Hip Bursitis: Causes, Symptoms, and Physiotherapy Treatment

Hip pain that strikes when you lie on your side at night, climb stairs, or stand up from a chair is incredibly disruptive to daily life. While there are many possible causes of hip pain, one of the most common culprits is hip bursitis, an inflammation of the small fluid-filled sacs that cushion the hip joint. At Kinesio Rehab in Putra Heights, we treat hip bursitis regularly and have found that physiotherapy is consistently one of the most effective treatments, often eliminating the need for corticosteroid injections or surgery. Understanding the condition, its causes, and the treatment options available can help you take the right steps toward recovery.

What Is Hip Bursitis?

Bursae are small, fluid-filled sacs that act as cushions between bones, tendons, and muscles around joints. The hip has several bursae, but the two most commonly affected by bursitis are the trochanteric bursa, located on the outer point of the hip, and the iliopsoas bursa, situated at the front of the hip near the groin. Trochanteric bursitis is by far the more prevalent form and is the primary focus of this guide.

When the trochanteric bursa becomes irritated or inflamed, it produces pain on the outer aspect of the hip that can radiate down the outside of the thigh. This condition is now more accurately referred to as greater trochanteric pain syndrome (GTPS) in the medical literature, as research has shown that the pain often involves not just the bursa itself but also the gluteal tendons that attach nearby. This broader understanding has important implications for treatment, as addressing tendon health is just as important as managing bursal inflammation.

Causes and Risk Factors

Hip bursitis can develop from a variety of factors, and understanding your specific triggers is essential for effective treatment and prevention.

• Repetitive activities: Running, cycling, prolonged standing, or climbing stairs repeatedly can irritate the trochanteric bursa through friction between the iliotibial band and the greater trochanter.
• Gluteal weakness: Weak hip abductor muscles, particularly the gluteus medius, lead to altered hip mechanics that increase stress on the lateral hip structures.
• Hip posture habits: Habitually standing with your weight shifted to one side, sitting with legs crossed, or sleeping on the affected side all compress the bursa.
• Age and gender: Hip bursitis is more common in women, particularly those over 40, partly due to wider pelvic anatomy that increases the angle of pull on the lateral hip.
• Previous injury or surgery: A hip fracture, hip replacement, or fall onto the hip can trigger bursitis as part of the inflammatory response.

Recognising the Symptoms

The hallmark symptom of trochanteric bursitis is pain on the outer aspect of the hip, directly over the bony prominence known as the greater trochanter. This pain is typically sharp or burning initially and may become a broader, dull ache over time. Many patients report that the pain is worst when lying on the affected side, making sleep particularly difficult. Pain also commonly intensifies when climbing stairs, getting up from a deep chair, walking for extended periods, or crossing the affected leg over the other.

The pain may radiate down the outer thigh toward the knee, which sometimes leads to confusion with other conditions such as sciatica or hip arthritis. A thorough assessment by a physiotherapist can differentiate hip bursitis from these other conditions through specific clinical tests, ensuring you receive the correct treatment from the outset.

Physiotherapy Treatment Approach

Physiotherapy for hip bursitis targets both the symptoms and the underlying causes. In the acute phase, treatment focuses on reducing pain and inflammation through activity modification, avoiding positions that compress the bursa such as lying on the affected side or sitting with crossed legs. Ice application over the outer hip for 15 to 20 minutes several times daily can help manage inflammation. Gentle soft tissue release of the iliotibial band and surrounding muscles relieves tension that contributes to bursal compression.

As pain settles, the focus shifts to addressing the biomechanical factors that caused the bursitis in the first place. Progressive gluteal strengthening is the cornerstone of rehabilitation. We begin with isometric exercises such as lying on your back and pressing your knees apart against a resistance band, which activates the gluteus medius without provoking the bursa. Over several weeks, we progress to side-lying hip abduction, standing hip hitches, single-leg balance exercises, and eventually functional movements like squats and step-ups with proper hip control.

Research strongly supports exercise-based physiotherapy as the most effective long-term treatment for greater trochanteric pain syndrome, outperforming corticosteroid injections which provide only short-term relief and carry the risk of tendon weakening with repeated use.

Lifestyle Modifications for Recovery

Beyond structured exercises, several simple lifestyle changes can significantly accelerate your recovery. When sleeping, place a pillow between your knees to keep your hips aligned and reduce pressure on the bursa. Avoid crossing your legs while sitting, and if you sit for long periods, get up and move every 30 minutes. When standing, distribute your weight evenly between both legs rather than habitually leaning to one side. If you are a runner or walker, temporarily reduce your distance and intensity, and consider softer surfaces until symptoms resolve. Wearing supportive footwear with adequate cushioning also helps reduce impact forces transmitted to the hip.

Expected Recovery Timeline

Most patients with hip bursitis experience significant improvement within six to eight weeks of consistent physiotherapy and adherence to lifestyle modifications. However, full resolution, particularly of the underlying gluteal tendon weakness, can take three to six months. Patience and consistency with the exercise programme are essential. Patients who commit to their rehabilitation and continue with a maintenance exercise programme after symptoms resolve have the lowest rates of recurrence. At Kinesio Rehab, we work with each patient to develop a clear, achievable plan that fits their daily routine, ensuring that recovery is sustainable and lasting.