Best Exercises for Hip Bursitis

What is Hip Bursitis?

Hip bursitis is the inflammation of the bursa in the hip region.

(Also related to: Trochanteric bursitis, Greater Trochanter Pain Syndrome, Glute tendonitis, ITB issues.)

The bursa is a sac of fluid which sits under the tendons/muscles.
(Its role is to reduce friction between sliding tissues.)

What Causes Hip Bursitis?

Hip Bursitis can occur when the hip is exposed to an unaccustomed amount of stress that is more than what the hip can handle.

This could be associated with:

• Increase in exercise intensity
• Poor movement mechanics
• Gluteus Medius weakness
• Tight muscles
• Weight gain
• Direct trauma
• Prolonged side lying

Hip Bursitis Test

a) Ultrasound scan

The most reliable way is to get an ultrasound scan of the hip.

b) Pain region

“What does bursitis in the hip feel like?”

The pain is initially sharp, then tends to go into a dull ache.

The pain is located around the greater trochanter and can spread down to the outer thigh. (see above)

c) Unable to sleep on the painful hip

d) Hip side thrust test

Instructions:

• Stand with your feet shoulder width apart.
• Thrust your hips directly towards and then away from the side of the painful hip.
• Results:
  • If this reproduces your hip pain, then it may suggest you have Hip Bursitis (… and/or have associated tendon issues).

How long does it take to heal Hip Bursitis?

If you are consistent with the hip bursitis exercises, it will take at least 6 weeks.

(Note: This time frame is largely dependent on factors such as age, severity of condition, strength, pre-existing and current injuries etc!)

Hip Bursitis Exercises

The following exercises will go through how to treat Hip Bursitis at home.

Keep in mind – Bursitis rarely occurs in isolation.

There is usually involvement of the muscles/tendons surrounding the area and can often be the source of pain.

The following hip bursitis exercises are designed to address both simultaneously.

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Step 1: Stop (or modify) all activities that cause pain.

… How can you expect your Hip Bursitis to improve if you keep exposing it the activities that irritate even more?

To be honest – this is probably the hardest step to implement on a practical level. (… but please try your best!)

The goal here is to remain as active as possible without exceeding the capacity of what the hip can comfortably tolerate.

Tip: If doing your desired activity hurts – try to modify and/or reduce the intensity so that it is more tolerable for the hip.

What aggravates Hip Bursitis?

You may need to temporarily avoid, reduce exposure to or modify aggravating positions/activities such as:

• Walking:
  • Consider using a walking cane
• Running:
  • Reduce distance and/or speed
  • Stick to flat surfaces
• Standing:
  • Take regular sit breaks
• Sleeping on the painful hip:
  • Sleep on the back or on the unaffected side.

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Step 2: Reduce inflammation

An excessive amount of inflammation may cause the hip to be very sensitive and painful.

As a result – this will make it very difficult to perform some of the Hip Bursitis exercises.

a) Anti-inflammatory gel

Apply an anti-inflammatory gel to the area of pain for 3 times per day.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the Hip Bursitis.

(** Please consult your general practitioner before taking any new medication.)

c) Cold therapy

Apply an ice pack to your hip for at least 10-15 minutes.

Do this 3-5 times per day.

Note: Switch to a heat pack if your hip pain is not acute in nature.

d) Try natural products

It is suggested that taking turmeric, ginger, chia seeds, olive oil and/or fish oil capsules are natural ways to help reduce the inflammation.

e) Cortisone injection

If you have already been to your doctor, then the chances are that they have already suggested that you get the cortisone injection.

This particular injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to:

• a) reduce the inflammation and
• b) reduce the pain by numbing the area.

Sounds great in theory… right?

Yes, it does…

BUT – The problem is that it does absolutely nothing to address the underlying cause of the Hip Bursitis.

More often than not – the injection may provide some short term relief, but only to have the pain come back at a later date (… and usually with a vengeance!).

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My recommendation:

• Persist with the following Hip Bursitis exercises for about 6 weeks.
• If there is absolutely no improvement (… or if it’s getting worse), then it might be the next step to take.
• (It should NEVER be the first thing that you do.)

Step 3: Releases

Releases on certain muscles can help take some pressure off the bursa.

Apply as much pressure as you are able to comfortably tolerate.

(Use Google if you are unsure of where these areas are.)

a) Greater trochanter

Releases to this area are great for gluteal tendon issues.

However – if you release directly onto the inflamed bursa, this may potentially make the inflammation worse!

Instructions:

• Place the side of your hip onto a massage ball.
• Apply an appropriate amount of your body weight on top of the ball.
• Target the areas around the greater trochanter.
• Do not press directly onto the bone.
• Duration: 1-2 minutes

b) Glute/TFL complex

Instructions:

• Place the side of your hip onto a massage ball.
• Apply an appropriate amount of your body weight on top of the ball.
• Target the glute/TFL muscles.
• Do not press directly onto the bone.
• Duration: 1-2 minutes

c) Lateral quads

Instructions:

• Place a foam roller directly underneath the outer thigh region.
• Apply an appropriate amount of your body weight on top of the foam roller.
• Make sure to release the entire muscle
• Duration: Aim for 1-2 minute.

Step 4: Pain- free movements

The goal with these Hip Bursitis exercises is to preserve as much movement in the hip as possible.

Aim to move your hip without causing any pain.

a) Hip Flexion/Extension

Instructions:

• Stand on your unaffected leg.
  • Hold onto something for balance.
• Slowly move your affected leg forwards/backwards.
• Aim to move the hip as much as possible without causing any pain.
• Repeat 20 times.

b) Hip Abduction/Adduction

Instructions:

• Stand on your unaffected leg.
  • Hold onto something for balance.
• Slowly move your affected leg side-to-side.
• Aim to move the hip as much as possible without causing any pain.
• Repeat 20 times.

c) Hip External/Internal rotation

Instructions:

• Sit down on a high chair that prevents the feet from touching the floor.
• Keep your knees bent at 90 degrees.
• Whilst keeping your knee pointing forwards, slowly lift your ankles from side-to-side.
• Repeat 20 times.

Step 5. Progressive Isometric contraction

The goal with these hip bursitis exercises is to be able to perform the 3 different hip positions at 100% intensity without reproducing your pain.

Hip abduction (Standing)

Instructions:

• Stand with your weight shifted onto your unaffected leg.
  • Hold onto something to keep your balance.
• Place your affected hip in -30 or 0 or 30 degrees angle. (see above)
• Push the side of your foot into the wall as hard as you can.
  • Maintain an intensity that you are comfortable with.
  • (You might need to start at 10-20% of your maximum intensity and progress from here.)
• Hold for 30-45 seconds.
• Repeat 3 times.
• Note: You can do this exercise at any hip angle as you wish.

Step 6. Non-weight bear exercises

It is important to make the following hip bursitis exercises as challenging as possible.

Use resistance bands and/or ankle weights to increase the difficulty!

1. Eccentric exercises

Leg drop (Side lie)

Instructions:

• Lie on your side with the painful hip on the up side.
• Bend the knee at the bottom.
• Straighten the leg at the top.
• Make sure your hips are stacked directly on top of each other.
  • Do not let your pelvis twist.
• Have someone lift your top leg up as high as possible.
  • Keep relaxed.
• Slowly control the leg back down.
  • Let it drop as low as possible without aggravating your pain.
• Repeat 20 times.
• Progression:
  • Add ankle weights
  • Use resistance bands

2. Concentric + Eccentric

Hip abduction (Side lie)

Instructions:

• Lie on your side with the painful hip on the up side.
• Bend the knee at the bottom.
• Straighten the leg at the top.
• Make sure your hips are stacked directly on top of each other.
  • Do not let your pelvis twist.
• Elongate your top leg away from you.
  • This will help you to isolate the contraction in the glute muscle.
  • You should not be using the muscles on the top side of your waist.
• Lift your top leg upwards.
• Aim to feel a contraction in the muscle at the painful area.
• Slowly lower the leg back down.
  • Only lower to a height that you are comfortable with.
• Repeat 20 times.
• Progression:
  • Add ankle weights
  • Use resistance bands

Hip abduction (Standing)

Instructions:

• Stand on your unaffected leg.
  • Hold onto something for balance.
• Lift the leg with your painful hip up to the side as high as possible.
• Aim to feel a contraction in the muscle at the painful area.
• Slowly lower the leg back to the starting position.
• Repeat 20 times.
• Progression:
  • Add ankle weights
  • Use resistance bands.

Step 7: Weight bear exercises

If you are experiencing difficulty with the following hip bursitis exercises, take a % of your body weight off your legs by holding onto something as you perform them.

a) Lunge

Instructions

• Stand in the lunge position.
  • The painful side should be at the front.
• Apply a resistance band onto your leading knee.
  • The band should be pulling your knee towards the mid line.
• Push your leading knee outwards.
  • Do not let your knee cave inwards.
• Lunge as low as you are comfortable with.
• Repeat 20 times.
• Progression:
  • Hold onto a weight

b) Squat

Instructions

• Stand up right with your feet shoulder width apart.
• Apply a resistance band between your knees.
• Push your knees outwards.
  • Do not let your knees cave inwards.
• Squat as low as you are comfortable with.
• Repeat 20 times.
• Progression:
  • Hold onto a weight

c) Hinge

Instructions:

• Stand up right with your knees slightly bend and feet at shoulder width apart.
• Apply a resistance band between your knees.
• Push your knees outwards.
  • Do not let your knees cave inwards.
• Hinge forwards at the hips.
  • Keep your back straight.
  • Go as low as possible.
• Repeat 20 times.
• Progression:
  • Hold onto a weight

Step 8: Single leg exercises

Keep your pelvis level through the following exercises.

a) Step ups

Instructions:

• Place your foot onto a step.
  • The side of the painful hip will be on the step.
• Slowly step up as you raise your other knee upwards..
• Aim to keep your pelvis as level as possible.
• Repeat 20 times
• Progression:
  • Hold onto a weight
  • Perform the exercise slower
  • Use a higher step

b) Side steps

Instructions:

• Whilst standing sideways, please your foot onto a step.
  • The side of the painful hip will be on the step.
• Slowly step side ways onto the step as you lift up the other knee.
• Aim to keep your pelvis as level as possible.
• Repeat 20 times
• Progression:
  • Hold onto a weight
  • Move slower
  • Use a higher step

c) Toe reach and tap

Instructions:

• Stand on the side of your painful hip.
• Whilst keeping a level pelvis, slowly reach your other foot as far away from you as possible.
• Lightly tap the foot on the ground.
• Return to the starting position.
• Repeat 20 times.
• Progression:
  • Go slower
  • Reach further
  • Perform the exercise whilst on a step

d) Running man

• Stand on the side of your painful hip.
• Keep your knee slightly bent.
• Keep other leg elevated throughout exercise.
• Main a neutral pelvis as you hinge forwards and backwards.
• Repeat 10 times.

e) Fire Hydrants

Instructions:

• Place a resistance band between your knees.
• Hinge forwards at the hips.
• Stand on the side of your painful hip.
  • Hold onto something for balance.
• Keep this knee slightly bent throughout the exercises.
• Whilst maintaining a level pelvis, lift your other leg to the side.
• Repeat 20 times.

Step 9: Hip Bursitis exercises (Concentric/Eccentric)

The goal with these exercises is to strengthen your hips as the pelvis tilts sideways.

a) Cross-over Side lunges

Instructions:

• Assume the standing position.
• Bring your foot behind and as far to the side of the other foot. (See above)
  • The side of the painful hip will be at the front.
• Perform a lunge.
• Repeat 20 times.
• Progression:
  • Do a deeper lunge
  • Reach your foot further to the side
  • Hold onto a weight

b) Hip hitches

Instructions:

• Stand sideways onto a step.
  • The side of the painful hip will be on the step.
• Keep the leg on the step completely straight.
• Lower your other foot towards the floor.
  • Aim to feel a stretch in the stance hip.
• Hitch your hip upwards.
  • Aim to feel a contraction in side of the stance hip.
• Repeat 20 times.
• Note: Hold onto something if you have issues with your balance.
• Progression:
  • Hold onto a weight
  • Go slower
  • Go deeper

c) Dynamic side planks

Instructions:

• Assume the side plank position. (see above)
  • The painful hip should be the side closer to the floor.
• Allow your hip to drop towards the floor.
• Lift your hip off the floor.
• Aim to feel a contraction the side of the hip closest to the floor.
• Hold for 3-5 seconds
• Repeat 10 times.
• Note: If this exercises is too difficult, keep both knees bent instead.
• Progression:
  • Keep your top leg lifted up throughout the whole exercise

Step 10: Re-introducing the aggravating activity

After persisting with the hip bursitis exercises, the muscles of your hip should be much stronger than what it was to begin with.

The next step is to slowly re-introduce the aggravating activity/movement that caused your Hip Bursitis in the first place.

Over the next couple of weeks, you will need to progress the intensity of the desired activity to test out what your hip can tolerate.

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If you have come this far, it is likely that these Hip Bursitis is well on its way to being fixed.

However – If you would like to improve the function of your hip to its fullest potential, I would suggest you carry on to Step 11!

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Step 11: Addressing posture

Your posture can affect the way that you move your hip.

This may eventuate to an excessive amount of stress placed on the hip … and possibly lead to Hip Bursitis.

Here is a list of postural deviations that may potentially be predisposing you to hip bursitis. (… and links to the blog posts to help address them!)

1. Lateral pelvic tilt

Lateral pelvic tilt refers to the asymmetric positioning of the pelvis where:

• one waist height is higher than the other side. (Hip hike)
• or one waist height is lower than the other side. (Hip drop)

Check out this post: How to fix a Lateral Pelvic Tilt.

2. Rotated pelvis

A Rotated pelvis refers to when the pelvis is twisted and facing more towards one side.

Check out this post: How to fix a Rotated Pelvis.

3. Scoliosis

Scoliosis refers to the lateral curvature that occurs in the thoracic and/or lumbar spine.

Check out this post: Scoliosis Exercises.

4. Knee valgus

Knee Valgus is a condition where the knees cave inwards towards the mid line of the body.

Check out this post: How to fix Knee Valgus.

5. Flat feet

Flat feet is where there is a collapsed inner arch of the foot.

Check out this post: How to fix Flat Feet.

6. Tight Psoas (Hip Flexor)

Tight hip flexors can limit the amount of hip extension available at the hip during walking.

As a result, the hip will abduct and externally rotate during hip extension placing more stress on the outside hip.

Hip flexor stretch:

Instructions:

• Assume the lunge position as above.
• Perform a posterior pelvic tilt
  • “Tuck your tail bone underneath you” 
  • Keep your glutes contracted.
• Lean your torso away from the side you are stretching.
• Aim to feel a pulling sensation at the front of your hip.
• Hold for 30 seconds.
• Repeat 2-3 times.

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Exercise to avoid with Hip Bursitis

Any exercise which reproduces the pain in the side of the hip should be avoided or modified.

(Even stretches to the Gluteus Medius can aggravate the pain!)

The main exercises that tend to increase pain with Hip Bursitis are:

• Jumping
• Running
• Single leg exercises
• Sports that involve quick changes in direction

Do I need to have surgery?

Surgical removal of the hip bursa is RARELY indicated.

Please give these hip bursitis exercises a try before considering any surgical intervention.

(Note: Not all surgeries are successful!)

Is walking good for Hip Bursitis?

Yes – the goal is to walk as much as you comfortably can tolerate without increasing any symptoms in the hip.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.