One not-so-pleasant day, you get out of bed and experience hip pain. Many can relate to this because hip pain is one of the most common musculoskeletal problems.
According to the review paper “Chronic Hip Pain in Adults: Current Knowledge and Future Prospective,” hip pain affects 10% of the general population, a figure that tends to rise with age. As much as 14.3% of adults experienced noticeable hip pain most days during the study’s six weeks. (1)
There are many causes of this issue, but almost 10 years of working with clients as a personal trainer has shown me that hip bursitis is among the top three most common causes of hip pain.
In this article, I cover exercises and stretches to help you treat this problem and bulletproof your hips. I’ve also included how to cope with the pain until the situation improves.
- What is Hip Bursitis?
- 9 Exercises for Hip Bursitis
- Enhance Recovery and Prevention: The Role of Stretching in Your Routine
- Coping with Pain
- What If Conservative Treatment Does Not Help?
- Other Possible Causes of Hip Pain
- Wrapping Up
What is Hip Bursitis?
Hip bursitis arises when the bursa, a small fluid-filled sac, becomes inflamed.
Our bodies have more than 150 of these bursae, and any of them can undergo inflammation. These bursae act as protective cushions, lessening friction between bones, tendons, and muscles during movement. When bursitis occurs, the bursa loses its usual lubricating function.
Since we are focusing on hip bursitis today, this condition specifically involves the inflammation of two major hip bursae: the trochanteric bursa and the iliopsoas bursa. The predominant location of pain is typically on the outer side of the hip, indicating inflammation of the trochanteric bursa.
If you feel pain in the groin region, the largest bursa in the body (the iliopsoas bursa) may be inflamed. However, pain in the groin region is more likely to stem from other issues, such as adductor strain or hernia.
9 Exercises for Hip Bursitis
Strengthening the muscles around the hip joint is of utmost importance.
You must integrate these nine exercises into your workout program to make the recovery swift and successful.
Side-Lying Straight Leg Raise
This exercise strengthens the gluteus medius, one of the three gluteal muscles and abductors. The strain on the bursa will decrease once those outer hip muscles become strong. It is a low-taxing movement, great for the initial phase of recovery.
- Lie on your side with your legs straight and aligned.
- Lift the top leg toward the ceiling while keeping it straight.
- Hold for two to three seconds, then lower it back down.
Pro tip: If this is too easy for you but you don’t have access to a hip abductor machine, use ankle weight.
Introduce the hip abduction (abductor) machine after strengthening the abductors with less strenuous exercises and when the pain has mostly subsided.
Avoid using excessive weight initially and concentrate on proper form.
- Adjust the machine and sit with your back against the backrest.
- Place the outside of your thighs against the machine’s pads.
- Push your thighs outward against the resistance, opening your legs as far as possible.
- Slowly return to the starting position.
Pro tip: Drive with the outer part of your knees. That is the best way to activate abductor muscles while safeguarding your hip and bursa.
The clamshell is beneficial in every recovery routine targeting injuries or syndromes in the hip region. It activates all muscles, including deep ones, and will not cause the pain to return or intensify.
- Lie on your side and bend your knees.
- Keeping the feet together, open the top knee like a clamshell, lifting it toward the ceiling.
- Hold for a moment and return to the starting position.
- Repeat for 10 to 15 reps before changing sides.
Pro tip: Using a resistance band (banded clamshell) is an excellent way to make this exercise more challenging. Put the band above the knees and choose an appropriate resistance so your range of motion is not impaired.
If you have a problem with the iliopsoas bursa, this is the most important exercise because it strengthens the adductors.
Nevertheless, it is equally helpful for the trochanteric bursa issue. Weak adductors create imbalance and misalign the pelvis even if your abductors are strong, so you must also do side-lying adduction.
- Lie on your side with the bottom leg straight and the top leg bent.
- The thigh of the top leg should be perpendicular to your torso.
- Lift the bottom leg upwards while keeping it straight.
- Hold for a moment, then slowly lower it back down.
Pro tip: Maintain a neutral spine position and avoid excessive tilting of the hips. Also, ankle weights can make the exercise more challenging.
Activating the posterior chain (lower back, glutes, and hamstrings) should be a top priority for every person, whether you have hip bursitis or not.
The glute bridge is an excellent movement for the posterior chain. It also strengthens the core, and all of this together improves hip stability. You can do it with your body weight or use a barbell or dumbbell.
- Lie on your back with your knees bent and feet flat on the ground.
- Lift your hips upwards as high as possible by contracting your glutes.
- Hold the isometric contraction for a second, then lower back down.
Pro tip: Do not overextend your lower back; otherwise, you risk strain and reduce the effectiveness of the exercise.
During the initial assessment with my clients, one of the problems I most often notice is poor hip mobility and control due to weak flexors, rotators, and abductors.
The fire hydrant exercise is a way to improve lateral strength and mobility quickly.
- Start on all fours in a tabletop position.
- Lift one knee outward to the side, keeping the hips square.
- Hold before returning the leg to the starting position.
- Repeat on each side.
Pro tip: Focus on movement to improve mind-muscle connection. (2)
Compound movements are great, but the problem is that they are very tiring and not always suitable during recovery.
The wall squat is a compound exercise engaging the muscles around the hips, thighs, and core. Yet, it is not as strenuous as a regular square, for example, and it does not create direct pressure on your hip.
- Stand with your back against a wall and feet hip-width apart.
- Slide down the wall by flexing your knees, hips, and ankles.
- Thighs should be parallel to the ground.
- Hold the position for at least 20 seconds.
Pro tip: Pay attention to proper knee alignment to prevent unnecessary joint stress.
The leg press primarily targets the quads in the upper (proximal) part, closer to the hips.
This exercise allows you to use and control resistance without placing excessive strain on the bursa and hips.
- Load weights.
- Sit on the leg press machine with feet hip-width apart.
- Unrack the sled by pushing the platform away by extending your legs.
- Lower the platform using a slow and controlled motion.
Pro tip: Every machine is different, so make sure you set it up correctly. The inappropriate position will prevent a full range of motion.
The bird dog is a core-strengthening movement, especially popular in yoga workouts.
I like incorporating yoga in recovery programs, and the bird dog movement is one of my go-to. It is perfect for improving stability and coordination.
- Start in a tabletop position.
- Extend one arm forward and the opposite leg backward, creating a straight line.
- Repeat on the other side and continue alternating.
Pro tip: Engage your glutes and core throughout the range of motion.
Enhance Recovery and Prevention: The Role of Stretching in Your Routine
Exercises alone will not bring the same benefits if you fail to stretch every day. Also, stretching can provide immediate tension relief and temporarily reduce pain.
The piriformis muscle is located deep in the buttocks, and when it’s tight, hip bursitis symptoms worsen.
This stretch aids in releasing tension in the piriformis and surrounding muscles.
- Sit or lie down with one leg crossed over the other.
- Use the leg below to gently push the knee of the crossed leg towards the opposite shoulder.
- Hold the stretch for 15-30 seconds, feeling a gentle stretch in the buttocks.
Pro tip: Avoid jerking your limbs to avoid pain.
The quad stretch targets the muscles at the front of the thigh.
Although it will not solve the problem all alone, you will undoubtedly feel relief in the entire quads and hips after performing this stretch.
- Lift one foot toward your butt by flexing your knees.
- Grab the ankle with the corresponding hand.
- Hold the stretch, feeling a pull in the front of the thigh.
- Maintain balance and repeat on the other side.
Pro tip: Keep the knees close during the stretch.
Kneeling Hip Flexor Stretch
This is my favorite hip stretch. After sitting for several hours in a car or plane, for example, I find kneeling hip flexor stretch amazing for alleviating tension and restoring range of motion in no time. It is helpful when the bursa is inflamed, too.
- Kneel on one knee with the other foot in front, creating a 90-degree angle with the knee.
- Shift your weight forward, feeling a stretch in the hip of the kneeling leg.
- Hold for 15-30 seconds, then switch sides.
Pro tip: Keep the back straight throughout the entire stretch.
The knee-to-chest is a versatile stretch, and I recommend it even to senior clients. Everyone can perform it, even those with reduced mobility.
- Lie on your back with your legs extended.
- Bring one knee towards your chest, holding it with both hands.
- Hold the stretch, then switch legs and repeat.
Pro tip: You can keep the opposite leg bent if that is more comfortable.
This exercise provides a deep stretch for the hip rotators and glutes. It is amongst the most effective stretches, making it part of the daily routine of many pro athletes, including NFL superstar Russell Wilson.
But there is one problem. This is an advanced stretch, and many of my clients cannot perform it correctly, regardless of age and hip bursitis status.
- Get in a plank position.
- Bring one knee forward and place it near the opposite wrist.
- Extend the other leg straight back, feeling a stretch in the hip and glutes.
- Hold, then switch sides.
Pro tip: Try grabbing the ankle of your extended leg for a deep quad stretch.
Coping with Pain
It takes time for exercise and stretching to alleviate the symptoms of hip bursitis. The pain won’t go away overnight.
The following steps will make the pain bearable until you heal.
OTC and Topical Analgesics
Over-the-counter (OTC) medications like non-steroidal anti-inflammatory drugs (NSAIDs) help reduce pain and inflammation. You must consult your healthcare provider before using any new medication.
Ice and Heat Treatment
Applying an ice pack to the affected area in the acute phase will minimize swelling and relieve pain. Use a thin cloth as a barrier to prevent frostbite, and apply the cold pack for 15-20 minutes.
After a few days, introduce heat therapy to promote muscle relaxation. Take advantage of hot packs or warm baths for around 30 minutes.
If you have Achilles tendinopathy, I would tell you to put some weight on the tendon, but for hip bursitis recovery, rest is crucial.
You need to give your body time to heal. Additionally, avoiding movements that exacerbate pain prevents overcompensation and subsequent injuries to other body parts.
A foam roller can help you work on muscle tightness around the hip.
Gently roll the gluteal area over the foam roller, applying moderate pressure. This allows the release of tension and enhances flexibility.
Don’t roll the outer part of your hip and thigh because you don’t want to put more pressure on the bursa or massage the IT band. The band of connective tissue does not benefit from massage/foam rolling, which was proven in a randomized controlled trial. (3)
Change Your Mattress
We spend a third of the day on the mattress, and most people don’t even think about whether the mattress suits their sleep position and health condition.
The largest percentage of people sleep on their side. Side sleepers with hip bursitis will have difficulty falling asleep, especially if they have a mattress that is too hard. If this sounds familiar, you should buy a medium-firm mattress to avoid worsening issues during the night.
What If Conservative Treatment Does Not Help?
Additional interventions may be necessary when conservative measures fall short in managing hip bursitis.
For those who did not opt for diagnostic imaging like MRI or ultrasound when the pain initially started, it is vital to do it now if the pain and limited mobility persist.
Shock wave therapy (ESWT) may be one of the doctors’ first recommendations. It is a non-invasive treatment option using shock waves to stimulate healing and diminish inflammation.
Steroid injections are next in line. These injections deliver corticosteroids directly into the affected bursa, reducing inflammation. It is often effective, but there are theoretical risks.
If all other approaches fail, surgery is a last resort. Surgery may include removal of the inflamed bursa (bursectomy) or other procedures addressing underlying issues contributing to hip bursitis.
Other Possible Causes of Hip Pain
If it’s not hip bursitis, what could it be?
I’m not trying to encourage you to self-diagnose. I just want to tell you about other causes of hip pain.
- Tendinitis: Inflammation of the tendons surrounding the hip joint. Overuse, repetitive stress, or sudden injuries can trigger tendinitis.
- Strains: Muscle and tendon strains result from sudden movements, overexertion, or inadequate warm-up. Strains include the hamstring, adductor, abductor, or quadriceps muscles.
- Labral tear: It is damage to the ring of cartilage (labrum) surrounding the hip socket. This condition can cause pain, clicking sensations, or instability in the hip joint.
- Sciatica: Widespread problem stemming from compression or irritation of the sciatic nerve. It can manifest as hip pain. Causes include herniated discs or spinal stenosis.
- Arthritis: It is inflammation of the hip joint. The most common forms are osteoarthritis (wear and tear of the joint cartilage) and rheumatoid arthritis (an autoimmune condition). Both require professional evaluation and treatment.
How can lifestyle modifications contribute to managing hip bursitis?
Lifestyle modifications play a vital role in solving hip bursitis. Daily exercise, weight loss, ergonomic chairs, and comfortable footwear can significantly alleviate stress on the hip joint.
Can hormonal changes impact the severity of hip bursitis?
Hormonal changes can indeed influence the severity of hip bursitis symptoms. Fluctuations in hormones, especially estrogen, may increase inflammation and heightened pain sensitivity. Lower estrogen levels in postmenopausal women are also a potential culprit for hip bursitis.
What is the typical recovery timeline for individuals with hip bursitis?
Mild cases will probably see improvement within a few weeks, while more severe ones may require several months. However, it’s important not to rush your recovery, as the timeline for healing varies from person to person. Treatment outcome is influenced by factors such as adherence to plan and severity and overall health, age, and occupation.
Are there specific benchmarks that indicate returning to high-impact activities is safe?
Safe reintegration of high-impact activities depends on individual progress. Benchmarks include a significant reduction in pain, increased joint flexibility, and the ability to perform low-impact exercises without discomfort. Nonetheless, reintegration of high-impact activities depends on individual progress, and playing sports before you are fully healed is harmful.
Hip pain not only hampers your workouts but also makes everyday activities difficult.
Hip bursitis can be solved with regular exercise and stretching routine in over 90% of cases, but you have to be persistent because improvement can be slow.
Just take it day by day, and the pain will slowly subside. If, even after a few weeks, the situation is not improving, it is time to visit a doctor and find out the actual cause of hip pain.
In the comment section below, tell me more about your condition, and if you have additional questions, I will be happy to answer them.
- Ahuja V, Thapa D, Patial S, Chander A, Ahuja A. Chronic hip pain in adults: Current knowledge and future prospective. J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):450-457. doi: 10.4103/joacp.JOACP_170_19. Epub 2020 Sep 26. PMID: 33840922; PMCID: PMC8022067.
- Calatayud J, Vinstrup J, Jakobsen MD, Sundstrup E, Brandt M, Jay K, Colado JC, Andersen LL. Importance of mind-muscle connection during progressive resistance training. Eur J Appl Physiol. 2016 Mar;116(3):527-33. doi: 10.1007/s00421-015-3305-7. Epub 2015 Dec 23. PMID: 26700744.
- Pepper TM, Brismée JM, Sizer PS Jr, Kapila J, Seeber GH, Huggins CA, Hooper TL. The Immediate Effects of Foam Rolling and Stretching on Iliotibial Band Stiffness: A Randomized Controlled Trial. Int J Sports Phys Ther. 2021 Jun 1;16(3):651-661. doi: 10.26603/001c.23606. PMID: 34123517; PMCID: PMC8169023.