causes of hip bursitis include:
Repetitive movements that irritate bursae, such as walking, running hills, and stair climbing
Abnormal gait pattern due to injury, spinal issues, or leg length differences
Incorrect posture
Bone spurs in the hip
Hip surgery or replacement
Pinched nerve in the low back
Infection
Autoimmune diseases such as gout, rheumatoid arthritis, thyroid disease, or psoriasis
Direct trauma from being hit or falling on the side of the hip
Gluteal muscle weakness
IT band or hip muscle tightness
Abnormal hip or knee mechanics
Sudden increase in an exercise routine
Symptoms of hip bursitis can include pain on the outer side of the hip, thigh, buttocks, or outside of the leg and pain that worsens when getting up from sitting, lying on the affected hip, climbing stairs, pushing on the outer side of the hip, walking or running, lifting the leg up to the side, or sitting with crossed legs.
Physical Therapy for Hip Bursitis
Physical therapy can effectively treat hip bursitis, reducing pain, addressing muscle-related weakness, and helping patients return to daily activities and sports safely. A physical therapist treats hip bursitis with a combination of stretching, strengthening, and movement retraining to decrease irritation in the hip, improve strength and range of motion, resolve pain, and restore normal function.
At the start of treatment, the physical therapist assesses the patient’s gait, ability to complete functional movements like getting in and out of a chair or going up and down stairs, alignment of the pelvis and lumbar spine, strength of the hip muscles, and range of motion of the hip joint.
Physical therapy for hip bursitis can include:
Management of pain using ice, heat, ultrasound, electrical stimulation, manual therapy, and taping to reduce swelling and minimize pain.
Range of motion exercises of the hip to help restore mobility in the hip joint. Improving mobility in the low back and knee joints is also key as improper movement in these areas can increase tension at the greater trochanter and the trochanteric bursa.
Manual therapy involves hands-on soft tissue and joint mobilizations, moving the hip and low back through gentle movement to improve motion and relieve pain.
Flexibility stretches of tight leg and spinal muscles.
Targeted strengthening of the hip and low back muscles using cuff weights, stretch bands, weightlifting equipment, and aerobic exercise equipment. Muscle weaknesses or imbalances in the hip, leg, and low back can contribute to excessive strain at the greater trochanter. The physical therapist teaches patients the correct exercises to steadily restore their strength and agility.
Balance training to improve dynamic control and balance when navigating uneven surfaces.
Functional training begins once pain has been reduced and strength and mobility have improved. The physical therapist helps the patient relearn safe, controlled movements for daily activities, work, and sports to ensure a safe return to activity.
Home exercise program.
Common exercises to improve hip bursitis include:
Straight leg raises while lying down to improve the strength of the gluteus medius which supports the outside part of the hip.
Hip bridges to build strength in the gluteal and low back muscles.
Hip rotator stretch to stretch the piriformis muscle, which is located deep in the hip, and improve the mobility of the joint.
Clamshell exercise to strengthen the gluteal muscles and improve muscular support of the hip joint.
Standing hamstring stretch, as tight hamstrings can contribute to tightness and overuse of surrounding muscles of the hips.
Lying leg circles to promote range of motion, flexibility, and strength in the small muscles that make hip and leg rotation possible.
Hip bursitis can cause significant pain and swelling, limiting hip function and mobility. Work with a physical therapist to address pain and restore strength and movement in the hip!
