Hip Bursitis: Symptoms, Causes & Treatment
Hip Pain Doesn’t Have to Limit Your Movement
Hip bursitis can cause pain and tenderness on the outside or front of the hip, making it uncomfortable to walk, climb stairs, stand after sitting or lie on the affected side. Although hip pain can have several causes, the location of the discomfort and the activities that make it worse can help an orthopedic specialist determine whether an irritated bursa is contributing to your symptoms.
At CHRISTUS Health, our orthopedic specialists evaluate hip pain and develop an individualized treatment plan to help reduce discomfort, restore mobility and address factors that may cause symptoms to return.
What Is Hip Bursitis?
Bursae are small, fluid-filled sacs that cushion the bones, tendons and muscles around a joint. Hip bursitis occurs when one of these sacs becomes irritated or inflamed.
Two bursae in the hip are most commonly associated with bursitis:
- Trochanteric bursitis affects the bursa over the greater trochanter, the bony point on the outside of the hip. This is the more common form of hip bursitis and typically causes outer hip and upper thigh pain.
- Iliopsoas bursitis affects a bursa near the front of the hip. It is less common and may cause pain in the groin or front of the hip.
Pain on the outside of the hip may also involve irritation or injury in the nearby gluteal tendons. A thorough evaluation helps distinguish bursitis from tendon injuries, arthritis, referred back pain and other possible causes of hip pain.
What Does Hip Bursitis Feel Like?
Hip bursitis symptoms may develop gradually or begin after an injury or increase in activity. Common symptoms include:
- Pain or tenderness on the outside of the hip
- Pain that extends along the outside of the upper thigh
- Groin or front-of-hip pain when the iliopsoas bursa is affected
- Pain when lying on the affected side
- Discomfort when getting up after sitting
- Pain when walking, running, climbing stairs or squatting
- A sharp pain that gradually becomes a broader, persistent ache
- Hip stiffness or discomfort after prolonged activity
Hip bursitis pain is often worse at night, especially when pressure is placed directly on the affected side.
What Causes Hip Bursitis?
Hip bursitis can develop when repeated movement, direct pressure or an injury irritates a bursa. Contributing factors may include:
- Repetitive stress from running, cycling, climbing stairs or standing for long periods
- A fall or direct blow to the outside of the hip
- A rapid increase in exercise or training intensity
- Frequently lying on the same side
- Tightness in the iliotibial band, also known as the IT band
- Weakness or imbalance in the muscles supporting the hip
- Differences in leg length or walking mechanics
- Scoliosis, lower-back arthritis or other spine conditions
- Rheumatoid arthritis, gout or other inflammatory conditions
- Prior hip surgery
Because hip bursitis can resemble arthritis, tendon injuries and pain referred from the lower back, proper diagnosis is important before beginning treatment.
How Is Hip Bursitis Diagnosed?
An orthopedic specialist will ask about your symptoms, activity level, medical history and the movements that increase your pain. During a physical examination, the specialist may check for tenderness over the outside or front of the hip and evaluate hip strength, flexibility and range of motion.
An X-ray may be used to rule out arthritis, a fracture or another bone-related condition. Ultrasound or MRI may be recommended when the diagnosis remains unclear or when a gluteal tendon injury or another soft-tissue condition is suspected.
Non-Surgical Hip Bursitis Treatment and Relief Options
Most cases of hip bursitis improve without surgery. Treatment focuses on reducing irritation, improving movement and addressing the underlying factors placing pressure on the bursa.
Your treatment plan may include:
Activity Modification and Ice
Temporarily reducing activities that aggravate the hip can give the irritated tissues time to recover. Applying a wrapped ice pack may help reduce pain after activity. Avoid placing ice directly on the skin.
Medication
A physician may recommend an over-the-counter pain reliever or nonsteroidal anti-inflammatory drug when it is appropriate for your health history. Speak with your health care provider before beginning medication, especially if you have a kidney, heart, bleeding or stomach condition or take other medications.
Physical Therapy for Hip Bursitis
Personalized physical therapy can improve flexibility, strengthen the gluteal and hip-supporting muscles, and correct movement patterns that may contribute to recurring irritation.
A physical therapy program may include:
- Gentle hip and lower-body flexibility exercises
- Hip abductor and gluteal strengthening
- Core and pelvic stabilization
- Gait and movement assessment
- A gradual plan for returning to exercise or sports
Exercises should be selected for your specific condition. Stretching or strengthening through sharp pain may further irritate the affected area.
Corticosteroid Injections
When pain continues despite activity modification and physical therapy, a physician may recommend a corticosteroid injection to reduce inflammation and make rehabilitation more comfortable. Ultrasound guidance may be used to help place the medication accurately.
Learn more about therapeutic joint injections for pain.
Surgery
Surgery for hip bursitis is uncommon. It may be considered when persistent symptoms do not improve with an appropriate course of non-surgical treatment or when another condition, such as a significant gluteal tendon injury, requires repair.
Hip Bursitis vs. Hip Arthritis
Hip bursitis commonly causes tenderness on the outside of the hip and pain when lying on the affected side. Hip arthritis more often produces pain in the groin, stiffness and reduced joint movement, although symptoms can overlap.
When hip pain is caused by advanced arthritis rather than bursitis, an orthopedic specialist can discuss treatments that may include medication, physical therapy, injections or joint replacement options.
When Should You See a Doctor for Hip Pain?
Schedule an evaluation if your hip pain:
- Interferes with walking, sleep or daily activities
- Continues despite rest and activity changes
- Keeps returning
- Limits the movement of your hip
- Began after a fall or other injury
- Is accompanied by significant swelling or weakness
Seek prompt medical care for severe pain, an inability to bear weight, significant redness or warmth, or hip pain accompanied by fever. These symptoms may indicate an injury, infection or another condition that requires timely treatment.
Frequently Asked Questions About Hip Bursitis
Treatment usually begins with activity modification, ice and physical therapy. Medication may be appropriate for some patients. If symptoms continue, an orthopedic specialist may recommend a corticosteroid injection. Surgery is rarely needed for uncomplicated hip bursitis.
Trochanteric bursitis affects the outside of the hip and commonly causes pain over the bony point of the hip or along the outer thigh. Iliopsoas bursitis affects a bursa near the front of the hip and is more likely to cause pain near the groin.
Yes. Physical therapy can strengthen the muscles that stabilize the hip, improve flexibility and address movement patterns that place excessive pressure on the bursa. The exercises should be tailored to the cause and severity of your symptoms.
Massage may relieve tightness in surrounding muscles, but direct pressure over an irritated bursa can make pain worse. Ask your physician or physical therapist whether massage is appropriate and how it should be incorporated into your treatment plan.
Recovery time varies according to the cause, severity and duration of symptoms. Some patients improve within several weeks of activity modification and therapy, while long-standing or recurring pain may take longer. Following a personalized rehabilitation plan can help reduce the likelihood of another flare-up.
Light walking may be appropriate if it does not substantially increase pain. Long walks, hills and stairs may need to be reduced temporarily. A physical therapist can help you determine an appropriate activity level and a safe progression back to normal exercise.