Throughout the body, between bones and soft tissues, small, fluid-filled sacs provide cushion and reduce friction. These jelly-like sacs, called bursae, can become inflamed, and that painful condition is called bursitis. Any bursae in the body can be affected by bursitis, and when one of the bursae in the hip is inflamed, this is known as hip bursitis.
According to Dr. Vladimir Alexander, a founding partner of Alexander Orthopaedics, hip bursitis can result from something as simple as sleeping in the wrong position: “Anywhere in the body where the bone is close to the skin the body has a protective sac called a bursa and the bursa is the shock absorber that prevents the bone from rubbing through the skin. Sometimes if you lay just wrong or put too much undue pressure in one spot, that particular area will become inflamed, and you’ll get a bursitis, or inflammation of the bursa.”
The two major bursae of the hip are located at the outer, bony point of the hip and at the inner hip, in the groin area. Trochanteric bursitis is when the bursa at the bony outer part of the hip is inflamed, and iliopsoas bursitis is when the groin side of the hip is inflamed. Outer hip pain, trochanteric bursitis, is more common, but the treatments are similar, and both are generally referred to as hip bursitis.
What are the symptoms of hip bursitis?
The main symptom of hip bursitis is pain at the point of the hip, and this pain often extends to the outside of the thigh area. Dr. Alexander says patients with hip bursitis often describe the pain as sharp and intense at first, but duller and more widespread over time. “It’s painful to apply direct pressure, to wear tight garments or tight pants, and to lay directly on that slide to sleep,” he says. Symptoms of hip bursitis include:
- Pain on the outside of your hip and thigh or in the buttock
- Pain when you are lying down on the affected side
- Pain when you press on the outside of the hip
- Pain that worsens when you get up from a chair or out of a car
- Pain when walking up stairs, walking for extended periods, or exercising
What causes hip bursitis?
There are a number of possible causes of hip bursitis, including injuries and chronic conditions, and pinpointing the cause of your pain can help prevent painful inflammation in the future. Typically, hip bursitis results from one of the following conditions or situations:
- Injury: Falling and landing on the outside of your hip, lying for too long on one side, or hitting the side of your hip on an object can lead to hip bursitis.
- Overuse/repetitive stress: Hip bursitis can result from repeated movements during work or exercise, such as standing for long periods of time, running up stairs, or climbing.
- Spine and posture problems: Posture issues resulting from scoliosis or arthritis can lead to hip bursitis over time.
- Leg length: When one leg is much longer than the other, it affects the way you walk, and the imbalance can lead to inflammation of the bursae of the hip.
- Previous surgery: Prosthetic implants and past surgeries can irritate the bursae and cause hip bursitis.
- Other diseases or conditions: People with diabetes, rheumatoid arthritis, gout, psoriasis, and thyroid disease are more prone to experiencing inflammation, including hip bursitis. In rare cases, the hip bursa can also become infected, causing septic bursitis.
- Bone spurs or calcium deposits: When these occur in the tendons near the bursae of the hip, they can cause hip bursitis.
How is hip bursitis diagnosed?
When you talk to your physician about the pain in your hip or groin area, they will perform an exam to pinpoint the exact area where you are experiencing tenderness. They will also likely recommend tests and imaging, including X-rays or MRI, to rule out other conditions that can cause similar symptoms. An X-ray or MRI might also allow your physician to determine what is causing your hip bursitis and help them create a treatment plan.
What is the treatment for hip bursitis?
Dr. Alexander says most people can find relief from hip bursitis without surgery, though for some people, surgery or other medical intervention is helpful.
“Hip bursitis is treated with anti-inflammatory medication, modalities of physical therapy such as deep heat, ultrasound, electrical stimulation, and if those things don’t work, cortisone injection. Hip bursitis responds very nicely to all the conservative treatments and it’s exceptionally rare that anyone with hip bursitis requires surgery.”
There are some actions you can take at home to alleviate hip bursitis pain and prevent it from recurring. These nonsurgical treatments include:
- Rest: If your hip bursitis is the result of a repetitive use injury, such as climbing stairs or standing for long periods of time, your physician may recommend that you simply avoid those activities at least until your pain stops.
- Assistive devices: Using a walking cane, walker, or crutches for a short period may help take the pressure off the inflamed bursa.
- Over-the-counter medications: Ibuprofen, naproxen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and control inflammation associated with hip bursitis. Talk with your doctor about whether NSAIDs are appropriate for you, as they can have adverse side effects for those who have certain medical conditions or take certain medications.
- Physical therapy: To prevent chronic bursitis and to alleviate pain, your physician may recommend you start doing exercises or stretches to increase strength and flexibility in the muscles supporting your hip. You may be able to do these exercises on your own at home, or you may need to work with a physical therapist. A physical therapist may also be able to offer other treatments, including massage therapy (sometimes recommended with rolling), ice, ultrasound, electrical stimulation, and heat.
- Steroid injections: Your physician may elect to treat your hip bursitis with a steroid injection. This treatment is simple and can often be done in the office. Research shows that one or two steroid injections can relieve symptoms. It may be possible to do additional injections over time if pain and inflammation return.
Hip bursitis is rarely treated with surgery, but when necessary, surgery to remove the bursa is effective. The hip can function normally without the bursa. Some orthopedic surgeons recommend removing the bursa arthroscopically, through a very small incision, because it is less invasive, and recovery from it is less painful. Hip bursa removal surgery is usually scheduled as an outpatient procedure, and recovery from this surgery is generally very quick.
How do you prevent hip bursitis?
If you have struggled with hip bursitis, there are a few steps you can take to prevent hip bursitis from recurring:
- Avoid putting strain on your hips. This might mean avoiding stairs, reducing hill workouts, or finding ways to have fewer long stretches of standing.
- Stretch. Ask your physician, physical therapist, or yoga instructor to recommend simple stretches you can do before and after exercise to increase the flexibility in your hips.
- Lose weight. If you are overweight, you may be putting extra strain on your joints, including your hips. Losing weight might help alleviate this pressure.
- Build strength. With your physician’s guidance, starting a workout routine to strengthen the muscles supporting your hips can prevent a recurrence of hip bursitis. Ask your doctor what types of exercise would work best for you.
What is the hip bursitis recovery process?
Most people with hip bursitis experience relief with conservative treatments, and their symptoms resolve within a few weeks. If your pain persists despite your self-care efforts, or if your pain interferes with your normal daily activities, talk to your doctor. Also, if you have a fever or your hip appears red, swollen, or warm, talk to your doctor as soon as possible, as this may indicate an infection.
Many people with hip bursitis ask whether it’s safe to continue walking while experiencing pain from hip bursitis. Every person is different, but generally, it is safe to continue walking. However, if walking seems to cause pain in the hip, resting and walking as little as possible, or using assistive devices (such as crutches or a cane) temporarily may help. Walking up hills or stairs may further irritate an inflamed bursa, so you should minimize these activities if possible.
Doing the things you love and need to do shouldn’t be painful. If you are experiencing pain in your hip or groin, we can help. We can determine whether what you’re experiencing is hip bursitis or something more severe, and our personalized treatment plans, expert physicians and at-home recovery will get you back to your routine as soon as possible.