What to Expect From Trochanteric Bursitis Physical Therapy

Trochanteric bursitis is a condition of the hip that results from inflammation of the bursae, small fluid-filled sacs that provide cushioning between muscles, ligaments, and bones, at an area on the outside of the femur (thighbone) called the greater trochanter. This can cause hip pain, limiting your range of motion and making certain activities and positions uncomfortable.

Also called greater trochanteric pain syndrome, trochanteric bursitis is primarily caused by gluteal tendinopathies—inflammation or irritation of the tendons of the gluteus medius or gluteus minimus muscles of the hips, or irritation of the iliotibial (IT) tract that connects to the tensor fasciae latae (TFL) muscle of the hip.

Trochanteric bursitis is the main form of hip bursitis. Another form of hip bursitis called ischial bursitis occurs at the ischium, a portion of the pelvic bone. It causes pain in the back of the hip and groin rather than at the side of the hip.

Trochanteric bursitis most commonly occurs in adults in their 30s, 40s, and 50s, and is four times more likely to occur in women than men. Risk factors for developing trochanteric bursitis include a sudden increase in activity and repetitive motions that cause compression or tension at the lateral hip.

woman stretching hamstrings

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Assessing Trochanteric Bursitis

A physical therapist will assess the severity of your trochanteric bursitis by examining your gait (the way you walk), ability to complete functional movements such as getting in and out of a chair, squatting, and going up and down stairs.

They will also check the alignment of your pelvis and lumbar spine, strength of your hip muscles, and range of motion of your hip joint. Your physical therapist will also palpate (examine by touch) the area around the greater trochanter of your femur, which will often feel tender and painful if the surrounding tendons are inflamed.

Symptoms of trochanteric bursitis include pain and difficulty with prolonged standing and walking, going up and down stairs, walking up and down inclines and declines, sitting down and standing up from a chair, sitting for long periods of time, and lying on your side.

Pain is also increased when you actively move your leg to the side into abduction (away from the body) or when your leg is passively stretched into adduction toward or across your body.

Symptom severity can range from mild discomfort with certain positions to significant pain and limitations with everyday movements.

Trochanteric Bursitis Physical Therapy

The main goal of physical therapy is to reduce pain and irritation at the side of the hip so you can get back to performing normal activities without limitations. Trochanteric bursitis is treated on an outpatient basis in outpatient physical therapy.

Physical therapy for trochanteric bursitis typically involves:

  • Therapeutic exercises to stretch and strengthen the muscles of the hips
  • Manual therapy to reduce tension, tightness, and spasm in the hip muscles
  • Thermal therapy with cold packs to reduce inflammation at the hip
  • Patient education, including postural awareness to avoid positions that can increase hip irritation and activity modification to avoid activities that will worsen symptoms

Trochanteric Bursitis Exercises

Side-Lying Straight Leg Raise

Side-lying leg raises can help strengthen your gluteus medius, a muscle that helps stabilize the hip joint and move the leg out and away from your body. Weakness of the gluteus medius can lead to inflammation and irritation of the muscle or tendon at the side of the hip and underlying bursae as the muscle cannot keep up with activity demands to stabilize the pelvis.

To perform this exercise:

  • Lie on your side with your hips, knees, and ankles stacked on top of each other, keeping your legs straight.
  • Contract the quadriceps muscles of your top leg to lock out the knee joint.
  • While maintaining this contraction, slowly lift your top leg up while keeping your leg straight the entire time. Do not let your body or hips roll backward or forward.
  • Hold your leg at the top position for one second.
  • Slowly lower your leg while continuing to maintain a quadricep contraction to keep your knee straight.
  • Repeat 10 to 15 times, completing a total of three sets on each side.

Standing Hamstring Stretch

The hamstrings are a group of three muscles that run from behind the hip to behind the knee. When the hamstrings are tight, they cannot contract optimally. This can lead to either tightness or overuse of surrounding muscles of the hips, including the gluteus medius and TFL, which can cause irritation to the hip bursae.

To perform this exercise:

  • Place one foot on an elevated surface. The higher the surface, the deeper the stretch.
  • With your foot elevated, contract your quadriceps muscles to completely straighten your knee.
  • From here, lean your body forward to stretch the hamstrings, keeping your knee completely straight throughout the stretch. You should feel a stretch in the back of your thigh and behind your knee.
  • Hold this stretch for 30 seconds, then relax.
  • Repeat three times for 30 seconds on each side.

Clamshell

Clamshells help strengthen the gluteus medius and deep external rotators of the hip joint. When these muscles are weak, the femur can become misaligned, putting increased stress on the hip. This leads to inflammation and irritation of the gluteus medius muscle or tendon at the side of the hip and underlying bursae as the muscle cannot keep up with activity demands to stabilize the pelvis.

To perform this exercise:

  • Lie on your side with your hips, knees, and ankles stacked on top of each other. Your knees should be bent.
  • Keeping your ankles together, slowly lift your top knee up. Do not let your body or hips roll backward.
  • Hold your leg at the top position for one second.
  • Lower to the starting position, then repeat 10 to 15 times, completing a total of three sets on each side.

To increase the intensity, add a resistance band around your thigh above your knees to increase activation of your glute muscles.

Piriformis Stretch

The piriformis is a muscle in the back of the hips underlying the glutes which helps externally rotate the hip. When this muscle is tight, the hip joint cannot move properly, causing increased tension and friction at surrounding structures, including the hip bursae.

To perform this exercise:

  • Lie on your back with your knees bent and feet flat.
  • Lift one foot up and place it on the thigh of your opposite leg while using your hand to push your knee away from your body.
  • Hold this stretch for 30 seconds, then relax.
  • Repeat three times for 30 seconds on each side.

Prevention

Physical therapy can help prevent future issues with hip bursitis by appropriately strengthening the muscles of your hips to support and stabilize the femurs and pelvis to reduce irritation and repetitive joint and muscle irritation.

Your physical therapist will also provide you with a home exercise program of strengthening and stretching exercises that will supplement your physical therapy visits. They should be used when you complete your physical therapy to continue on your own to maintain good hip alignment and prevent the recurrence of symptoms.

To minimize symptoms, you should also:

  • Avoid crossing legs while sitting
  • Avoid leaning over one hip when standing
  • Avoid sleeping on the side of the affected hip

Outlook

Physical therapy usually requires sessions two to three times a week and may take three to six weeks for symptom improvement. Because symptoms can recur, it is important to regularly attend physical therapy sessions and be compliant with your home exercise program to keep your hip muscle strong and prevent irritation and inflammation of your hip bursae.

Summary

Trochanteric bursitis is inflammation of the bursa at the part of the hip called the greater trochanter. Physical therapy can reduce pain and help you get back to everyday activities. The focus of the exercises in this article is on reducing inflammation, tension, and spasm in the hip muscles.

Frequently Asked Questions

How can physical therapy help with trochanteric bursitis?

Physical therapy can help with trochanteric bursitis by strengthening the muscles of the hip and improving alignment of the pelvis to decrease irritation and inflammation that can occur at the lateral hip and underlying bursae from muscle strength and flexibility imbalances.

How effective is physical therapy for hip bursitis?

Hip bursitis typically improves with conservative measures such as activity modification and physical therapy, with an expected symptom improvement rate of 90% or more, according to a 2011 systematic review of clinical trials. Despite positive outcomes, symptom recurrence is common, requiring patients to keep up with their corrective exercises prescribed by their physical therapist in order to prevent ongoing problems.

How long does it take for physical therapy to treat bursitis?

Hip bursitis usually improves within three to six weeks with regular attendance to physical therapy and compliance with activity modification and a home exercise program.

A Word From Verywell

Trochanteric bursitis of the hip is typically very responsive to physical therapy treatment to restore proper hip alignment, muscle strength, and movement patterns. During the time that you attend physical therapy, you may have to modify your activities—especially prolonged standing, walking, running, or athletic activities—until your pain and inflammation start to subside.

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2 Sources
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  1. Ohio State University Wexner Medical Center. Greater trochanteric pain syndrome clinical practice guideline.

  2. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011;21(5):447-453. doi:10.1097/JSM.0b013e318221299c