Hip Bursitis: Symptoms and Diagnosis
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Hip bursitis is an inflammatory condition that can affect any of the many bursae of the hip. There are several bursae at the hip that protect soft tissues by providing a smooth, lubricated surface. Soft tissues can be damaged as they move over harder tissues, such as a muscle moving over a bone, due to friction or compression if bursae were not present. To heal a hip bursa quickly, the causes of the irritation, such as compression or friction from certain positions and actions, need to be identified. Once identified, these need to be stopped or reduced as much as possible to prevent further inflammation.
It is aggravated by positions like lying on your side, crossing your legs or activities such as walking, running or prolonged standing. Someone could develop this bursitis after a walking holiday, for example. They may, therefore, need to have a period of reduced walking and may find it painful to lie on their side, so they should avoid this.
It can be caused by a snowboarder falling heavily onto their seat bones on hard snow and ice. They may need to avoid sitting on hard chairs, reduce the amount of time they spend sitting, and avoid hamstring stretches and other bowed positions, as these will all compress the ischiogluteal bursa.
Is commonly seen with runners who have changed their training to include more incline running or sprinting. In a mild case, a runner may be able to continue running but with restrictions on speed and incline. It would also be sensible for them to avoid positions of hip flexion like deep squats, as these compress the iliopsoas bursa.
A sports doctor, orthopaedic hip consultant or experienced physical therapist can treat a hip bursitis injury. Often this injury will be first assessed by a physical therapist, as in most cases, physical therapy is the best and most effective treatment. If treatment is not successful within the expected time frame, the case may be referred to a doctor for further assessment, which might include diagnostic imaging. Once the diagnosis is confirmed, additional treatments may be offered if appropriate.
Corticosteroid injections are a common additional treatment if physical therapy has not been successful. These are administered in the form of an injection directly into the bursa, usually with the guidance of ultrasound imaging. Often this is a mixed injection of the corticosteroid with other pain-relieving medications. In our related article, you can read more about injections and surgery for hip bursitis.
To get rid of hip bursitis, all the contributing factors must be identified and addressed. Bursitis can often develop gradually over time from repetitive activities or postures. For example, trochanteric bursitis can develop related to weakness in the gluteal muscles that cause the pelvis to drop with each step when walking or running, which compresses the bursa. Over time this may cause inflammation to develop in the bursa. What is commonly seen is that the body has been coping with a gradual change, and no pain is felt despite the increased risk. If activity increases, such as someone increasing how much they walk or increasing how much they run, this injury can develop.
Addressing all of the contributing factors reduces the risk of the reoccurrence of this injury. This doesn’t only mean building strength and improving flexibility but might also mean educating about training to avoid future training errors. And educating about biomechanics so the individual understands what postures and positions could aggravate the bursa and risk future bursitis.
Additional treatments, such as taping, can sometimes help with pain relief. KT tape is an elasticated tape that can be applied directly to the skin around the painful area. It can work in many different ways depending on where and how it is applied. A major way that it reduces pain is by increasing your awareness of the area, and tightening if you move into a position that might aggravate the bursa. Some brands suggest it can lift the upper layers of tissue to improve blood circulation, which may provide some pain relief also, though there is mixed evidence to support this.
For trochanteric bursitis KT tape can be applied to the glute as shown in this video:
As bursitis is an inflammatory condition, taking non-steroidal anti-inflammatory medication can be effective for reducing pain as well as swelling and inflammation. Other medications can be taken to target the pain, specifically if it is severe.
The best home remedies for hip bursitis are using ice or heat for pain relief and avoiding painful activities. Both heat and ice can provide pain relief, and neither will affect long-term recovery, so you can use whichever gives you the best relief. There is usually an accurate relationship between pain and aggravation of the bursa, so pain should be avoided and not ignored.
Home exercises such as stretches and strengthening the muscles around the hip can be very effective, even more so if guided by a physical therapist. If they have prescribed them specifically for you after a thorough assessment. Additionally, tape can be used at home once you have been shown how to apply it.
Recovery from hip bursitis will vary between individuals. Hip bursitis can resolve over 4-6 weeks. This is for cases that have developed suddenly from trauma, such as a fall onto the hip, in an otherwise healthy and strong individual, and they follow the appropriate rest and exercises for recovery. Or cases that have sought advice and treatment very early after the onset of symptoms.
However, it is more commonly a chronic condition that has gradually developed over a prolonged period of time, even if the pain has started suddenly. It may be that the bursa has been stressed for a long time, and the muscles may be weak. In these cases, it may take 3-4 months to recover fully. And if symptoms have been ignored for a long time, or appropriate treatment and rest have not been followed, it can take longer.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments.