Hip bursitis is a condition commonly affecting the outer side of the hip and thigh, but can also be experienced in the groin. It is caused by inflammation in the bursae, small jelly-like sacs located around the hips, as well as around other parts of the body.
It is a relatively common injury in runners because it can be caused by repetitive strain and overuse. The bursae act as cushions reducing friction between the bones and soft tissues, but when they become irritated and inflamed the resulting effect is painful.
There are two major bursae in the hip that are most prone to bursitis. Runners usually experience pain in the outside of the hip bone (greater trochanter), and inflammation of this bursae is called trochanteric bursitis.
Less common is inflammation of the iliopsoas bursa located on the inside (groin side) of the hip. Although the condition is fairly rare compared to trochanteric bursitis, it is treated in a similar manner.
*Disclaimer: The advice in this guide should not replace a medical assessment and/or advice. The only way to receive a proper injury diagnosis – and personalised treatment plan – is to see a health professional.*
What are the symptoms of hip bursitis?
Symptoms depend on which bursae is inflamed in the hip, but it's most commonly experienced as pain at the side of the hip, often in the upper thigh, and can also refer into your buttock. The pain is felt when running but also when undergoing daily activities and may be tender to touch. It may begin as a sharp pain before becoming more of a dull ache spread across a larger area of the hip.
'You can get pain when you lie on your hip on the affected side,' explains physiotherapist at Complete Pilates Helen O'Leary. 'And it can get worse when you stand up after sitting because suddenly all that contraction is happening around the area. It can also get worse when you are moving around, and going up stairs, because you are asking all the tissue to slide and glide on top of it,' she says.
Who is most prone to hip bursitis?
Although hip bursitis can affect anyone, it is more common in women and middle aged or older people. Far fewer cases are seen in younger people and men. The reason for this is unknown but O'Leary suspects it may be because women (generally) weight train less and have far more hormonal changes, than men. It is also likely due to the shape of women's pelvis and hips.
'Hormone levels change a lot in puberty when women start having periods. If you go through pregnancy your pelvis shape completely changes and then changes back again. And then when you get to perimenopause and menopause, women's hormones are fluctuating massively again. These huge changes influence not only our hormones but our core structure and how we naturally function and I think that often plays a part,' says O'Leary.
What causes hip bursitis in runners?
Although hip bursitis can be caused by an inactive sedentary lifestyle and being overweight, it is also a risk for runners. It's usually caused by a sudden increased load on your hip or a change to activity levels – this most commonly occurs when runners do too much too soon, and put repetitive stress on the hip by overusing it.
It can also be related to issues with your mechanics and your posture. 'When strength or mobility deficits are present, they can lead to altered movement patterns or asymmetries,' explainsJohn Schilkowsky, a US-based physical therapist at Pappas OPT Physical, Sports and Hand Therapy in Johnston, Rhode Island. 'This can cause increased friction of the bursae during movement, which can then lead to inflammation and swelling of the bursa.'
Weak hip abductors are a common culprit. The role of the hip abductors is to move your legs away from the centre of your body, and so they keep your pelvis steady when you run. If the hip abductors are weak, this can lead to excess movement through the pelvis, which can extra stress on the pelvis, lower back and muscles around that area, which may then cause increased friction of the bursae.
Stiffness in the lower back (which limits mobility), could also be to blame, as well as overpronation, which put extra stress on the hips.
What is the best hip bursitis treatment?
The first step is to get a clinical assessment with a physiotherapist who can perform an ultrasound to diagnose the problem. The earlier you get a diagnosis, and the right treatment, the quicker you can get back to your normal running routine. It is important to get a proper clinical diagnosis of hip bursitis because pain around the hip could be caused by other acute and chronic conditions.
Claire Morrow, an orthopedic clinical specialist and senior physical therapy consultant at Hinge Health, recommends partial rest from running. 'Make a small reduction in your training load until the discomfort has subsided and then gradually work back up to your prior training volume. I always say, "calm it down, and then build it back up".'
O'Leary agrees, highlight that resting for a couple of weeks, or reducing your load, will help reduce the inflammation, although many runners are reluctant to do this.
Hip bursitis pain can be managed with anti-inflammatories such as Ibuprofen, but if you are keen to get back to your normal routine, a steroid injection along with a local anesthetic can be a simple and effective treatment.
'An ultrasound guided corticosteroid injection into the outer hip can work really well,' says O'Leary. You'll probably have a couple of days where you're letting it settle afterwards, but then we'll have a return to running programme where you won't have to take too much time off. We generally say it can take up to three weeks for the best of the steroid to work, but the reality of it is, most people notice a significant difference within three to five days.'
It is also important to slowly strengthen the tendons and muscles connected to the hip so it is able to bear more weight and cope with repetitive motion to prevent the condition from returning. A strength and conditioning training programme for 12 weeks, focused on the lower body, will allow adaptation to occur and strength to develop.
O'Leary also advises looking at how you sleep, to prevent lying on one side, which may aggravate the affected bursae.
What are the best hip bursitis exercises?
There are a raft of exercises that will help to strengthen the hips and connected muscles. Since running involves moving the legs independently rather than together, it is important to incorporate unilateral exercises. These are a weight bearing movement involving one limb at a time, such as a single-leg squat.
Only do these exercises if your pain levels are below 5/10. If pain increases reduce the number of times you do a movement, reduce the speed of a movement and increase rest time between movements.
Strength work should not make your hip bursitis pain worse overall. However you may experience some delayed onset muscle soreness (DOMS) as the body gets used to moving in new ways. Stop these exercises if your pain symptoms become worse, or they cause a new pain which does not ease quickly.
When starting new exercises, begin with just two to three repetitions a time. Gradually increase this to two sets of 15, or three sets of 10, with a minute rest between each set.
Bulgarian split squat
Take a step away from an exercise bench, medicine ball or stable chair. Reach your left foot back and rest it on the bench. Bend your right knee, lowering as far as you can with control, before pushing through your left foot to stand. That's one rep. Complete 10 reps and repeat on the other side. You can increase difficult by holding a weight on the same side as your bent leg.
Hip flexor stretch
Kneel on your left knee, with your right foot in front of your body so your knee and ankle form a 90-degree angle. Lean forward from the hips, engaging your core and left glutes. Keep your chest lifted and hips forward. Hold for 30 seconds. Then switch sides.
Side plank
Start on your side with your left forearm on the ground, forming a straight line from your head to your feet, feet stacked on top of each other. Make sure your left elbow is directly under your shoulder and place your right hand behind your head. Lift your hips as high as you can and hold for 30 seconds. Repeat on the opposite side.
Wall sit
Stand with your back facing the wall and your knees shoulder width apart. Send your hips back until your glutes, lower back and shoulders touch the wall. Glide down the wall until you’re in a seated position. Your back entire back should be braced on the wall. Engage your core to remain in this seat position for 30 to 60 seconds. Stand straight up and step away from the wall.
Bridge
Begin by lying on your back with your arms by your sides. Your knees should be pointing towards the ceiling. Using your arms for support, slowly push your hips up towards the ceiling. Hold for a few seconds while squeezing your glutes and then slowly bring your hips back down to the floor. That's one rep.
