Hip bursitis, specifically trochanteric bursitis, is a common condition characterized by pain on the outside of the hip, near the bony prominence known as the greater trochanter. This pain results from inflammation of the bursa, a small fluid-filled sac that cushions the tendons and muscles as they move over the bone. The goal is to maintain fitness without aggravating the inflamed bursa by focusing on low-impact activities that minimize pressure and friction on the lateral hip structures. Always consult a physician or physical therapist before beginning any new exercise regimen.
Understanding Movement Restrictions
Certain movements must be avoided because they directly irritate the inflamed bursa, either through compression or excessive friction. High-impact activities, such as running, jogging, and plyometrics like jumping jacks, should be temporarily stopped. These exercises produce significant ground reaction forces that travel up the leg and compress the bursa against the underlying bone.
Repetitive side-to-side leg movements, known as hip abduction and adduction, can also cause friction on the bursa. This includes exercises like side-lying leg lifts or using elliptical machines with a wide, forced stride pattern, which are often poorly tolerated. The inflamed bursa is sensitive to stretching and rubbing from the surrounding tendons, particularly the iliotibial band.
The condition is also sensitive to sustained compression, which is common during rest and sleep. Lying directly on the affected side should be avoided, and even sitting with the legs crossed can place uneven pressure on the hip joint. Exercises that require deep hip flexion, where the knee comes close to the chest, can compress the bursa, which is why deep squats and lunges are restricted.
Safe, Low-Impact Seated and Aquatic Cardio
Seated and aquatic exercises are often the best starting point because they eliminate or significantly reduce the weight-bearing impact on the hip. Stationary cycling, especially on a recumbent bike, is generally well-tolerated since the body weight is supported by the seat. When using a stationary bike, the seat height must be properly adjusted so there is only a slight bend in the knee at the bottom of the pedal stroke.
Maintain a very low resistance setting to prevent the need to push or pull forcefully with the legs, thereby reducing strain on the hip flexors and abductors. High resistance or attempting to pedal out of the saddle can increase the compressive forces that irritate the bursa. A rowing machine can also be used, but hip flexion at the catch must be limited to avoid pinching the hip. Achieve this by not sliding the seat all the way forward toward the foot platform, shortening the stroke and limiting the depth of the hip bend.
The pool offers an excellent environment for cardiovascular work because the water’s buoyancy counteracts gravity, minimizing joint compression. Deep-water running, where the feet do not touch the bottom, simulates the running motion without impact. Wearing a flotation belt helps keep the body upright. Water walking in chest-high water is another safe option, as the water resistance provides a full-body workout while the buoyancy supports the joints.
Safe, Low-Impact Standing Cardio
For individuals who tolerate some weight-bearing activity, certain standing machines and exercises can provide a cardiovascular benefit with minimal impact. Walking is the most accessible choice, but it should be done on flat, even surfaces, focusing on a shorter stride length. A shortened stride reduces the rotational forces and peak stresses placed on the hip joint during the push-off phase of the gait cycle.
The elliptical trainer is a popular non-impact option, but it requires careful use to prevent irritation of the bursa. Users should select a machine with a narrow, fixed stride pattern to minimize excessive side-to-side hip movement. Maintaining an upright posture and avoiding the tendency to lean or sway the torso laterally helps ensure the weight is distributed evenly and reduces friction on the outer hip. Stair climbers can be used safely by limiting the step depth. By only stepping shallowly and using the machine’s handrails for partial support, you can engage the leg muscles without forcing the hip into a deeply compressed position.
Technique Adjustments and Pain Monitoring
The primary rule when exercising with hip bursitis is to adhere to the “no pain” principle, which requires strict self-monitoring. Keep the pain level below a 3 out of 10 on a pain scale (where 0 is no pain). If the pain begins to increase during the activity, or if the quality of the pain becomes sharp or shooting, the exercise should be stopped immediately.
Monitoring the pain response for 24 hours after a workout is important, as tissue inflammation can have a delayed reaction. Increased pain, significant stiffness, or a return of night pain the following morning indicates that the exercise intensity or duration was too high and must be reduced. Always begin any new activity with short durations (10 to 15 minutes), and only increase the time or intensity gradually as long as the pain remains stable and mild. If a flare-up occurs, seek the guidance of a physical therapist for a personalized rehabilitation program.