Hip bursitis is a common source of pain on the outer side of the hip joint. This condition develops when the bursa, a small, fluid-filled sac that cushions the bone and soft tissues near the greater trochanter, becomes inflamed. While initial treatment often involves rest and ice to manage acute inflammation, controlled movement is necessary for long-term relief and recovery. A structured program of gentle, specific exercises helps address the underlying muscle tightness and weakness that frequently contribute to the problem.
The Mechanism of Exercise in Recovery
Movement plays a significant role in recovery by targeting the mechanical friction that causes the bursa to become irritated. The trochanteric bursa is situated beneath the gluteal tendons and the iliotibial (IT) band, which can become tight or dysfunctional. Controlled exercises are designed to improve the coordination and length of these surrounding muscles, thereby reducing tension and rubbing over the bony prominence.
Gentle movement helps restore the proper biomechanics of the hip joint, ensuring forces are distributed correctly during activities like walking or standing. This minimizes the repetitive stress that can trigger a flare-up. Exercise also increases blood flow to the hip area, aiding the body’s natural healing process by delivering oxygen and nutrients to the inflamed bursa.
Gentle Stretching for Flexibility and Pain Reduction
Stretching focuses on lengthening the muscles that may be pulling excessively on the hip structure, which reduces pressure on the irritated bursa. The supine hip rotator stretch, often referred to as the figure-four stretch, targets the deep gluteal and piriformis muscles. To perform this, lie on your back with both knees bent and place the ankle of the affected leg across the opposite thigh, just above the knee.
Gently pull the thigh of the unaffected leg toward your chest until you feel a stretch in the buttock and outer hip of the affected side. Hold this position for 15 to 30 seconds, ensuring the stretch remains gentle and does not cause sharp pain. Repeat this stretch two to four times, performing the movement slowly and in a controlled manner.
Another important stretch focuses on the iliotibial (IT) band, a thick band of tissue running along the outside of the thigh. Stand facing a wall, placing the affected hip closest to the wall for support. Cross the unaffected leg in front of the affected one, then lean your upper body away from the affected hip until you feel a stretch along the side of the thigh. Hold this stretch for 15 to 30 seconds and repeat three to five times.
Targeted Strengthening for Hip Stability
Once acute pain has subsided, introducing specific strengthening exercises is necessary to stabilize the hip and pelvis. Strengthening the gluteal muscles, particularly the gluteus medius, is a primary goal because these muscles are responsible for maintaining a level pelvis during movement. The glute bridge is also a foundational exercise for engaging the gluteus maximus, core, and lower back muscles, further stabilizing the hip.
Clamshell Exercise
The clamshell exercise isolates the gluteus medius. Lie on your unaffected side with both knees bent and your feet stacked. Keeping your feet touching, lift your top knee toward the ceiling without allowing your hips to roll backward. This movement should feel concentrated in the side of the top buttock. Hold the top position for a few seconds before slowly lowering your knee, aiming for two to three sets of 10 to 15 repetitions.
Side-Lying Hip Abduction
Side-lying hip abduction, or straight-leg raises, targets the hip abductors. Lie on your unaffected side with your top leg straight and your bottom leg bent for stability. Slowly lift the straight top leg about 12 inches off the floor, ensuring the toes and kneecap remain pointed forward and the pelvis does not tilt back. Hold the leg briefly at the top before a slow, controlled return, repeating for two to three sets of 10 to 15 repetitions.
Glute Bridge
Lie on your back with your knees bent and feet flat on the floor, hip-width apart. Press through your feet to lift your hips toward the ceiling until your body forms a straight line from your shoulders to your knees. Squeeze your glutes at the peak of the movement, hold for a few seconds, then slowly lower down, completing two to three sets of 10 to 15 repetitions.
Essential Safety Guidelines and Movements to Avoid
Listen carefully to your body and avoid any movement that reproduces a sharp, localized pain. When beginning an exercise program, start with low repetitions and short hold times, gradually increasing the duration or number of repetitions before adding any resistance. Progression should be slow, focusing on maintaining perfect form to avoid placing undue stress on the bursa.
Certain activities are known to aggravate trochanteric bursitis and should be avoided, especially during a flare-up. High-impact movements, such as running, jogging on hard surfaces, and jumping exercises like burpees or jumping jacks, should be temporarily stopped. Deep squats and lunges can also worsen symptoms by forcing the hip into extreme flexion and increasing pressure on the bursa.
Daily habits that put direct pressure on the inflamed bursa must be modified. This includes avoiding lying directly on the affected side when sleeping. Using a cushion or pillow between the knees can help keep the hip properly aligned when lying on the unaffected side. If symptoms persist or worsen despite a conservative exercise program and activity modification after four to six weeks, consult a physician or physical therapist.