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Bursitis is a condition in which the bursa, the small fluid sacs that act as cushions between the tendons, ligaments, and bone, becomes inflamed. It is quite common, affecting more than 1 in 10000 people each year. Bursitis can often be spotted as a swollen lump on the outside of a joint and is incredibly painful.
The most common location is in the knees, where it’s most common in people who spend time kneeling on hard surfaces, such as tilers, roofers, gardeners, etc. Hip bursitis is common and can be caused by a fall, prolonged pressure on the hip, or a tight ITB band causing friction. Sometimes, hip bursitis is linked to arthritis or hip replacements, or it can just spring up out of nowhere.
What Is Hip Bursitis?
Hip bursitis refers to bursitis around the hip. The hip has three main bursa, and all can become affected. The most commonly affected (over 90% of cases) is the Trochanteric Bursa, which sits on the outside of the hip, at the widest part of the hips. This bursa is a cushion between the greater trochanter and the tendons that pass over it, particularly the gluteus medius and iliotibial (IT) band.
Other tendons that can be affected include the iliopsoas Bursa, which is at the front of the hip, between the iliopsoas muscle (the hip flexor muscle) and the hip joint capsule.
The last main bursa is the Ischial Bursa, which is at the back of the hip beneath the ischial tuberosity, the bony part of the pelvis that you sit on. This can become inflamed after prolonged sitting.
Hip bursitis is common and can be caused by a fall, prolonged pressure to the hip, or a tight ITB band causing friction. Sometimes hip bursitis is linked to arthritis, hip replacements or it can just spring up out of nowhere.
How Common is Hip Bursitis?
Although hip bursitis is fairly common, it’s much less common than tendonitis. An interesting study at Harvard pointed out that 90% of outer hip pain is actually caused by tendonitis, not bursitis.
What Causes Hip Bursitis?
Although it was once thought that outer hip pain was often a sign of bursitis, what we see now is that outer hip pain that comes from running and impact activities is actually more often than not a sign of tendonitis, which responds very well to strengthening exercises.
Hip bursitis is often caused by direct trauma to the hip, for example, after a fall or prolonged pressure on the hip, such as sleeping on a hard surface for a prolonged period.
Rheumatoid arthritis, gout, and psoriasis have also been linked to hip bursitis.
When hip pain is caused by bursitis it is often inflamed by further exercise where as tendonitis will respond quickly to slow eccentric exercise. It can also be much more difficult to treat.
Diagnosing Hip Bursitis
Hip bursitis can be diagnosed from assessment and case history alone; a history of trauma or prolonged friction with pain and swelling around the area is usually a sign that the pain is hip bursitis. Often, an X-ray is needed to make sure that the pain isn’t coming from a bone-related issue. In some cases, blood tests may be conducted to rule out infection or systemic conditions like rheumatoid arthritis, and in rare instances, fluid from the bursa might be drawn to rule out infection.
Signs and Symptoms of Hip Bursitis
The primary symptom is substantial pain and tenderness around the bursa area along with swelling and stiffness. The pain will often feel a bit more burning than tendonitis and can be incredibly painful.
How Does Physical Therapy Help Manage Hip Bursitis?
Physiotherapy is the main treatment for hip bursitis. Physiotherapy aims to reduce inflammation. It usually requires three stages of treatment:
Stage 1: Pain and Inflammation Reduction:
This stage is about reducing the initial inflammation. Your therapist will likely use treatments such as ultrasound, ice therapy, electrical stimulation, NSAIDs, or anti-inflammatory injections to reduce the inflammation.
Stage 2: Reducing Friction
Each bursa lies between a tendon and a bone. To reduce friction, your therapist can release the muscles with dry needling or assisted stretching, and they will also give you stretching exercises to go home with.
Stage 3: Gait Training and Biomechanical Correction
Often, once a bursa is inflamed, the bursitis is likely to return with minimal cause. To prevent this, your physical therapist will show you exercises to correct your gait. This usually involves stretching the hip flexor, glute activation, and strengthening the movement patterns to avoid recruitment of the ITB (for greater trochanteric bursitis) or the muscle that leads to the tendon covering the bursa in another hip bursitis.
How Long Does It Take to Recover from Hip Bursitis?
Recovery from hip bursitis can take a while, depending on the severity of the condition and the patient’s ability to rest and adhere to physical therapy.
Final Thoughts
Physical therapy is highly effective for hip bursitis and is the mainline treatment. Your therapist can do a lot for hip bursitis, and it’s essential to seek an entire course of treatment as it is doubtful it can be resolved by itself. Hip bursitis also has a high recurrence rate, so completing all three stages of physical therapy is essential. You can read more here if you’re looking for more information on managing hip bursitis through physical therapy.
