What to Expect From Physical Therapy for Hip Bursitis

If you have pain in your hip or hips, you may be suffering from a condition called hip bursitis. Hip bursitis occurs when the small fluid-filled sac, called a bursa, becomes inflamed on the outside or inner part of your hip. Hip bursitis causes pain, decreased strength, and difficulty with movements like walking or running.

If you have hip bursitis, you may benefit from working with a physical therapist. Your therapist can assess your condition and determine the mechanical causes of your problem. Then, strategies can be implemented to improve your functional mobility and strength.

In this article, we will discuss the causes of hip bursitis, how a physical therapist assesses pain and mobility, and what exercises you can do to help.

What Causes Hip Bursitis?

Throughout your body, there are small sacs of synovial fluid called bursae. (Bursae is the plural form of bursa.) These sacs allow soft tissue, like muscles and tendons, to slide and glide freely over bony prominences. You have a bursa on the outside of each hip called the trochanteric bursa and one on the inner part of your hip called the iliopsoas bursa. Sometimes, excessive rubbing of soft tissue over these bursae causes inflammation and pain.

Trochanteric hip bursitis usually manifests as pain on the lateral, or outer, side of your hip. It may hurt when you walk, press on your hip, or lie on one side while sleeping. You may also feel warmth on the outer aspect of your hip, a sign of inflammation. Iliopsoas bursitis is usually felt on the inner aspect of your hip and groin. If the problem is chronic, meaning it is present for more than a few months, the bursa can become calcified and thickened, leading to more pain and less mobility.

Risk Factors

There are several risk factors for hip bursitis. These may include:

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

Assessing Hip Bursitis

When you visit a physical therapist for hip bursitis, they will conduct an initial evaluation. Questions will be asked about your hip pain and how it started. Be prepared to talk about how your symptoms are changing, how they behave, what makes your pain better or worse. Tell your therapist how your hip pain from bursitis is affecting your functional mobility.

Your therapist can get an idea of the severity of your hip bursitis during this evaluation. More severe cases cause significant limitations in walking and sleeping; mild cases may cause some pain, but functional mobility may not be affected to a great extent.

After your therapist performs an examination, they should have enough information to determine the root cause of your hip bursitis and start treatment. A plan of care will be discussed with you.

Common Assessment Tests

After your physical therapist takes your history, they will perform several tests and measures to get an idea of what impairments may be causing your hip bursitis. These may include:

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

Hip Bursitis Physical Therapy

Treatment for hip bursitis involves implementing strategies to reduce inflammation and pressure on the bursae around your hip(s). The goals of rehab for hip bursitis are to decrease pain, improve range of motion and strength, and restore normal functional mobility.

Most people with hip bursitis benefit from working with a physical therapist who is an orthopedic specialist or sports therapist. These types of professionals have a vast amount of knowledge of musculoskeletal conditions and can implement the correct treatments and exercises to manage your bursitis.

Common physical therapy treatments for hip bursitis include:

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

Many of these treatments, like heat or ultrasound, are passive; you do nothing while the therapist performs the procedure. The most effective treatments for hip bursitis require active involvement. This includes stretching, strengthening, and balance exercises.

Hip Bursitis Exercises

Exercise should be your main treatment for hip bursitis. It has been shown to improve strength and range of motion, thus relieving pressure on your hip bursae. Exercise can also improve your ability to walk or run normally without hip pain.

Lying Straight Leg Raise

The straight leg raise exercise is great to improve strength of your gluteus medius. This muscle supports the outside part of your hip, and strengthening it can be an effective strategy for treatment of trochanteric hip bursitis.

To perform the exercise, lie on your side with your painful hip up. Be sure your hips are stacked, and keep your top leg straight. Then, slowly lift your leg up, keeping it as straight as possible. When you lift your leg up about 12 inches, hold it at the top for three seconds, and then slowly release back to the starting position. Repeat the exercise 10 times.

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

Hip Bridges

Hip bridges are a great exercise for strengthening your gluteal and back muscles, and they can be helpful in treating both iliopsoas and trochanteric hip bursitis.

To perform the bridge, lie on your back with both knees bent and your feet flat on the floor. Engage your abdominals by gently pulling your navel toward your spine, and lift your buttocks off the floor, making a bridge with your body. Lift your buttocks about 15 inches, and then slowly release. Repeat 10 times.

Hip Rotator Stretch

The hip rotator stretch can stretch your piriformis muscle located deep in your hip. This can improve mobility of the joint and give the bursa more room to live without being compressed.

To perform the stretch, lie on your back with one knee bent. Cross the hip to be stretched over your bent knee, resting your ankle on your thigh just above your knee. 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, and you can then pull your bent leg up, stretching the hip of the leg that is crossed over your knee and thigh.

You should feel a stretch in your hip; hold this stretch for 15 to 30 seconds, and then slowly release the stretch. Repeat three times.

Clamshell

The clamshell exercise can strengthen your gluteus muscles and improve muscular support to your hip joint. To perform the exercise, start by lying 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.

Engage your abdominals, and then slowly lift your top knee, keeping your feet in contact with one another. Your top thigh and hip should lift up and rotate, and you should resemble a clamshell opening up. Hold the lifted position for three seconds, and then slowly release. Repeat 10 times.

If any exercise causes pain in your hip, stop and speak with your therapist about the pain. Minor adjustments can be made to your exercise program for hip bursitis so you can do the movements without pain.

Prevention

As you improve with your hip bursitis rehab, your therapist should provide you with education about preventing future episodes of hip pain. There are several strategies to prevent hip bursitis, including:

• Performing hip stretches daily
• Performing hip strengthening exercises three to five times a week
• Maintaining appropriate physical fitness
• Maintaining low back and spinal mobility and strength

If you start to feel your hip pain creeping back in, your physical therapist may have you modify some of your activities. A little bit of rest, combined with the right stretches and strengthening exercises, may be the recipe to prevent a full-blown attack of hip bursitis.

Outlook

Most episodes of hip bursitis last about three to six weeks, with some severe cases lasting several months. Many people with hip pain benefit from working with a physical therapist two to three times a week for a few weeks, and then decreasing the frequency of their visits as symptoms improve.

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

Summary

Hip bursitis occurs when the bursa on your hip becomes inflamed and irritated. This can cause pain, decreased strength, and difficulty with movements like walking or running.

A physical therapist can assess your condition and provide exercises to help you with rehabilitation. These may include lying straight leg raises, hip bridges, hip rotator stretches, and clamshells. By performing stretching and strengthening stretches daily, most people are able to reduce pain and improve their quality of life in three to six weeks.

A Word From Verywell

While hip bursitis isn't fatal, it can have a serious effect on your quality of life. A physical therapist can assess your condition and help you find the right exercises to improve your comfort. By participating in regular stretching and strength exercises, you can lower your odds of developing further hip pain in the future.