Hip bursitis can be extremely painful and debilitating, but simple exercises can be effective in addressing this issue. The pain can result from trauma to the hip, overuse, weakness, poor biomechanics or tight structures surrounding the hip joint. Simple exercises and stretches can control the pain and let you to get back to living life to the fullest.
Anatomy
The term bursitis refers to an inflammation of a bursa. Bursae are located in various locations throughout the body and are fluid filled sacs that provide a cushion where muscle, tendons, ligaments and bone rub against each other.
In the hip region, one of these bursa is located near the greater trochanter, called the trochanteric bursa. The greater trochanter is the bone protuberance that you can feel at the hip when you rotate your leg in and out. Once it is inflamed, the bursa can cause severe pain that radiates from the hip, down the side of the leg to the knee. It is usually extremely painful directly over the lateral hip region, and many people affected by this will be unable to lie on the affected side.
Causes
One of the causes of hip bursitis is repetitive motion such as walking, running, climbing stairs or cycling. During these movements, the muscles and tendons that surround the hip joint move back and forth over the trochanteric bursa. This repetitive motion irritates and inflames the bursa.
Another cause of hip bursitis is lack of flexibility. When the muscles, tendons and ligaments around the hip joint are tight, they produce a greater amount of stress and friction on the bursa as they move back and forth.
Overweight individuals can also develop hip bursitis due to the extra weight and stress that is placed on their load-bearing joints, including the hips.
A fall or other trauma to the hip can cause irritation to the bursa, resulting in inflammation and pain. Hip bursitis can also be caused by faulty biomechanics or any abnormality which affects the way a person walks. This can include injuries, leg length differences or other reasons for an abnormal walking pattern or gait.
Treatments
The first way to treat this painful condition is to rest the affected area. Since the inflammation will only get worse with continued repetitive motion, it is best to take a break from any aggravating motions.
The next ideal treatment to control the pain and inflammation is to use ice over the lateral hip region. The ice should be placed on the affected hip for approximately 10 minutes. Be sure to place a towel or clothing between the ice pack and your body to protect your skin. Ice can be used two to three times daily or as needed for pain relief.
The third way to treat bursitis is with proper stretching. A good stretching routine for the following muscles is effective at treating hip bursitis:
--The hip flexors and quadriceps muscles on the front of the leg
--The hamstrings in the back of the leg
--The iliotibial band, or ITB, which runs along the side of your leg from your hip to your knee
These muscles are active during walking, running, climbing stairs, cycling and many other activities, and if they are tight, they can rub over the bursa, causing inflammation and pain.
Another important component of treating hip bursitis is strengthening exercises. By properly strengthening the muscles surrounding the hip joint, movement at the hip is made more efficient and less irritating to the bursa.
If conservative measures do not help, your physician may suggest anti-inflammatory medications, anti-inflammatory injections or possibly surgery. While surgery is always a last resort, it can be effective for chronic hip bursitis. The surgery involves removal of the trochanteric bursa, removal of any bone spurs and sometimes removing part of a tendon that is chronically rubbing over the hip.
Hamstring Stretch
All stretches should be held for 30 seconds and repeated three times. These stretches should be performed two times per day. It is important that you feel a stretch and not a burning, sharp, stabbing, throbbing, aching or other type of pain. If you feel anything other than a stretch, stop immediately and consult your physical therapist or physician.
It is also important to breathe properly. When performing stretches or exercises it is natural to want to hold your breath. Be aware of this, and breath in through your nose and out through your mouth.
The first stretch to perform is for the hamstrings in the back of your leg.
1. Lie on your back.
2. Wrap a towel, bed sheet, belt or even a dog leash around the bottom of your foot.
3. Keeping the knee straight, slowly lift the leg until a gentle stretch is felt in the back
of your leg.
4. The opposite knee can be kept straight or bent. A bent knee on the opposite leg
will place less stress on your low back.
5. Hold this stretch for 30 seconds and repeat three times. Repeat with the opposite
leg.
If lying on your back is painful or not comfortable you can stretch the same group of muscles in a chair.
1. Move toward the edge of your chair and place your heel on the floor with your knee
straight. The opposite leg should be bent, as in the normal sitting position.
2. Keeping the knee straight, slowly move your chest forward until a gentle stretch is
felt in the back of your leg.
3. Hold this stretch for 30 seconds and repeat three times. Repeat with the opposite
leg.
It is important to perform all stretches and exercises with both legs regardless of whether both hips are painful. Keeping each side of your body flexible and strong prevents future injuries.
Quadriceps and Hip Flexor Stretch
The next group of muscles, the quadriceps and hip flexors are on the front of your leg. The first way to stretch these muscles requires you to lie on your back on a bed, couch or exercise table.
1. Wrap the strap or bed sheet around your leg near the ankle.
2. Let the leg drop off the side of the table.
3. Slowly pull the strap, keeping the leg relaxed.
4. The strap will bend your knee and you will feel a stretch in the front of your thigh.
5. Hold this stretch for 30 seconds and repeat three times. Repeat with the opposite leg.
The second way to stretch these muscles is in a lunge position.
1. Place a pillow or mat on the floor to provide some cushion for your knee. It is
helpful to set this up near a table or counter so you have something to hold onto
for support.
2. Kneel on the cushion with one knee as in a lunging position.
3. Keeping your back and torso straight, slowly lunge forward onto your front foot
until a gentle stretch is felt in the thigh of the kneeling leg.
4. Hold this stretch for 30 seconds and repeat three times. Repeat with the opposite
leg.
Iliotibial Band Stretch
The ITB runs from the hip to the knee on the side of the leg. This muscle plays a significant role in hip bursitis.
1. Lying on your back, place the strap around the bottom of your foot.
2. Slowly lift the leg, keeping the knee straight.
3. Bring the leg across your body to stretch the outside of the affected leg.
4. Hold this stretch for 30 seconds and repeat three times. Repeat with the opposite leg.
Hip Strengthening
Once the muscles surrounding the hip have been stretched properly it is time to begin strengthening the area. You should perform these exercises two times per day.
An effective exercise that recruits a large number of muscles in the lower extremity is a squat. To perform these safely and effectively at home you should perform what is called a wall squat.
1. Lean against a door or wall. It should be a surface that you can use to slide
against. If you have an exercise ball you can place this behind you on the wall.
2. You should be leaning against the wall so that your feet are in front of you and not
directly under you.
3. Slowly lower your body in a squat position. Your knees should remain over your
ankles during the entire exercise and should not go forward over the toes.
4. You should descend to just above the point where your thighs are parallel with the
ground and then return to the starting position.
5. Perform 10 reps, take a rest, and perform a second set of 10.
The next exercise for the hip is called hip abduction. Abduction simply means moving away from the midline of the body. This motion strengthens the muscles on the outside of the hip.
1. While standing, move one leg out to the side, keeping the toes pointed forward or
slightly inward.
2. To increase the difficulty of this exercise you will lie on your side and lift the top
leg straight up. This is more advanced and may irritate an acute hip bursitis, so
use your best judgment. If it bothers the hip, stop immediately.
3. Perform 10 reps, take a rest, and perform a second set of 10.
This exercise can be performed standing and lying down as well. It strengthens the hamstring and buttock muscles.
1. While standing, keep your leg straight and move it straight back.
2. To advance this exercise, lie on your stomach and, keeping the knee straight,
raise the leg straight back.
3. Perform 10 reps, take a rest, and perform a second set of 10.
The last exercise will target the quadriceps and hip flexors on the front of the thigh.
1. While standing, raise one leg up as in a marching motion.
2. To advance this exercise, lie on your back and keep your knee straight. Keep
the opposite knee bent.
3. Slowly raise the straight leg to the height of the opposite knee and return to the
starting position.
4. Perform 10 reps, take a rest, and perform a second set of 10.
The number of reps, sets and times per day are a guide for you. As always, listen to your body and adjust accordingly. Always end your stretching, strengthening or activity with ice.
References
- "Sports Medicine"; An overview of hip injuries in running; Paluska, SA; 2005
- "Clinically Oriented Anatomy," 5th ed.; Keith L. Moore and Arthur F. Dalley; 2006
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