Introduction

Abursa is a small sac of fluid in a joint that helps to decrease the friction between the bones and the soft tissues surrounding them. Bursitis refers to the inflammation of one or more of these bursae. There are two important bursae in the hip joint, and when they become inflamed, they can cause a dull and achy pain that is made worse with movement or pressure on the area.¹ The hip may also become swollen, tender or redder in colour than the surrounding skin.² Most of the time, hip bursitis is caused by repetitive stress from things like running or from pressure when lying on one side of the body for a long time. Other risk factors for the condition include rheumatoid arthritis, diabetes, obesity, hip surgery, and certain occupational factors. 

Importance of physical therapy in treatment 

Some treatment plans for hip bursitis use strategies that reduce inflammation and pressure on the hip bursa, such as physical therapy. The goals of physical therapy for hip bursitis are to reduce pain, improve range of motion, strength, and restore normal functional mobility.⁶ The professionals are experts in musculoskeletal conditions and plan an exercise program tailored to the specific patient. These exercises can be done at home, and with guidance, the patient can progress and benefit holistically, as these exercises help with a multitude of other things, such as weight loss and reducing the risk of heart disease.⁷ 

Most people with hip bursitis benefit from seeing an orthopaedic specialist, physiotherapist or sports therapist, who all have a great deal of knowledge about musculoskeletal conditions and can ensure that your treatments and exercises for bursitis are optimized.⁸ Some treatment strategies may include:

• Heat therapy
• Ultrasound therapy
• Ice therapy
• Balance
• Electrical stimulation
• Massage
• Manual stretching
• Exercises focussing on range of motion and strength
• Hip stability

The majority of strategies are passive, but the most effective treatment plans include a variety of strength and balance exercises alongside stretching.⁹ 

Understanding hip bursitis

Anatomy of the hip and bursae¹⁰

Causes of hip bursitis

The main causes of hip bursitis include overuse with repetitive movements and pressures within the joint. Stress to the two bursae covering the trochanter and the iliopsoas can inflame, causing pain to the bursa sac.¹¹ Injuries such as bumps, falls or lying on one hip for extended periods can also damage the bursae. Bursitis can also be a direct effect of overuse of the joint from things like running or standing for an extended period. Other conditions such as rheumatoid arthritis, diabetes, obesity, and tendonitis of the leg muscles can also cause inflammation of the hip bursae.^3,12 Surgery in the hip area or prosthetic implants can also irritate the bursae.^3,4 Lifestyle factors such as occupational work involving gardening, painting and musical instruments can also contribute.⁵ 

Symptoms of hip bursitis 

Symptoms of hip bursitis include hip pain, which is often exacerbated by walking, climbing stairs or standing.¹³ Discomfort may also be felt when lifting legs to exit a bed or car, sitting with crossed legs or lying on the hip. The hip area may also be tender to touch, and the patient may notice swelling and red discolouration of the area. Over time, the hip may become stiff, which may limit movement due to pain.¹⁴ 

Role of physical therapy

Goals of physical therapy for hip bursitis 

The pain caused by bursitis can be targeted with daily physical therapy.¹⁵ The exercises aim to improve the circulation of blood to the area as well as joint mobility. The activities work to improve the musculoskeletal, nervous and integumentary systems. They can help to strengthen your muscles, bones and joints.

Techniques used during physiotherapy include ice therapy (cryotherapy), electrical stimulation and ultrasound therapy.¹⁶ Some may use strength exercises which aim to strengthen the hip rotator and abductor muscles. When these muscles are weak, the hip bursae are under more stress, which can also lead them to become inflamed.¹⁷ Stretching the iliotibial and hip flexor muscles also helps to decrease tightness and pressure on the bursae. Improving posture and gait can also reverse any biomechanical issues that may cause bursitis. Physiotherapists also provide further education in these techniques, which help patients manage their symptoms.¹⁸ 

Benefits of physical therapy 

One advantage of physical therapy is that it is much cheaper than medication or surgery.¹⁹ Additionally, the non-invasive approach allows for the body’s natural recovery and strengthening, which is beneficial in the long run. The long-term impact encourages the health and well-being of the musculoskeletal system and reduces the chance of the recurrence of hip bursitis.n.²⁰ Overall, the holistic approach manages pain and reduces the risk of chronic conditions and problems with the musculoskeletal system. 

Physical therapy techniques

Initial assessment 

Firstly, physiotherapists will need the patient's history including their medical history, current symptoms and previous treatments or injuries. This allows for the professional to be able to tailor the treatment plan to the individual. The initial assessment also includes a physical examination through which the professional can gain a greater understanding of the physical condition of the patient.²¹ This consists of observing a range of movements, joints and checking for pain. 

Treatment modalities 

The variety of treatment modalities includes manual therapy, which can be through soft tissue and joint mobilisation. This aids in reducing tension in the muscles by applying pressure and stretching muscle tissue. This allows for any fluid trapped in the tissue to be released, removing the source of pain and inflammation. The other therapeutic exercises use stretching and strengthening to improve the quality of life by correcting impairments and rehabilitating skeletal and muscular functioning.²² Additional treatment modalities include ice therapy, ultrasound and electrical stimulation, which aid the short-term symptoms of the patient. 

Activity modification and ergonomics 

Activities stretching a range of motion can help reduce the risk of aggravating old injuries and worsening their condition. Physiotherapists can support patients to guide them on the correct movement patterns to ensure they are done the most efficiently.²³ They also make sure that movements which may trigger repetitive stress injuries are avoided or corrected.

Home exercise program 

Importance of continuing exercises at home 

A physiotherapy treatment plan may include gluteal strengthening exercises such as clamshells and glute bridges. Additionally, stretching exercises done standing or kneeling, for example, iliotibial band stretching and hip flexor stretching target the flexibility of the hip area.²⁴ For stability and core engagement, an exercise ball can be used, as well as standing on one leg. 

Progress monitoring and adjustments

The progression through physical therapy requires regular follow up for monitoring, as well as identifying any issues that may need some adjustments in the treatment plan. Follow-up gives the opportunity to discuss any concerns which may lead to further risks and complications causing further damage.²⁵ This supports a quick recovery; other evaluations may require the use of other professionals, such as dieticians and doctors. Positions should be held for 30 seconds, then relaxed for 5 seconds before repeating. To reduce the risk of further injuries, a warm-up and cool-down should also be done. 

Summary

Physical therapy is an efficient and effective treatment option to relieve pain from hip bursitis and prevent its recurrence. The help of professional support and a holistic approach to the improvement of overall health, as well as the understanding of good practice in daily life, promotes a higher quality of life. This recovery method can become part of life-long habits that can manage further pain and reduce the risk of future inflammation for patients.