What Is Hip Bursitis and How To Treat It
Hip bursitis is a painful, inflammatory condition of the largest weight-bearing joint in your body: the hip. Hip bursitis can have a dramatic impact on how you move about your day – literally. This is what you need to know about this condition.
What is hip bursitis?
Hip bursitis is a condition that causes hip pain ranging from moderate, occasional twinges to a nearly-constant, searing ache. Confusingly it is often caused be either too much activity or not enough. The reason for that comes down to the anatomy of the hips.
Your hip joint is large and weight-bearing, allowing you to move fluidly through your days at a variety of paces. Your pelvis, on the other hand, is the large, bony structure that connects the top of your skeleton through the spine with the bottom of it at the femur bone.
At the top of your femur bone, two rounded protruding bones—the femoral head and the greater trochanter—connect with the pelvis via the acetabulum. The femoral head nestles into the bowl of the acetabulum (the ball into the socket, respectively), with the greater trochanter sitting outside of that space.
Muscles on the outside of this ball-and-socket joint stabilize these structures, as well as ligaments and tendons inside and around the joint itself. One of these muscle groups, the iliopsoas, connects to the head of the femur bone and inserts into your lumbar spine. Ligaments that attach bone-to-bone further stabilize the joint. Lining the acetabulum is the synovium, a thin, lubricated membrane that helps your femur to glide smoothly in the socket.
Finally, fluid-filled sacs—bursa—provide further cushioning and help ensure comfortable movement in this area. These bursae are the key to hip bursitis. When these bursae become irritated or inflamed, hip bursitis symptoms can flare up. Bursa may also lose fluid over time, allowing bone to rub painfully on bone.
Types of hip bursitis
There are two types of hip bursitis, both named for the location of the irritated bursa:
- Trochanteric bursitis: Occurs when the greater trochanteric bursa are inflamed
- Iliopsoas bursitis: Occurs when bursa tucked under the iliopsoas become irritated and painful
With over 150 bursae throughout the body, most people experience bursitis at some point in their lives. But, because the hip a highly mobile and weight-bearing joint, hip bursitis is the most common type of bursitis that people experience.
Trochanteric hip bursitis is more common in older adults, but iliopsoas bursitis is seen more often in adolescents and young adults.
What causes hip bursitis?
Hip bursitis can occur naturally as we age due to wear and tear in the hip joint over time. Beyond this, there are six other common causes of hip bursitis, including:
- Repetitive motion
- Abnormal gait
- Sedentary lifestyle
- Injury due to lack of warmup before physical activity
- Related conditions
Let’s look at these in more detail.
Hip bursitis due to repetitive motion is most common in professional athletes, like marathon runners or long-distance hikers.
High-impact exercise that is repeated frequently is tough on your hip joints. Bursitis may occur in the hip and knee joints simultaneously in the case of these repetitive motion injuries.
Overtraining could be considered a repetitive motion injury as well.
Weight-lifters that perform hundreds of squats with extra weight place tremendous stress on their hips and the muscles, ligaments, and tendons of the hip joint. When done incorrectly or without scaling up slowly, this could lead to bursae issues.
Many of us are born with one leg slightly longer than the other. In more severe cases, though, we grow into an abnormal gait. This might occur if we have an injury in another part of the body and adjust our weight slightly to accommodate it, becoming a habit over time. Or maybe the shoes we wear alter our walk enough to unevenly distribute the pressure in our hip joint.
Whatever the reason, when we make allowances for injury or pain in the lower body, the hip joint often bears the brunt of the imbalance over time. The result is an abnormal gait that may be nearly imperceptible but just enough to lead to hip bursitis.
If hip bursitis is a wear-and-tear condition that can be caused by excessive activity, how is it possible that a sedentary, inactive lifestyle can also cause hip bursitis symptoms?
The average person in the U.S. sits an average of ten hours a day. In a seated position, your hip flexors become shorter while your glutes and hip rotators become longer. With these structures so dramatically altered by a sedentary lifestyle, the tissues in the hips can become rigid, inflexible, and susceptible to tears or injury. Even minor tears can result in inflammation in the hip bursae, causing hip bursitis that is painful and made worse by more sitting.
Injury due to lack of warmup before physical activity
Injury due to lack of a warmup is an especially big risk for weekend warriors who come off the couch for an occasional game of tennis or touch football.
People who exercise regularly are often used to making a warmup part of their exercise time. Those who do too much action too quickly may not. This can lead to irritation and pain in the hips.
Accidents of all kinds, including falls, car crashes, and work-related injuries, are another common cause of hip bursitis (and disability).
Many people ignore minor aches that occur after a fall or other type of accident, only to find themselves with hip bursitis symptoms a few days later.
Certain conditions can also increase your risk of bursitis. These include:
- Rheumatoid arthritis
- Thyroid disease
- Bacterial or viral infection
What are common hip bursitis symptoms?
Hip bursitis symptoms have one thing in common—hip pain—but the quality of the pain and where it occurs depends on the type of bursitis, as do other symptoms.
Trochanteric hip bursitis symptoms
The pain of trochanteric hip bursitis is felt primarily on the outside of your hip. It can also move to the thigh and wrap around to the buttocks.
Pain may be searing and sharp, or it may be a constant dull ache. Many report that their pain increases when they touch or palpate the painful hip. Other activities that can cause this type of pain to worsen include:
- Walking up stairs
- Standing up from being seated in a deep chair
- Getting out of a low-slung car
Iliopsoas hip bursitis symptoms
Iliopsoas hip bursitis is also called “snapping-tendon” syndrome due to one of its hallmark symptoms: a snapping feeling or noise that occurs when the hip flexes.
Pain may begin in the front of the hip and radiate across the buttocks and down the leg. Some patients report pain that is worse in the morning but that subsides with gentle movement throughout the day. Over time and left untreated, this pain may get worse as the day wears on. It may also increase with certain activities, like lifting the legs or walking up and down stairs.
Another set of symptoms that can occur in both trochanteric and iliopsoas hip bursitis is swelling that is accompanied by fever and warmth in the painful area. In severe cases, this could be a case of septic hip bursitis, an infection of the bursa. Any infection in the body can cause serious issues. If you’re suffering from this symptom, talk to a doctor immediately.
Getting a hip bursitis diagnosis
Most often, a hip bursitis diagnosis starts with a medical history and physical examination.
Your doctor will take your complete medical history. This will help them determine if there are risk factors or any accidents or injuries that may have led to pain and inflammation in your hip joint.
Your doctor will also do a physical exam that includes a gait analysis and palpation of the tender area. Once they determine the type of pain and where it originates, they may confirm a diagnosis with an MRI.
In most cases, X-rays are not necessary, as they do not show the soft tissues of the body. If your doctor suspects a bone spur is forming in the hip joint, though, they may order an X-ray to confirm.
How to treat hip bursitis: 8 approaches
In the most severe stages of hip bursitis pain, the best treatment is rest. Inflamed and painful bursa need time to recover. An extended rest period may do more harm than good, though.
There eight hip bursitis treatments can typically help ease inflammation and get you back in action. As always, follow your doctor’s instructions for recovery and case.
1. Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen sodium can ease pain and inflammation at the same time. This can allow you to participate in other treatment approaches, like physical therapy.
Follow your doctor’s dosage instructions, as too many NSAIDs over time can be damaging to your gastrointestinal tract.
2. Cold therapy
Icing your hip, especially if you’re suffering from septic bursitis, can bring profound relief.
Follow a 20-minutes-on, 20-minutes-off schedule, completing some gentle stretches in between.
Although walking up and down stairs with either kind of bursitis may cause more pain, walking on a level surface is typically a good and low-impact way to rehabilitate hip bursitis.
Walking is also an easy exercise that combats the epidemic of sitting. Start slowly and gradually add either speed or distance (not both at the same time) as you feel better.
4. Physical therapy
Adding physical therapy to the mix can be a great way to heal hip bursitis, especially if you suffer from an abnormal gait that is learned and not anatomical.
A physical therapist can teach you a better gait pattern. They can also offer stretches and strengthening exercises to better support your hips.
5. Prescription antibiotics
For septic bursitis, prescription antibiotics are necessary to resolve the infection. Take antibiotics as directed.
If approved by your doctor, also consider adding probiotics to your diet while taking antibiotics to help repopulate your beneficial gut flora.
6. Draining the bursa
If bursa are infected, the infected fluid can be drained to provide relief. This is not a treatment generally used unless the bursa are infected.
When other conservative measures have failed and pain persists, your doctor may recommend a hip injection to help relieve your pain and inflammation. Corticosteroids and anesthetic medication are injected into the hip to provide immediate pain relief. Although pain may return when the anesthetic wears off, the steroid then kicks in to reduce inflammation that is causing pain.
While many patients find long-lasting relief after just one injection, others may need to receive more than one. With this approach, it’s always best to couple it with physical therapy to resolve the underlying cause of your pain.
Most cases of hip bursitis recover from the therapies listed above well before surgery becomes a consideration. If conservative measures fail, though, you still have options. These may include:
- Bone spurs procedure: If you have developed bone spurs, your doctor can surgically remove them to ease your pain and swelling
- Bursectomy: Painful bursa are removed, sometimes in conjunction with an iliotibial (IT) band release
- Repair of tendons and IT band release: For hip bursitis due to a torn tendon, surgery to repair the tendon and lengthen the IT band may help speed healing
- Osteotomy: An osteotomy procedure removes a bit of the greater trochanter to minimize its contact with the acetabulum