Hip Bursitis Physical Therapy: Here's What to Expect (2024)

Pain in your hip can be caused byhip bursitis. Hip bursitis is when the small fluid-filled sacs (bursa) on the outside or inner part of your hip get inflamed. Hip bursitis causes pain, decreased strength, and trouble with movements like walking or running. Hip bursitis can be recurrent, especially if you continue to do activities that are putting stress on the bursa.

If you have hip bursitis, you may benefit from working with adoctor of physical therapy (DPT/PT). A therapist can assess your condition and determine the causes of your symptoms. They can show you exercises and other strategies that will help improve your functional mobility and strength if you have hip bursitis.

This article will cover the causes of hip bursitis, how a physical therapist assesses pain and mobility, and what exercises you can do to help with bursitis in your hips.

What Causes Hip Bursitis?

Throughout your body, there are small sacs of synovial fluid called bursa (or bursae if you’re talking about more than one).These sacs allow soft tissue, like muscles and tendons, to slide and glide freely over bony parts (prominences).

You have a bursa on the outside of each hip. One is called the trochanteric bursa and the other on the inner part of your hip is called the iliopsoas bursa.Sometimes, excessive rubbing of soft tissue over the bursae causes inflammation and pain.

Trochanteric hip bursitis usually starts as pain on the outer (lateral) side of your hip.Iliopsoas bursitis is usually felt on the inner part of your hip and groin.

If you have hip bursitis, it can hurt when you walk, press on your hip, or lie on one side when you're sleeping.You may also feel warmth on the outer part of your hip, which is a sign of inflammation.

If pain and inflammation are present for months or keep returning, the bursa can become calcified and thickened. Over time, hip bursitis can lead to more pain and less mobility.

Risk Factors

There are several risk factors for hip bursitis, including:

• Spine conditions
• Rheumatoid arthritis
• Trauma and falls
• Overuse and repetitive strain
• Lack of physical exercise

Assessing Hip Bursitis

When you visit a physical therapist (PT) for hip bursitis, they will start by doing an evaluation.

A PT will ask you about your hip pain and how it started. They will want to know if your symptoms are changing and what makes your pain better or worse.

Your PT will also ask you how the hip pain from bursitis is affecting your functional mobility. Based on what they observe and talk to you about at your first meeting, your PT can get an idea of how severe your hip bursitis is.

Mild cases of hip bursitis cause some pain, but functional mobility is not always affected. More severe cases of hip bursitis cause major limitations in activities like walking and sleeping.

Common Assessment Tests

After your PT talks to you about your symptoms, they will do several tests and measures to see what could be causing bursitis in your hip.

Tests that PT use to evaluate you for hip bursitis include:

• Palpation
• Range of motion
• Strength
• Gait analysis
• Spinal mobility
• Hip and leg flexibility
• Balance assessment
  

Hip Bursitis Physical Therapy

After your first meeting, your PT should have enough information to determine the cause of bursitis and make a treatment plan.

PT treatment for hip bursitis uses strategies that reduce inflammation and pressure on the hip bursa.

The goals of rehab for hip bursitis are to reduce pain, improve range of motion and strength, and restore normal functional mobility.

Most people with hip bursitis benefit from working with a PT who is anorthopedic specialistor sports therapist.These providers have a great deal of knowledge about musculoskeletal conditions and can make sure that you are doing the best treatments and exercises to manage bursitis.

Common physical therapy treatments for hip bursitis include:

• Heat
• Ice
• Ultrasound
• Electrical stimulation
• Massage
• Manual stretching
• Exercise for range of motion and strength
• Balance
• Hip stability
  

Many of these treatments (like heat or ultrasound) are passive. That means you do nothing while the PT does the moving for you.

While passive exercises are part of therapy, they are not the only ones you’ll need to do.The most effective treatments for hip bursitis are active and include stretching, strengthening, and balance exercises.

Hip Bursitis Exercises

Exercise is the main treatment for hip bursitis. It has been shown to improve strength and range of motion, which can relieve pressure on your hip bursae.

The exercises recommended by your PT can also improve your ability to walk or run normally without hip pain.

Sidelying Straight Leg Raise

The sidelying straight leg raise exercise is great for improving the strength of yourgluteus medius (the muscle supports the outside part of your hip). Strengthening this muscle can be an effective strategy for the treatment of trochanteric hip bursitis.

To perform the exercise:

1. Lie on your side with your painful hip up. Keep your hips stacked and your top leg straight.
2. Slowly lift your leg up, keeping it as straight as possible.
3. When you have lifted your leg up about 12 inches, hold it at the top for three seconds.
4. Slowly release back to the starting position.
5. Repeat the exercise 10 times.
   

You can make the straight leg raise exercise harder by adding a resistance band around your ankles.

Hip Bridges

Hip bridges strengthen your gluteal and back muscles. They help treat both iliopsoas and trochanteric hip bursitis.

To perform the bridge:

1. Lie on your back with both knees bent and your feet flat on the floor.
2. Engage your abdominal muscles by gently pulling your belly button toward your spine.
3. Lift your buttocks about 15 inches off the floor, making a bridge with your body.
4. Slowly release and bring yourself back down to the starting position.
5. Repeat 10 times.

Hip Rotator Stretch

The hip rotator stretch can stretch yourpiriformis muscle, which is deep in your hip. Exercising this muscle can improve the mobility of the joint and give the bursa more room and protect it from getting compressed.

To perform the stretch:

1. Lie on your back with one knee bent.
2. Cross the hip you want to stretch over your bent knee and rest your ankle on your thigh just above your knee.
3. Place one hand through the hole created by your crossed leg, and grab your inner thigh. Your other hand can grab the outer portion of your thigh.
4. Pull your bent leg up, stretching the hip of the leg that is crossed over your knee and thigh.
5. You should feel a stretch in your hip. Hold the stretch for 15 to 30 seconds.
6. Slowly release the stretch.
7. Repeat 3 times.

Clamshell

The clamshell exercise can strengthen your gluteus muscles and add muscular support to your hip joint.

To perform the exercise:

1. Lie on one side with your knees bent about 90 degrees. Your hips should be stacked and your top foot should be resting on your bottom leg.
2. Engage your abdominal muscles.
3. Slowly lift your top knee, keeping your feet in contact with one another. Your top thigh and hip should lift up and rotate (you should look like a clamshell opening up).
4. Hold the lifted position for 3 seconds.
5. Slowly release and go back to the starting position.
6. Repeat 10 times.
   

Prevention

As you make progress with your hip bursitis rehab, your PT will talk to you about how to prevent future episodes of hip pain.

There are several strategies to prevent hip bursitis, including:

• Doing hip stretches daily
• Performing hip strengthening exercises 3-5 times a week
• Staying physically active and fit
• Maintaining low back and spinal mobility and strength

If you start to feel your hip pain coming back, your PT may have you modify some of your activities.

A little bit of rest combined with the right stretches and strengthening exercises can often be enough to prevent a full-blown attack of hip bursitis.

Outlook

Episodes of acute hip bursitis may last a few days. More severe cases may last several weeks to months and become recurrent or chronic.

Many people with hip pain benefit from working with a PT 2-3 times a week for a few weeks. They can have fewer visits with their PT as their symptoms get better.

If your pain from hip bursitis lasts for more than 12 weeks, schedule a visit with your healthcare provider.Other treatments, such as cortisone injections, might be needed to decrease the pain and inflammation caused by hip bursitis.

Summary

Hip bursitis is when the bursa on your hip is inflamed and irritated. You can have pain, decreased strength, and difficulty with movements like walking or running.

Working with a physical therapist can be helpful because they can show you exercises to help you get better and prevent future episodes of hip bursitis pain.

By doing stretching and strengthening stretches daily, most people are able to reduce hip bursitis pain and improve their quality of life in a matter or weeks.

While hip bursitis is not fatal, it can have a serious effect on your quality of life. A physical therapist can assess your condition and help you find the best stretching and strength exercises to relieve pain and prevent future episodes.