Trochanteric bursitis (TB) is a common source of chronic hip pain caused by the inflammation of the bursa that cushions the greater trochanter, the bony prominence on the outside of the thigh. This fluid-filled sac normally functions to reduce friction between the bone and overlying tendons and muscles, such as the iliotibial band. When the bursa becomes irritated or inflamed, it causes localized pain on the outer hip and upper thigh, often worsening with activity like walking or climbing stairs. The pain is particularly noticeable when lying on the affected side, disturbing sleep and everyday comfort. Lasting relief requires a comprehensive approach that addresses both immediate symptoms and the underlying mechanical issues that led to the inflammation.
Immediate Strategies for Reducing Pain
The initial focus during a flare-up is to calm the irritated bursa and reduce discomfort. Activity modification is the first step, involving a temporary reduction in movements that compress or irritate the hip, such as avoiding prolonged standing or high-impact activities like running. This relative rest allows the inflamed tissues to settle down.
Applying cold therapy to the painful area helps decrease inflammation and numb the sharp sensation. Ice packs should be used for 10 to 20 minutes at a time, several times a day, using a thin cloth barrier placed between the ice and the skin. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can also manage pain and reduce the inflammatory response. Consult a healthcare provider before using NSAIDs for more than a few days due to potential side effects.
Simple adjustments to sleeping posture are beneficial for avoiding direct pressure on the bursa. Avoid lying on the affected hip entirely, opting instead to sleep on the unaffected side or on the back. Placing a pillow between the knees when side-lying helps maintain neutral hip alignment and prevents the top leg from pulling the affected hip inward, which can aggravate the bursa.
Professional Medical Treatment Options
When initial self-care measures do not provide adequate relief, a healthcare professional can offer targeted interventions to break the cycle of pain and inflammation. Corticosteroid injections are a common and highly effective treatment, typically mixed with a local anesthetic. The anesthetic provides immediate, temporary pain relief and helps confirm the bursa is the source of the pain.
The corticosteroid component, a potent anti-inflammatory medication, is delivered directly into the bursa or surrounding tissue to reduce swelling. This procedure is often performed in the office and may sometimes be guided by ultrasound to ensure precise placement of the medication. Many patients experience significant and lasting relief after a single injection. Repeating the procedure is sometimes necessary if pain returns, but is generally limited to two or three injections per year due to potential side effects.
In rare and persistent cases where conservative treatments, including injections and physical therapy, have failed to resolve symptoms for six months or more, surgical intervention may be considered. The most common surgical approach is a bursectomy, which involves removing the inflamed bursa. This is typically a last resort, as the vast majority of trochanteric bursitis cases resolve without the need for an operation.
Structured Physical Therapy and Rehabilitation
Structured physical therapy (PT) is the most important component for achieving long-term healing, as it addresses the underlying biomechanical issues rather than just the inflammation. A physical therapist prescribes a specialized program of exercises designed to restore the normal function and strength of the hip complex. The primary goals are to increase flexibility and strengthen the muscles that stabilize the hip and pelvis.
Stretching exercises often focus on the iliotibial (IT) band and the hip flexors, as tightness in these areas increases friction over the greater trochanter. Specific stretches, like the standing IT band stretch or the gluteal stretch performed while lying on the back, are incorporated to improve tissue extensibility. These should be performed gently, without exacerbating the existing hip pain.
Strengthening the hip abductors, particularly the gluteus medius and gluteus minimus muscles, is a cornerstone of rehabilitation. Weakness in these muscles leads to instability and poor movement patterns during walking or running, increasing strain on the bursa. Exercises such as side-lying leg lifts, clamshells using a resistance band, and single-leg bridges help build the necessary strength to stabilize the pelvis and reduce friction.
The typical timeline for a structured rehabilitation program spans several weeks to a few months, depending on the severity of the condition and the consistency of the patient’s effort. The therapist may also incorporate modalities like ultrasound or heat and cold therapy to manage residual pain during early recovery. Exercise progression is gradual, moving from simple isometric contractions to more functional, weight-bearing movements as pain subsides.
Addressing Underlying Causes and Preventing Relapse
True healing involves identifying and correcting the factors that initially caused the bursa to become inflamed, ensuring the condition does not return. Trochanteric bursitis is often a symptom of underlying biomechanical problems, such as a leg length discrepancy, which alters the gait and places unequal stress on the hips. Correcting this may require shoe inserts or orthotics to balance the leg lengths and restore proper alignment.
Weakness in the core and gluteal muscles, combined with poor posture or improper form during exercise, contributes significantly to the problem. Individuals engaging in repetitive activities, like running or cycling, must evaluate their form and equipment to minimize friction on the outer hip. Maintaining a healthy body weight is also beneficial, as excess weight increases the load on the hip joints during everyday movement.
Ongoing maintenance is necessary to prevent a relapse once the initial pain is gone. This involves regularly incorporating the prescribed stretching and strengthening exercises into a daily routine, even when symptom-free. Avoiding prolonged periods of pressure on the hip, such as sitting with crossed legs or leaning heavily on one leg while standing, helps maintain a healthy hip environment. By addressing these structural and habitual factors, individuals can solidify the gains made in therapy and sustain long-term relief.