Hip Bursitis: A Real Pain in the (Side Of) the Butt

Hip Bursitis: A Real Pain in the (Side Of) the Butt

Georgio Baylouny, PT, DPT, OCS

Physical Therapist, New York, NY

Pain on the outside of your hip?

Can’t sleep on your side because of the pain?

Worse when you walk, or stand on one leg? Or when you go down the stairs?

This annoying pain on the outer hip could be trochanteric bursitis – commonly just called “hip bursitis” for short. Trochanteric bursitis is quite common. While it can affect some younger athletes (like runners), it’s most common in people over 40 (with women outnumbering men up to 4:1 in incidence).

What is Hip Bursitis?

In order to really understand the pain on the outer hip area, it’s best to start with a really quick anatomy lesson of the area. It’ll be easy…I promise!

Let’s start with the pointy part of the outside of your hip. The one you can feel pretty easily with your hand (and where you might be experiencing the pain). This bony prominence is called the greater trocahanter (seen below).

That greater trochanter is a pretty popular area, as a total of 9 different hip muscles attach there! This includes the buttock muscles and deeper hip muscles. Because there’s so much action in one area, there is something called a bursa (a small sack of fluid) there to help reduce friction. Irritation of this bursa due to excessive compression, overuse of the area, or poor mechanics will lead to bursitis.

Now, just to confuse you – what we call “hip bursitis” usually isn’t a bursitis at all. In up to 80% of cases of lateral hip pain, it’s actually an issue in the tendons that attach in the area, not the bursa itself. We call this gluteal tendinopathy – the medical term for pain in the tendons of the buttock muscles.

So, while the layman’s term for that outer hip pain is “hip bursitis”, we actually know that it’s a breakdown or irritation of the glute tendons that’s causing the pain.

Just to stay consistent with what the public calls this, we’ll just call it hip bursitis rather than gluteal tendinopathy.

Strategies to Reduce Pain in Hip Bursitis

Here are some simple yet effective strategies to help reduce the pain associated with hip bursitis in your everyday life.

  • Avoid stretching the area. While our instinct is usually to “stretch” a tight or painful area, stretching might actually be painful in this case and just isn’t worth it.
  • If sleeping on your side is the only way you like to sleep and it’s just too painful, consider getting an egg crate foam topper to lie on in bed. This might be easier to lay on then your typical mattress.
  • Avoid “hanging on one hip” when you stand. This could cause unnecessary stress on the outer hip in cases when the bursitis is irritable and painful.
  • If you notice that it’s increasing pain, try not to cross your legs when you sit.

Physical Therapy for Hip Bursitis

Since we now know that the nagging pain on the outer hip is actually a tendinopathy (AKA pain at the tendon) of the glutes, physical therapy treatment will involve gradually strengthening the tendons and muscles in the area. This will improve the load tolerance of the tendons on the outer hip. This will eventually allow you to walk, run, squat, and go down stairs pain-free.

A great way to start “loading” the affected side is through isometric exercise and then gradually increasing to movements like clamshells and leg raises. Eventually, when irritability of the area decreases, we progress to resisted exercises and more dynamic movements like squats and lunges.

Do Injections Work for Hip Bursitis?

Your doctor may offer you a steroid injection. And if the pain is that bad, you might just take it! Just be aware that studies show that injections can decrease pain in the short term, but may not work long term.

Research shows that when it comes to cortisone injections, they’re no different than exercise when it comes to long term outcomes. This means that for longer lasting results, a graded exercise program is key. Injections can help decrease pain in the short-term only.

Exercises for Hip Bursitis

The image below outlines some common exercise progressions that we may use to treat hip bursitis AKA gluteal tendinopathy. Be sure to check in with your physical therapist before starting an exercise program, as everyone has a different starting point. There’s no one size fits all!

Check out the full article: Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management by Grimaldi and Fearon.

Dr. Georgio Baylouny, PT, DPT, OCS

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