Hip Bursitis

Hip bursitis, also known as Trochanteric bursitis is inflammation of a bursa or small sack of fluid between tendon and bone which prevents friction. The bursa can become inflamed causing pain in the hip.

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.

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.

Iliopsoas muscleBy 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 treatment

What can the athlete do?

Rest until there is no pain. Continuing to train will increase the inflammation and prevent hip bursitis from healing. Apply ice to the area to reduce pain and inflammation. Cold can be applied for 10 minutes every hour and reduced to 3 or 4 times a days as the injury heals. Run only on flat, even surfaces to reduce the pressure on the bursa from uneven ground. See a sports injury professional.

What can a sports injury specialist do?

Prescribe anti-inflammatory medication e.g. ibuprofen to reduce pain and inflammation. Do not take ibuprofen if you have asthma. A doctor may send you for an X-ray or MRI to confirm the injury is not as a result of a bone spur. Refer you for physical therapy to correct any muscle imbalances which may have contributed to the condition. Orthotic insoles for the feet may be prescribed to correct poor foot biomechanics.

Use of ultrasound can help reduce pain and inflammation. A needle can be inserted into the bursa to drain off the fluid or aspirate it. A steroid injection may be prescribed in conjunction with rest. A surgeon may operate if it is a long term injury which has not responded to conservative treatment.

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.

See more on exercises for hip bursitis.