Exercises for Hip Bursitis/ITB Tendonitis: How to Treat your Pain
Hip bursitis, or greater trochanteric bursitis, is an inflammation of the bursa, a the fluid filled sac, on the outside of the hip. If you have hip pain, read on for exercises for hip bursitis. You can treat it AND prevent it from happening again.
*Please note that many of the exercises here can also be used to treat ITB tendonitis (also known as ITB Syndrome).*
About Hip Bursitis
The lateral hip bursa acts as a shock absorber and friction reducer between the muscle of the outside of the hip and the bone. If the bursa becomes inflamed, it can become painful and tender to touch. If left untreated, this can lead to difficulty and pain with daily activities.
Common Symptoms of hip bursitis:
- Pain at the outside of the hip, with or without swelling or redness
- Pain that starts at the hip and radiates down the side of the leg
- Pain when doing the stairs
- Pain when lying on the involved side
- Pain when getting up after sitting for a while
- Pain with walking and/or running
- Hip bursitis may occur along with a tight ITB (illiotibial band)
Reasons why hip bursitis might develop:
- Weakness in the hips or knees
- Stress or strain to the hip from overuse or a sudden change in activity level
- Hip injury: whether in sport, a slip and fall, or blunt force/direct trauma to the hip bursa itself
- Hip surgery: such as a total hip replacement, or labral surgery
- Poor posture
- In women especially, a large Q angle (hip to knee angle), can cause ITB tightness, which in turn can aggravate the bursa.
Disclaimer: Although I am a physical therapist by profession, I am not YOUR physical therapist. This article is for informational and educational purposes only, does not constitute medical advice and does not establish any kind of therapist-patient relationship with me. I am not liable or responsible for any damages resulting from or related to your use of this information.
How to Treat Hip Bursitis
During the acute phase, when things are the most painful, there are three main things you can do. These are: taking over the counter medications, resting and icing.
Let’s talk about each one of these a little bit further.
Take NSAIDs.
Non-steroidal anti-inflammatories are over the counter medications, like Aleve or Ibuprofen. A course of 5-7 days of religiously taking an NSAID can help to significantly reduce the inflammation.
Aleve is nice because it’s a 12 hour medication and you can just take it once in the morning and once at night. Make sure to take NSAIDs with food as they can cause stomach upset if taken on an empty stomach.
As always, check with your doctor first if you are unsure about taking these.
Rest!
You need to take a break from the activity or activities that are causing the pain.
If stairs are aggravating, try to limit how often you’re doing them. If your symptoms are from overuse, limit your walking, running, squatting, or whatever is exacerbating your symptoms. If you have pain during an activity, you’re just inflaming things further.
Hip bursitis is not something that you want to “push through” as it can often make matters worse.
Ice.
Ice the hip either in addition to the NSAIDs or in place of them.
Some people can’t take or don’t want to take NSAIDs, so this is a natural alternative. Ice is an anti-inflammatory in and of itself.
Apply ice to the area at least once a day, up to 3 times a day for 10-15 minutes at a time.
Ice works as an anti-inflammatory locally from the outside, in. NSAIDs work as an anti-inflammatory systemically from the inside, out. Doing both is the most helpful.
Exercises for Self-Care
There are two type of exercises that can help treat hip bursitis: stretching exercises and strengthening exercises.
I would recommend starting with the stretches, even if you’re still in a somewhat acute phase. Move onto the strength exercises as symptoms start to decrease.
Stretching
The two muscle groups to target when treating hip bursitis are the ITB and the piriformis. An example of a stretch for each of these is outlined below.
ITB stretch
The iliotibial band (ITB) runs along the outside of the hip and over the bursa. It connects just below the knee joint. If tight, it can cause hip or knee pain, sometimes both at once. A tight ITB can also worsen hip bursitis symptoms by putting pressure over the bursa.
There are LOTS of different ways to stretch the ITB. The one described here is just one of them. My favorite way to isolate this muscle is shown below.
How to do it:
Lie down on your back, place a strap (belt, yoga strap or dog leash work great) around the foot and allow the leg to cross over the body to the opposite side.
Piriformis stretch
Here is another great stretch that gets the ITB, but also gets the piriformis, which can also be involved with hip bursitis. The piriformis runs through the buttock area and attaches to the greater trochanter or hip bone.
How to do it:
Lie down on your back and bend the knee of the affected side toward your chest. Then, place the hands on top of the knee and bring the knee closer toward the chest and then toward the opposite shoulder, in a diagonal plane.
You should feel this in the outside of the hip or in the buttock area.
Exercises for Self Care: Strengthening
There are two main muscle group that are helpful to strengthen to alleviate hip bursitis pain: the gluteus maximus and gluteus medius.
Sometimes a weakness present will actually precipitate the onset of hip bursitis symptoms. Conversely, chronic symptoms can cause compensatory strategies functionally and lead to weakness in these muscle groups.
Do the following strengthening exercises for hip bursitis to help alleviate pain.
Gluteus Maximus strengthening
Strengthen the glute max with glute squeezes, bridges and squats. Here’s how to do each one and progress the exercises to fit with your level of fitness:
Glute squeeze
A glute squeeze is exactly how it sounds: Squeeze the bum! Do this in sitting, when lying down, or when standing. Do this A LOT throughout the day. You cannot do too many of these.
Glute bridges
Lie on your back with knees bent, then, squeeze the glutes and lift the hips up as high as is comfortable.
If this is too easy, progress your bridge by putting legs up on an elevated surface like a couch, a bench or a physioball. And to further progress, perform a single leg bridge, as shown below.
Squats
Start with air squats or body weight squats. Make sure the knees don’t go past the toes when bending. Also, squeeze your glutes on return to standing. Once this feels comfortable or easier, you can begin adding weight to your squats.
This is the general progression of glute max strengthening from glute squeezes to bridges to squats. Keep all exercises pain free! Do not advance to the next exercise in the series unless your symptoms allow you to.
Gluteus Medius Strengthening
Strengthen the glute med with clamshells and lateral band walks. Here’s how to do each one and progress the exercises to fit with your level of fitness:
Clamshells
Lie on your side and bend both knees. Keeping the feet together, and the hips stacked on top of one another, lift the top knee toward the ceiling. Do not allow the hips to roll back.
Lateral band walks
Place a TheraBand or other exercise band around the thighs, just above the knees. Then, walk sideways by taking a step out to the side. Keep the band taut as you bring the feet back closer together.
In Summary: How to treat hip bursitis
So, to recap, start with rest/ice/NSAIDs. Progress to exercises for hip bursitis. First start with stretching the ITB and piriformis. As symptoms begin to calm, initiate strengthening of the gluteus maximus and medius.
Always keep things in a pain free range and if an exercise is aggravating symptoms, this is a good indicator that you’re not ready for it!
With this guide, you should feel able to tackle and treat your hip bursitis in a step-by-step manner based on your symptoms. Keeping up with the stretches and strength exercises can help keep symptoms at bay in the long run.
Are you trying to return to running after rehabbing your bursitis or ITB Syndrome? Get The Running (Re)Start Training Plan HERE!
Please Remember…
Please keep in mind that these exercises for hip bursitis are just a guide. It is not an individualized exercise prescription.
These are general recommendations for treating hip bursitis. I do not know you and your specific case. I am not YOUR physical therapist. If you are unsure if these exercises are right for you, you should go see a physical therapist in person for an individualized evaluation and specialized exercise prescription.
Additionally, a physical therapist can use adjunctive therapies like kinesiotaping, ultrasound and iontophoresis when indicated to help with pain and inflammation.
Questions? Comments?
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