Exercises for hip bursitis (GTPS) – Video Tutorials included
Before we delve into exercises for hip bursitis, it would be prudent to find out more about this condition..
What is Hip Bursitis (GTPS)?
When thinking of hip bursitis, imagine an intense pain on the outside of your hip after you go for a walk around the shops. When you lie down, you simply can’t lie on that side due to pain.
Whenever you sit in low chairs, it hurts getting up and you have no hope of standing for more than 10 minutes. You push around your hip trying to find the painful source and almost jump as you hit an exquisitely tender spot.
Maybe you don’t have to imagine because you are experiencing these symptoms?
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, like most things medical, we don’t exactly know – hence the vague, non-descriptive diagnosis – but we do have some ideas! It’s most likely your tendon (that cable-like structure attaching muscle to bone) that gets compressed and overloaded.
Who commonly suffers from hip bursitis?
For all the males reading this, be thankful that your chances of getting this are much lower, however you’re not fully out of the woods and I have seen a few males suffer from this condition in my time.
A far more likely picture is the 40-60-year-old female with a little extra padding, who may have put herself through more physical activity than usual – and it doesn’t have to be squatting 100kg’s at the gym!
It could be you recently moved, or that tennis match you played with some old university friends, or even a new workplace which was recently fitted-out with ‘ergonomic’ standing desks without the option to sit.
What causes hip bursitis (GTPS)?
Pain in 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.
If you look at the above hip joint the gluteal tendon wraps from behind, all the way around to the big ridge of the femur. You can imagine that as the leg moves inwards, the tendon is compressed on the 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 (No, I’m not talking from personal experience).
I just recently thought it was a great idea to run 10km’s after not having run in years. I paid for it the next week, but thankfully my tendons coped. This may not be the case for everyone, especially as we age, our 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.
So 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.
If you’re like me though, you may want to be difficult and try to self-diagnose. Fortunately, there are some tests you can do to help you come to a better conclusion.
Firstly, just try poking 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.
I have made a video on youtube that 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!
The other important question to answer is… how do I help it?
I want to share some secrets that, if every person understood, would mean I wouldn’t have a job as a physiotherapist. 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.
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.
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.
Check out this next video where I break down 7 tips to help with hip bursitis:
Let’s go through some exercises for hip bursitis!
I will teach you 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. I have made one more clip of this exercise for ease of explanation.
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.
Let’s talk about 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!
Yes, I just said it. 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.
So what about that injection?
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 trialing 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!
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