exercises for hip bursitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally-known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Bursae are small fluid filled sacs that help cushion joints.

Several of these bursae are located around the outer portion of the hip, near the part of femur (upper leg bone) called the greater trochanter. The greater trochanter is a broad area of bone that anchors several large muscles. Inflammation of the trochanteric bursa is a very common cause of hip pain.

Repetitive stress (overuse) injuries.

• Multiple minor traumatic injuries.

• Lumbar spine disease such as scoliosis.

• Leg-length difference.

• Rheumatoid arthritis.

• Lying on one side of the body for an extended period (perhaps due to another injury or illness).

• Excessive stress on the hip from standing too long.

• An acute trauma such as a fall.

• Previous surgery in the hip.

Trochanteric bursitis is more common in women and the middle-aged or elderly than in men or younger people. The main symptom is pain.

• Aching pain is usually noticed on the outside of the upper thigh at the point of the hip.

• Pain may radiate down the outside of the thigh as far as the knee.

• Pain is worse with lying down or rolling onto the affected side.

• Climbing stairs, sitting or standing too long and walking may all be painful.

• Pain at night may make sleeping difficult.

The primary diagnostic test is the physical examination.

If the bursitis is caused by overuse, the first step in treating it is rest. Simply giving the hip an opportunity to heal by taking some time off from the activity or by modifying your exercise regimen may be sufficient. Other conservative treatments include:

• Ice applications (apply for 15 to 20 minutes, two or three times a day; do not apply ice directly to the skin).

• Non steroidal anti-inflammatory drugs such as ibuprofen.

• Stretching exercises, especially for the lower back and hip muscles.

• Weight loss, to reduce pressure on the hip.

• Exercises to strengthen the muscles.

• Physical therapy.

• Using a cane to reduce pressure on the hip.

• Using a lift in your shoe if one leg is markedly different in length than the other.

If conservative treatment does not relieve the pain, an injection of a corticosteroid may relieve symptoms.

Three steps you can take to prevent hip bursitis from returning are:

1. Avoid prolonged standing or repetitive tasks that involve your hip muscles.

2. Exercise to strengthen and stretch the muscles in your hips and lower back.

3. Be sure to see your physician before beginning any exercise program, and to follow a planned program.

Improving range of motion: When movement of a joint is limited, the pain and symptoms of a hip bursitis may worsen. Improving hip movement can help keep the joint surfaces aligned and healthy, while helping to control friction against the bursa. Getting more motion can give you the relief you need for daily activities.

If you don't have full range of motion, there are several ways to get more movement including graded joint mobilization, manual stretching, and select exercises. Active movement and stretching as part of a home program can also help restore movement and get you better faster.

Strengthening: When muscles weaken, other muscles may overpower the weaker ones. This leads to an imbalance where the lengthened muscle becomes weaker and the shorter muscles become stronger. These imbalances change the way the joints usually work, leading to problems like a hip bursitis.

Problems with alignment of the pelvis, hips, or knees can affect the balance of muscles and tendons. The exercises you do to help strengthen weakened muscles of the hip and buttocks areas can often make the difference in getting your hip back in balance.

Progressive exercise: Your exercise program will be advanced as your symptoms ease. Exercises will be given to help improve motion, strength, and endurance in the hip. Your program will also address key muscle groups of the abdomen, buttocks, and thigh. Other exercises can be used to simulate day-to-day activities like stair climbing, pivoting, and squatting. Here are some types of exercises that may be used to help your condition:

Progressive resistive exercises (PREs): Many choices of PREs are now used in rehabilitation. Some of these choices include pulley systems, free weights, rubber tubing, manual resistance, and computerized exercise devices. Using PREs is a way to apply graded resistance to muscle groups to gradually help them gain endurance and strength. These exercises typically start with lighter weights with lots of repetitions, and as endurance increases, more weight is gradually used with fewer repetitions. Stabilization exercises: Muscles that are closer into the "core" of the body act as stabilizers. The job of these stabilizers is to put your joints in the right position and to steady them while you squat, walk, or jump. These muscles form a stable platform letting you move your leg and foot with precision. If these muscles aren't doing their job, your hip loses some of its control, keeping it from working its best.

The stabilization exercises you'll be working on can be thought of in the way you take care of the tires on your car. If you had a wear spot on one of your newer tires, you'd be pretty upset with a tire dealer who simply wanted to replace it. You would first want to be sure the car was checked for alignment, that the wheels were balanced, and that the lug nuts were tightened. Otherwise, your new tire would end up getting worn like the last one. Treating hip bursitis takes more than just pain control (new tire). It requires training the stabilizers of the buttocks, hip, and thigh to assist with posture (alignment) and to guide the joint in the right placement (lug nuts) while you go about your daily tasks.

Closed chain exercises: These are exercises in which the foot is kept on the ground while movement and resistance take place in the joints and muscles above. These types of exercises are important because they are so much like the activities we do every day. For example, a partial squat exercise is the same action as lowering yourself onto a chair or couch. A leg press is a lot like the action of going up a stair or step. These exercises add strength and stability around the muscles and joints of the hip.

Home program: Once your pain is controlled, your range of motion is improved, and your strength is returning, you will be progressed to a final home program. Your therapist will give you some ideas to help take care of any more soreness at home. You'll be given some ways to keep working on the range of motion and strength too. Before you are done with therapy, more measurements will be taken to see how well you're doing now compared to when you first started in therapy.

Exercises for hip bursitis