What Is Hip Bursitis?
Hip bursitis is an inflammatory condition affecting the bursae—small, fluid-filled sacs that cushion the bones, tendons, and muscles near joints. When these bursae become inflamed, they cause pain and discomfort in the affected area. In the hip, bursitis commonly occurs in the trochanteric bursa on the outside of the hip or the iliopsoas bursa on the inside of the hip. This condition can affect individuals of various ages, though it tends to be more prevalent in middle-aged and elderly populations, potentially limiting mobility and affecting quality of life.
Common Symptoms of Hip Bursitis
The following symptoms may indicate the presence of hip bursitis, which can vary in intensity depending on the severity of inflammation and individual factors.
Outer Hip Pain
The most common symptom is sharp pain on the outer side of the hip that may extend to the thigh or buttock. This pain often worsens with prolonged standing, walking, climbing stairs, or lying on the affected side.
Tenderness to Touch
The affected area may be sensitive to pressure, making activities such as lying on the affected side uncomfortable.
Visible Inflammation
In some cases, swelling or redness may appear over the affected bursa, indicating acute inflammation.
Activity-Related Discomfort
Symptoms typically intensify during physical activities that involve the hip joint and may diminish during rest.
Limited Mobility
Reduced range of motion and stiffness in the hip area may develop, particularly after periods of inactivity or sleep.
What Causes Hip Bursitis?
Hip bursitis develops due to various factors that contribute to bursal inflammation, with some individuals having a higher predisposition based on specific elements.
Repetitive Movements
Activities that require repeated hip motions, such as running, cycling, or stair climbing, can lead to irritation and inflammation of the hip bursae.
Trauma or Injury
Direct impact to the hip, such as from a fall or bump, may damage the bursa and trigger inflammation.
Spinal Conditions
Disorders like scoliosis or arthritis of the lumbar spine can alter biomechanics, placing additional stress on the hip bursae.
Surgical History
Hip surgeries, particularly those involving implants, may irritate nearby bursae, leading to inflammation.
Calcium Build-up
Calcium crystals can form within the bursa, causing irritation and inflammation.
Bone Spurs
Bony growths that develop along bone edges near the bursa can rub against soft tissues, causing irritation.
Ageing
Hip bursitis becomes more common with age as tissues lose elasticity and become more susceptible to inflammation.
Autoimmune Factors
Conditions like rheumatoid arthritis can contribute to bursal inflammation throughout the body, including the hip.
Anatomical Variations
A difference in leg length can alter gait mechanics, placing extra stress on the hip bursa of the longer leg.
How Hip Bursitis Is Diagnosed
Various assessment techniques are used to accurately identify hip bursitis and rule out other conditions with similar presentations.
Physical Examination
Examination of the hip area for tenderness, swelling, and pain patterns. Specific movements and positions may be tested to reproduce symptoms. Range of motion tests and walking patterns help evaluate hip function and identify any compensatory movements.
Medical History
A thorough review of symptoms, their onset, duration, and aggravating or relieving factors helps establish a timeline and potential causes. Information about previous injuries, surgeries, medical conditions, and activity levels provides context for the current symptoms.
Advanced Imaging
X-rays can reveal bone spurs, calcium deposits, or joint abnormalities that may contribute to bursitis. MRI scans provide detailed images of soft tissues, including the bursa, and can confirm inflammation, fluid accumulation, or associated tissue damage. Ultrasound imaging allows real-time visualisation of the bursa and surrounding structures while also enabling assessment during movement.
Fluid Analysis
In some cases, fluid may be drawn from the affected bursa using a needle. This procedure serves both diagnostic and therapeutic purposes by relieving pressure and allowing analysis of the fluid to rule out infection or gout.
Treatment Options
Management of hip bursitis ranges from conservative measures to more invasive interventions, with treatment selection based on severity, duration, and individual patient factors.
Non-Surgical Approaches
Activity Adjustment and Rest
Temporarily avoiding activities that aggravate symptoms allows the inflamed bursa to heal. This may include limiting high-impact exercises, prolonged standing, or other movements that trigger pain. Modified activity rather than complete rest is generally recommended to maintain overall fitness and prevent deconditioning.
Temperature Therapy
Applying ice to the affected area for 15-20 minutes several times daily helps reduce acute inflammation and pain. After the initial inflammatory phase, heat application may help relax muscles and improve blood flow to aid healing. Some patients find alternating between ice and heat provides optimal symptom relief.
Targeted Exercise Programmes
Structured physical therapy focuses on strengthening hip muscles, improving flexibility, and correcting biomechanical issues. A physical therapist may also employ techniques such as manual therapy, ultrasound, or electrical stimulation to reduce pain and inflammation. Customised home exercise programmes extend the benefits of therapy sessions.
Pain Management Medications
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen help reduce inflammation and alleviate pain. For those who cannot take NSAIDs, paracetamol may provide pain relief without addressing inflammation directly. Topical anti-inflammatory creams or gels can deliver medication directly to the affected area with fewer systemic effects.
Targeted Injections
An injection of corticosteroid medication directly into the affected bursa can provide significant inflammation reduction and pain relief. The effects typically last for several weeks to months, though repeated injections may have diminishing benefits. These injections are usually performed with ultrasound guidance to ensure accurate placement.
Surgical Solutions
Bursa Removal
Surgical removal of the inflamed bursa may be considered for chronic cases that do not respond to conservative treatments. This procedure can be performed through traditional open surgery or minimally invasive arthroscopic techniques, depending on the specific bursa location and patient factors. Recovery typically involves a rehabilitation programme to restore strength and function.
Iliotibial Band Release
For trochanteric bursitis associated with tight iliotibial band syndrome, a surgical release procedure may help reduce tension and pressure on the bursa. This procedure involves making small incisions in the iliotibial band to allow for greater flexibility and decreased friction against the greater trochanter.
Bone Irregularity Correction
When hip bursitis is caused or exacerbated by bone spurs that irritate the bursa, surgical removal of these bony prominences may be necessary. This procedure addresses the underlying mechanical cause of bursal irritation, potentially providing more lasting relief than treatments focused solely on the bursa.
Prevention Strategies
Preventing hip bursitis involves a few key approaches that can make a significant difference. Maintain a regular stretching routine focusing on hip flexibility, and strengthen core and hip muscles to improve joint stability. Wear supportive footwear with proper cushioning and consider orthotics if you have biomechanical issues.
Keep your weight in a healthy range to reduce pressure on your hips, and always warm up properly before exercise. If you’re starting a new activity, increase intensity gradually to avoid overload. For those who sit or stand for long periods, take regular breaks to change positions and maintain proper ergonomics in your workspace.
Conclusion
Hip bursitis, while uncomfortable, typically responds well to appropriate treatment. With proper diagnosis and a tailored management approach combining rest, physical therapy, and sometimes medication, most people experience significant improvement. By incorporating preventive strategies into your daily routine, you can reduce the risk of recurrence and maintain healthy hip function.
If you’re experiencing persistent hip pain, schedule a consultation with Dr LS Wang to get an accurate diagnosis and start your path to relief.
