5 Effective Exercises for Hip Bursitis Relief

Do you have pain on the outer side of your hip when walking, lying on your side or even going up stairs?

To understand more about hip bursitis we’ll go over the anatomy of the hip and then dive into the cause of pain and some treatments.

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Anatomy of the Outside Hip Area

If you place your hand on the outside of your hip you should feel a bone that sticks out more than the others. This bone is called the greater trochanter or the “thigh bone”. It's a bone where your smaller glute muscles, called the gluteus medius and gluteus minimus attach (see photo below). These muscles function when walking, running or going up/down stairs to stabilize your pelvis. Between the thigh bone (greater trochanter) and the gluteus medius and minimus muscle tendons is a bursa which is a sac filled with fluid (called the trochanteric bursa or hip bursa) its purpose is to cushion this area and reduce friction from the tendons. Lying over the top of the gluteal tendons and the trochanteric bursa is the infamous IT band (iliotibial band).

What is Hip Bursitis?

Hip Bursitis, is a diagnosis often given to people with pain in the region mentioned above. Typically this refers to inflammation of that bursa. The “itis” in the word bursitis means inflammation, and the “burs” in the word bursitis refers to the bursa. Even though this is a common diagnosis given to people with pain in the outside hip area, research spanning over 15+ years has shown that bursitis is typically not what is causing your outside hip pain. Many studies have shown that there is a low chance of inflammation in patients with outside hip pain and  inflamed bursae (bursitis of the hips) happens almost equally in people with and without outside hip pain (Woodley et al.)

A lot of research points to the tendons we spoke on above, the gluteus medius and minimus tendons. These muscle tendons are often the culprits of this pain you feel in the outside hip. This is called Gluteal Tendinopathy. Gluteal tendinopathy is a type of tendon disorder in your hips and buttocks area (gluteal region). The disorder causes the tendon tissue to break down or deteriorate. Gluteal tendinopathy is a common cause of hip pain.

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What Should I Do Now? This Is Where Physical Therapy Comes In

I know, for the average person this can be both confusing and overwhelming. This is where a skilled physical therapist can help. A skilled physical therapist will conduct a thorough evaluation that can help  determine the correct diagnosis between a true hip bursitis, gluteal tendinopathy, hip arthritis and many more potential injuries. This will then guide us, the physical therapist on how the symptoms should be treated. 

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• To put that in perspective if you were diagnosed with hip bursitis which we learned above is not typically the cause of outside hip pain. You may get prescribed rest, ice and antiinflammatories from your local medical professional. This however can create the idea that treating or managing your pain/symptoms is out of your control and does not treat the true root cause of the problem. Which may lead to feeling better temporarily but not truly fix the problem. Leading to symptoms returning once you return to normal activities. 

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As physical therapists, we are trained to rule out low back related pain, arthritis of the hip and bursitis. That way when treating we can be more efficient and target the areas that need treatment. 

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• Long story short, there can be many causes of outside hip pain. That's why it's important to rule out other causes of hip pain like hip osteoarthritis and low back related pain.
  • Someone with Hip arthritis may have groin pain that can refer to the outside hip and have pain with crossing legs, bending forward or going up stairs.
  • Someone with low back related pain may have discomfort that radiates from the back to the outside hip and have pain with bending, lifting or twisting motions.  

Characteristics/Clinical Presentation

Here are some common characteristics of people with gluteal tendinopathy:

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• Lateral/outside hip pain.
• Pain to the outside thigh and knee.
• Local tenderness over the greater trochanter (thigh bone). 
• Pain with lying on the painful side and sometimes when lying on the unaffected side too due to the crossing of the legs on the painful side.
• Pain with weight-bearing activities.
• Pain with sitting crossed-legged.
• Pain with prolonged sitting.
• A patient who reports lateral hip pain within 30 seconds of standing on one leg is very likely to have gluteal tendinopathy. 
• No pain when pressing on the greater trochanter (thigh bone) unlikely to have gluteal tendinopathy.

Causes Of Outside Hip Pain

When there is gluteal tendoninopathy with associated  hip bursitis, the following are possible causes/contributing factors:

• Direct trauma
• Female gender
• Overuse
• Compression of the tendon (and bursa)
• Obesity
• Poor pelvic control or weak hip abductors
• Gluteus medius and  tears (degenerative or traumatic)

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Gluteal tendinopathy is more common in women in their 4th to 6th decades of life. A recent study found that only 2% of women had isolated trochanteric bursitis, while 25% had hip abductor tendon pathology with an associated trochanteric bursitis.

Who Gets Gluteal Tendinopathy, Lateral Hip Pain, and Hip Bursitis?

• More common in women. 
  • Commonly it affects older less active menopausal women.

• Runners 
  • Running consistently loads your gluteal muscles and tendons (why runners need to strength train too! But that's another issue for another day.)
  • If the frequency, volume or intensity of your running training exceeds your capacity to recover, injury may occur.
  • Lateral hip pain or gluteal tendinopathy may occur by DOING TOO MUCH TOO SOON which is very common with runners.

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Recommendations 

Many of the recommendations are to temporarily modify painful activities.

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Example #1: If you have pain when sleeping on the affected side

• Sleep on your non painful side with pillows between your legs.
• Sleep on your back. 
• Add a mattress topper to soften the pressure between your hips and mattress.

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Example #2: If you have pain when sitting try to figure out what sitting position causes your pain.

• Sitting with legs crossed may cause pain
• Leaning to a specific side may cause pain
• Or just sitting for long periods of time may cause pain

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Example #3: Pain with going up or down stairs

•  Try doing one step at a time while using a rail

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If you have pain with walking try quicker shorter steps to put less time and pressure on affected side. If you have pain with running modify the frequency, intensity, miles, speed  or volume. 

Exercise

• Exercise
  • Can Improve function, by increasing strength in muscles which can affect walking, bending and lifting.
  • Can improve overall health and well being because the people with gluteal bursitis, and gluteal tendinopathy tend to be more sedentary and have more body weight.
  • Can Improve your confidence in moving your hips.
• Some people do get better with just resting.

• Cross training is an option if you are not able to run. You can swim, bike and use the elliptical.

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How to know what exercises to do for my recovery?

With so many exercises on the internet and social media on how to build strong hips and recover from hip bursitis. It can be confusing and intimidating to select exercises in fear of hurting yourself even more. 

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Here are some questions you need to answer when figuring out the appropriate exercises for your recovery: 

• Are your symptoms tolerable during exercise?
• Are your symptoms tolerable immediately after exercise?
• Are your symptoms tolerable the day after exercise?

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Remember pain doesn't mean the exercise is not useful for your recovery but if the pain is hindering your progress it's probably too intense for the stage you are in at that moment. 

That's the fine art of rehab and how a physical therapist can help find the perfect group of exercises specific for you. A triathlon runner probably won't get the same exercises or intensity than a sedentary patient.

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5 Exercises That May Help With Your Hip Pain

I must preface this by saying that you should consult with a medical professional before trying these exercises as not all exercises are appropriate for everyone even if diagnosed with the same injury. We all have unique bodies, with different demands from our everyday lives and there is no one cookie cutter way to treat hip bursitis, gluteal tendinopathy or any outside hip pain.