Exercises for hip bursitis in 2023 (GTPS) – Video Tutorials included
Exercises for hip bursitis are not only essential, they are easy to perform and don’t cost any money!
Often exercise can be overlooked as passive options like injections or pain-killers can seem like attractive alternatives. Although, evidence would suggest these other treatments will not get the same results as good old-fashioned exercise.
Before delving into exercises for hip bursitis, there are many important facts to know about this condition.
Want to skip ahead?
How do you know if you have hip bursitis?
Exercises to improve Hip Bursitis
What is Hip Bursitis (GTPS)?
Hip bursitis is a common condition which most often affects middle-aged women, although men can still have this problem.
The main symptoms involve intense pain on the outside of the hip after a walk, or standing prolonged periods. Other symptoms will include increased pain with lying on the affected side in bed, pain after sitting in low chairs, and pain with any pressure on the outside hip.
These symptoms are caused due to inflammation of the bursae and/or a problem with the overlying tendons where they attach into the bone.
Why is this condition now called GTPS?
Medical professionals commonly refer to this as hip bursitis. A more recent and correct term is Greater Trochanteric Pain Syndrome (GTPS) because there is little evidence showing that the bursae in your hip causes the pain.
As to what causes the pain, the evidence is slightly uncertain! However most health professionals will now agree it’s probably the tendon (that cable-like structure attaching muscle to bone) that gets compressed and overloaded.
The tendon of the muscle gluteus medius attaches into the outside of your hip and is responsible for holding your hips level as you walk. The bursae underlying this tendon can also have inflammation present and may account for some pain.
Who commonly suffers from hip bursitis?
Females aged between 40-60 years old are much more likely to suffer with GTPS. Some later research comming out speculate this may be due to changing levels of hormones during this period of life.
Males can suffer from GTPS and usually will present with worse symptoms. Although it is very rare for males to get GTPS in the first instance.
What causes hip bursitis (GTPS)?
Hip bursitis, now called GTPS, is caused by increased load on your hips causing the structures to react and become sore. This might include going for a long hike when not usually active, or just resuming weekend sports etc.
Pain on that outside hip will occur when the tendon in your hip is compressed and overloaded. Females are more prone because their hips are generally wider than males so the tendon has further to wrap around to attach to the thigh bone, which means more compression.
There are also links in the research that GTPS might be also linked with certain hormonal factors as it is much more common in post-menopausal women.
The above picture explains how the muscle Gluteus medius comes from the hips and then joins into the hip bone on the outside via the tendon. As the leg moves inwards this tendon can be compressed against the hip bone.
Other issues that can contribute to further compression can be weak hip muscles so the hips will drop down or that habit of crossing legs, or walking like you are walking on a tight-rope.
Tendons are made to transfer force
A tendons job is to transfer force. It’s very structure is made of fine threads all woven neatly together like a rope or cable to make it strong and able to resist and transfer force. When all things go well, tendons are perfectly suited to transfer load.
In the hip, the tendons job is to transfer load up and down the leg when you walk, run, or stand like a stork on one leg whilst attempting yoga.
Issues arise then the tendons capacity to transfer the load is exceeded. If there is too much load placed on the tendon it will become irritated.
Age will also affect a tendons ability to transfer load. When ageing, the tendons have less capacity to adapt to sudden loads. Once a tendon has been overloaded they can be very temperamental and difficult to settle back down.
How do you know if you have hip bursitis?
The easy way is to get diagnosed by a physiotherapist or a GP. Click Physiotherapy is an online physiotherapy service that can easily help you with this and get you back on your feet.
There are some tests you can try to help with a diagnoses for GTPS.
Firstly, just try pressing on the sore area – sounds simple? Because it really is! If you can find one point of exquisite tenderness right over the bony part of your outside hip, the chance is more likely that it could be GTPS. If you can’t locate one point of tenderness then the chances of your problem being GTPS is very low.
Secondly just stand on the sore leg for 30 seconds. After this amount of time, if you don’t have your usual outside hip pain then it’s extremely unlikely to be GTPS. Make sure you make it all the way to 30 seconds before you start high-fiving your partner, it may only start to get sore towards the end.
The video below describes these two tests in detail. You can see it right here:
These two tests alone can give you a very good idea about what’s going on. Remember though, you’re not a medical professional, so if things don’t add up, or aren’t improving then please see someone!
How can you improve hip bursitis?
The BEST way to fix this problem (and most others) is to manage the amount of load on the poor tendon that isn’t coping. If you can do that effectively, half of the battle will be won.
Remember the two problems in the first place was compression on the tendon, and sudden increases in load.
Managing compression
To avoid compression the best thing to do is imagine a line through the middle of your body down to the floor, and try to stop your sore leg from going across this line.
That means lie with two pillows under your leg when you sleep, don’t walk with a really narrow base (the tightrope walk) and don’t cross your legs as you sit. If you need, try an egg-shell mattress overlay to avoid compression.
Don’t be too rigid with the application of this rule, however it will help to settle the hip bursitis if you can manage this especially early on.
Managing load
Managing the load on your hip is easier said than done, that’s why sometimes you will need the help of an experienced physiotherapist.
In a nut-shell, you want to avoid drastic changes in activity, and things that will cause big loads on the hips. This would include jogging, standing for long periods (like hours), deep squats and things like these.
Your age and usual activity will impact the effect that load will have on your hip. For example, if I jogged 8km’s every day, then I may be able to get away with still jogging 4km as I have halved the load on my hip.
Watch this next video which breaks down the 7 tips to help with hip bursitis:
Exercises to improve hip bursitis!
Below are some basic exercises for hip bursitis to get started. If you need further assistance with these, book your appointment today with Click Physiotherapy for physio right where you are.
The most helpful exercise for hip bursitis is a very simple one. You can watch the video below for which explains the exercise in detail.
Simply lie on your side with your hips and knees bent and a pillow between your legs. From here go to lift the top leg, but not all the way from the pillow. Hold this static contraction for 5 seconds and then rest your leg.
Another exercise that is very helpful can be completed in your home standing at the kitchen sink! Although there is no video for this exercise, the instruction is quite sound.
Stand with you feet slightly wider than hip distance and knees slightly bent. Gently try to push your legs apart – like you are attempting the splits.
Obviously they wont move cause you’re standing, but the muscles will still work – we call this as isometric contraction. You should feel the muscles around your buttocks work and not at the front of your hip.
This exercise should be pain-free. You can begin by holding for 5 seconds and repeating this 5 times.
As you improve, progress this much like the side-lying exercise. First move to 10 repetitions with 5 second holds. As it gets easier you can try 10 repetitions with 10 second holds.
Exercises to avoid!
Not all exercises will be beneficial for your hip. I will say it again, there are some exercises that will make the pain worse.
Gone are the days where we said ‘no pain, no gain’.
Even as close as 10 years ago, physiotherapists’ would dish out exercises that could potentially make the problem worse.
Let’s talk about these exercises so you can stop doing them immediately!
Stay away from stretches!
Stretches can really flare up your hip bursitis due to reasons we have previously gone through.
If you recall, tendons don’t like to be compressed. Unfortunately, during a good gluteal stretch, the tendon will be squished right into the bone.
You need to stay away from bottom stretches and hamstring stretches as these have potential to make the problem worse.
But don’t worry, there is no evidence for stretching in prevention of injury anyway – however that’s a topic for another day.
Any jumping exercise will hurt!
Plyometric exercises will stir up any tendon pain. We need to make sure that these types of exercises are avoided whilst the hip is still painful.
This includes any hip intensity dance activity for weight loss, or any form of skipping and jumping.
If you stay away from these whilst the hip is sore, it will give it the best chance to recover well.
Are injections helpful for hip bursitis?
Often the management of hip bursitis will be cortisone or steroid injections, do they work?
Clinical papers show that in the short term they may offer relief, but have no difference moving past six weeks.
Interestingly, if you stick to exercises for hip bursitis and education, they can have the same or even better effects than an injection alone.
The bottom line:
In summary, our advice would be to try physio first, and if you are getting no-where, then see a GP about trialling the injection alongside graded exercise.
Remember an injection may make it feel better, but won’t change the underlying problem, which is why modifying load is so important! Unfortunately nothing in life comes easily which is the same for the management of injuries, so get working and lets see you pain-free soon!
References:
Cowan RM, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial. The American Journal of Sports Medicine. 2022;50(2):515-525. doi:10.1177/03635465211061142
Mellor R, Grimaldi. A, Wajswelner H, Hodges P, Abbot JH, Bennel K, Vicenzino B (2016) Exercise and load modification versus corticosteroid injection versus ‘wait and see’ for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BCM Musculoskeletal Disorders, 30:17,196
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This is amazing, great information