Hip bursitis, specifically trochanteric bursitis, involves inflammation of a small, fluid-filled sac located on the outer side of the hip. This condition causes pain that can range from a sharp, intense feeling to a dull ache, often making simple activities uncomfortable. For runners, the question of whether to continue training is immediate and important when this condition develops. While running is often a contributing factor to the initial irritation, a structured approach to recovery and a gradual return to the sport can allow many athletes to resume their training pain-free.
Understanding Trochanteric Bursitis
The hip joint contains several bursae, which function as cushions between bones, tendons, and muscles to reduce friction during movement. The type most commonly associated with running pain is the trochanteric bursa, situated over the greater trochanter, the prominent bony point on the outside of the upper thigh bone. When this bursa becomes irritated and inflamed, the condition is known as trochanteric bursitis, or greater trochanteric pain syndrome (GTPS).
Repetitive movements, common in activities like running, can cause friction or overuse, which is a frequent trigger for this inflammation. A tight iliotibial (IT) band, the thick band of tissue running down the outside of the thigh, can rub across the bursa, causing irritation. Symptoms typically manifest as localized pain and tenderness on the outer hip, which often worsens with activity or when lying directly on the affected side.
Pain may also radiate down the lateral aspect of the thigh but usually does not extend all the way into the foot. Muscle weakness or imbalances in the gluteal muscles can also alter hip mechanics, increasing the pressure and friction on the bursa.
Running During a Flare-Up
Running while experiencing an acute flare-up of trochanteric bursitis is discouraged. The repetitive, high-impact motion of running significantly increases the compression and friction over the already inflamed bursa. Continuing to run during this painful phase acts as a constant irritant, preventing the bursa from healing and risking the development of chronic inflammation.
Ignoring the pain signal that running produces can compound the issue. The pain may cause subtle changes in your running gait, which can then place undue stress on the knee, ankle, or low back, risking a secondary injury. Pain is the body’s protective mechanism, and pushing through it risks converting a temporary issue into a persistent condition.
It is recommended to discontinue running and any other activity that reproduces the pain until the discomfort has subsided. A period of rest from the aggravating activity is often the first and most necessary step in allowing the bursa to calm down.
Safe Movement and Activity Modification
While rest from running is necessary during a flare-up, maintaining cardiovascular fitness is possible through activity modification. Shifting to low-impact alternatives allows for movement without the high compressive forces associated with running. Swimming, particularly flutter-kicking with proper form, places minimal stress on the hip joint. Cycling or using an elliptical machine can also be good options, provided the resistance remains low and the movement does not trigger hip pain.
High resistance cycling or riding uphill should be avoided as these actions increase pressure on the hip joint. Short-distance walking on flat, soft surfaces can be used to maintain mobility but should be stopped if any pain is felt in the lateral hip.
Daily habits also require modification to reduce pressure on the bursa. Avoid sleeping on the affected side, and consider placing a pillow between the knees when lying on the unaffected side to keep the hip aligned. Avoiding crossing your legs and minimizing the carrying of heavy items on the painful side also contribute to reducing friction and promoting healing. Applying ice to the outer hip area for 15 to 20 minutes several times a day can help manage local inflammation and pain.
Returning to Running Safely
Resuming running should only begin once you can perform daily activities and specific strengthening exercises without pain. The focus of initial rehabilitation is strengthening the hip abductors and external rotators, particularly the gluteus medius, as weakness in these muscles contributes significantly to poor running biomechanics. Exercises like clamshells, side-lying straight leg raises, and glute bridges help stabilize the pelvis and reduce strain on the bursa. A physical therapist can provide a specific program that progresses from non-weight-bearing exercises to single-leg stability work, ensuring the hip can handle the forces of running.
Once a baseline of strength is established and the hip is pain-free, a gradual return-to-running program must be implemented. This protocol involves starting with short run/walk intervals, such as alternating one minute of running with two minutes of walking. Total running volume should be increased slowly, generally by no more than 10% per week, to allow the tendons and bursa to adapt to the renewed stress. Paying attention to running form and addressing any underlying biomechanical issues, such as a narrow foot strike or poor footwear, will help prevent the condition from recurring. Consistency with hip strengthening exercises must continue indefinitely, as a conditioned musculature is the best defense against future flare-ups.