Hip bursitis is a condition that can afflict runners, causing discomfort and hindering performance. Understanding hip bursitis and its impact on your running routine is crucial for maintaining a healthy and pain-free experience. Let’s talk about what you can do if this issue has flared up for you.
If you’ve been running for any amount of time, you’ve probably experienced some kind of pain or discomfort. To an extent, it’s the nature of the beast of the hobby we’ve chosen to pursue. But there’s a difference between typical discomfort from running and pain we should be worried about.
One area that tends to cause runners a number of issues are our hips. Sometimes we feel pain in our hips, but other times the pain appears elsewhere in our kinetic chain but is a result of a weakness or imbalance in our hip muscles.
There are a number of things would could cause hip pain while running and most are preventable and treatable. But recently, I’ve gotten an increasing number of questions specifically about hip bursitis and so I want to address it.
In this comprehensive guide, we will delve into the world of hip bursitis, exploring its causes, symptoms, diagnosis, treatment options, prevention strategies, and more.
What is bursitis and why do runners get it? How can I prevent hip bursitis before it starts? Are there exercises runners can do to prevent or treat bursitis? I’ll tackle these questions and more in this article.
What is Hip Bursitis?
When our hips are healthy, they’re padded with fluid-filled sacs known as bursae. These act as a cushion and reduce friction within our hip joints.
We actually have more than a dozen bursae in the hip joint.
When these little sacs in our hips become irritated and inflamed, it’s known as hip bursitis. The most common type is trochanteric bursitis, named because it involves the trochanteric bursa. Other bursa found in our hips include the ischial bursa, iliopsoas bursa, and the gluteus medius bursa.
You can also get knee bursitis, but that’s a topic for another day.
Bursitis can be quite painful.
- When it comes to hip bursitis, the pain is often on the outside of the hip but can also occur in the front.
- The pain may be worse when running or doing other impact activities.
- The area may also be tender to the tough and pain may radiate down the leg.
According to an article from the National Library of Medicine, hip bursitis can affect people of all ages, but is more common in women. Young female athletes are one group prone to hip bursitis, which is linked to the Q angle from the hip to the knee. As a result, females have tighter iliotibial bands (IT Band), that can place a strain on the bursae in the hip.
Symptoms of Hip Bursitis
Not sure if your hips are just sore after increasing mileage or there is something more going on? Let’s look at some of the signs and symptoms that you might be developing hip bursitis.
If you’re checking off a lot of these, then it’s time to get checked out. Don’t let this linger on and turn in to a bigger issue.
Pain (During and Not During Movement)
One of the primary symptoms of hip bursitis is pain in the affected hip area. The pain is often localized to the outer part of the hip, but it can also radiate to the thigh or buttock. The intensity of the pain can vary, ranging from mild discomfort to sharp, debilitating pain.
Tenderness
The affected hip area may feel tender to the touch, especially over the bursa that is inflamed. Pressing on the outer hip or lying on the affected side may elicit tenderness or increased pain.
Swelling
In some cases, hip bursitis can cause noticeable swelling around the hip joint. This swelling is a result of inflammation and fluid accumulation within the bursa.
Limited Range of Motion
Hip bursitis can lead to a decreased range of motion in the affected hip. Activities such as running, climbing stairs, or sitting for extended periods may exacerbate this restriction and cause discomfort.
It is important to note that these signs and symptoms can vary in severity and may come and go over time.
Why Runners Experience Hip Bursitis?
According to Isabella Diener, a corrective and pre/postnatal exercise trainer, the most common cause of hip bursitis is an overuse injury such as repetitive motion.
“In runners, this often occurs when you are not giving your body enough time to recover between runs, you are increasing volume or intensity too quickly for your joints to adapt, you are skipping warm up and cool down exercises, and you are not addressing muscle imbalances, tightness, or weakness, which may contribute to the stress being placed on the hip joint.”
Oh look! Someone else also find the dynamic warm ups and cool downs to be super important! Thank you, Isabella!
Other causes of bursitis include:
- trauma, which could be something as simple as tripping and landing awkwardly, or an infection
- personal biomechanics can also impact the likelihood of developing bursitis
- sudden and drastic change in the type of shoes you’re wearing for runs
How is Hip Bursitis Diagnosed?
Have you wondered does hip bursitis show up on an x-ray or an MRI? Once we’ve got pain and we’re ready to get it resolved, we want to know exactly what needs to happen next! So here’s what you should expect.
Physical Exam
Initially your doctor will perform a physical exam. They’ll be looking at all the symptoms we previously noted. A healthcare professional will examine the affected hip, assessing for tenderness, swelling, and range of motion limitations. They may also perform specific maneuvers to provoke pain and determine the precise location of discomfort.
For many this is enough to make a diagnosis and get you started on recovery.
Ultrasound
Others will also go forward and do an ultrasound, though in most cases this is not needed. So if you’re like me and trying to keep those medical bills down…if the Dr feels confident bursitis is the issue, you probably don’t need to add this on.
An ultrasound can detect areas of fluid, such as the excess synovial fluid found in a swollen bursa. So it would just be additional confirmation to make you feel better (or worse?!).
Additional Tests
If they go through the above and are not sure about the cause of your pain, they may choose to do additional imaging studies to rule out other causes.
X-rays or MRI scans can help visualize the hip joint and surrounding structures, allowing healthcare professionals to identify any abnormalities, such as bone spurs or structural issues, that may contribute to hip bursitis symptoms.
Can Runners Prevent Hip Bursitis?
Absolutely!
The easiest thing to do at the first sign of any discomfort is to take some time to rest. Evaluate your training load and either reduce it or take some time off until the signs and symptoms subside.
This doesn’t mean you have to be a couch potato. You can stay active but focus on cross training.
Very few injuries are totally resolved with rest. You need to find the underlying cause and get to work!!
Is It Ok to Run With Hip Bursitis?
As a running coach I know how badly you want to keep going, but in this case you gotta stop. The inflammation needs a chance to drop and if you keep pushing there’s simply no chance for the body to heal.
Instead, it’s time to dive in to the strength workouts, figuring out what went wrong with your training and creating a sustainable plan to prevent future issues.
It may be valuable to check in with your favorite physical therapist or personal trainer to make sure your suspicions are accurate. They can also give you a preventative or rehabilitative plan and provide guidance on how to get back to running without worsening your symptoms.
Anti-inflammatories can also be helpful for pain reduction, but not for long term healing. Remember, while this guide offers valuable information, it is essential to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.
9 Exercises to Prevent and Treat Hip Bursitis
As I said, hip bursitis is preventable and some of the prevention methods are also treatment methods too.
According to Diener, it’s important to focus on the musculature of the hip when trying to prevent or treat hip bursitis. Avoiding high impact movements is key.
“Exercises that build the musculature of the hip will assist in the prevention and treatment of hip bursitis,” said Diener.
“These exercises strengthen and stabilize the deep rotator muscles, which support the hip joint itself, as well as the larger muscles that move the leg and hip. Strengthening these muscles allows repetitive impacts from activities like running to be absorbed by the muscles of the hip, and less so by the joint itself.”
If you feel like you’ve heard me talk about the need for Core Strength a million times, well this will make 1 million and one.
If you aren’t yet doing the 30 Day Core program that’s just 10 minutes a day, get on it! This is such an easy way to incorporate movements that are going to prevent injuries in to your warm up.
“In addition, activities such as stretching and foam rolling the hip loosen the muscles surrounding the joint resulting in better range of motion through the hip joint and reducing the likelihood of overuse injuries stemming from repetitive movement.”
Below are some exercises and stretches that can be valuable in the prevention and treatment of hip bursitis. None of these movements should be performed super fast. Control is the name of the game!
#1 Foam Roll Hip Bursitis
If you’re currently in pain, then it may not be possible to start with some strength work. Instead, we want to spend some time moving through our full range of motion and trying to release tight muscles.
The goal is not to roll directly on your painful hips, but instead we are foam rolling surrounding areas. What happens with foam rolling is a compression of nerves that will send signals to the brain to relax.
- quads, hip flexors
- glutes, hamstrings
- abductors
- never directly on the IT Band
This is also a good chance to utilize your massage gun. The vibration also tells the body to relax and this again will help slow those pain signals and stop any pulling that might be aggravating the hip.
#2 Light Walks
As you start to come back from pain, it’s ok to begin including short walks. Consider this like your testing ground to know you can keep progressing your PT movements and work towards running.
If you begin to feel pain, then it’s time to cut the walk short.
Keep a log and note how far you are going and the intensity. As long as you are getting the inflammation under control and doing the other work, you should slowly begin to feel comfortable going longer and longer.
Once you are comfortably walking at a good pace pain free, you can start to play with some short run intervals.
#3 Lateral Walks with Band
Place a small exercise band either around the ankles or just below the knees (go above knees if this is too hard). Bend your knees slightly and then take steps to the right and to the left. You can alternate or do several reps in one direction and then repeat going the other way.
Try to keep tension on the band at all times and stay in the bent knee position to keep your muscles engaged throughout the set.
Do 10-20 repetitions in each direction and you can repeat for 2-3 sets.
#4 Squat Variations
We all know how to do a basic squat, but it’s important to mix up our positions. Some variations to the basic squat include:
- taking a wider stance with our toes pointed out (this will help target the hip adductors)
- taking a more narrow stance with our feet closer together
- single-leg squat (you can do this with a chair or bench)
You can also load these movements with a dumb bell or two for some greater resistance.
I would recommend 2 or 3 sets of 10-12 repetitions.
#5 Clamshells
While clamshells have been shown to be less effective than many other hip strength exercises, they are a good place to start when rebuilding from an injury. So if you are currently dealing with hip bursitis, you’ll want to include these.
Clamshells target our glute muscles and strong glutes are important for runners.
To do a clamshell, lay on your side with your knees slightly bent. You want your knees in line with your hips so your feet will be slightly behind you when your knees are bent.
Keeping your feet together, lift your top knee and then lower. You should feel muscles like your hip abductors engage while doing this exercise. It can help to place your top arm on your glutes to monitor muscle engagement.
Ideally you will progress this to include a mini band above the knees, increasing the intensity of the movement.
Do 10-12 reps and make sure to repeat the exercise on the other side.
#6 Lateral Leg Raises
You can do these standing or while laying down. Either way, focus on one side at a time.
If lying on the ground, lay on one side. Lift your top leg up keeping your toe pointed forward or down to the floor to engage the hip muscles and then lower. You don’t have to lift your leg super high. Do 10-12 reps and then repeat on the other side.
To do this standing, hold onto a chair or a wall and lift your leg out to the side and lower. Try to stay centered over your supporting leg and remember to lead your lift with your heel to ensure you’re engaging the muscles of your hips.
You can add a band around your ankles to either version of this for some resistance, if needed or desired.
Checkout a full video of some hip stability moves!
#7 Figure-Four Stretch
This stretch focuses on the muscles on the side of the hip and the glutes.
Lay on your back with your knees bent. Cross one leg over your opposite knee. Pull the supporting leg/knee toward you until you feel a stretch.
Hold this position for at least 20-30 seconds and repeat on the other side.
#8 Hip Flexor Stretch
If you have pain in the front of your hip, stretching your hip flexor can be helpful.
Kneel with one leg in front. You should have a 90-degree angle in the front and back knees to start. From there, engage your core and your glutes and move your hips forward to your front foot until you feel a stretch.
Hold this position for at least 20-30 seconds and then repeat on the other side.
My preference is to do this as a couch stretch. I find people often get in to a better position.
#9 Outer Hip Stretch
This stretch offers another way to target the outer hip muscles but while standing.
Standing with your feet together, cross the right leg behind the left. Take your right arm, reach it overhead and stretch to the left while allowing your right hip to lean in the opposite direction.
You should feel a nice stretch from your armpit all the way down to your knee. Again, hold for at least 20-30 seconds and make sure to repeat on the other side.
Other Ways to Treat Hip Bursitis
If your hip bursitis pain persists or is more severe, I want to emphasize the value in getting advice from a professional. Targeted physical therapy may be just what the doctor ordered!
Anti-inflammatory medication may be prescribed or suggested, as well as icing the affected area(s).
Sometimes, depending on the severity, a steroid injection or surgery may be advised. However, this will most likely be a last resort.
Common Questions about Hip Bursitis for Runners
Hip bursitis can raise several questions for runners seeking to understand the condition and its implications for their running routine. Here are answers to some of the frequently asked questions:
Can I continue running with hip bursitis?
While it depends on the severity of your symptoms, it is generally recommended to modify your running routine when experiencing hip bursitis. This may involve reducing mileage, adjusting intensity, or incorporating cross-training activities.
It’s essential to listen to your body, avoid activities that exacerbate pain, and consult with a healthcare professional for personalized guidance.
How long does it take to recover from hip bursitis?
Recovery time can vary depending on factors such as the severity of the condition, adherence to treatment, and individual factors. In mild cases, symptoms may improve within a few weeks with appropriate rest and treatment.
Most doctors will say 6 to 10 weeks if you don’t catch it right away and stop running. Which let’s be honest…most of you do not.
More severe cases or underlying factors may prolong the recovery process. Consistency with rehabilitation exercises and following medical advice can help expedite recovery.
Can I prevent hip bursitis from recurring?
YES!!! Please don’t see the list of exercises above as for just during treatment. Instead, think about making them a long term part of your preventative plan.
Focus on maintaining strong hip and core muscles, incorporating proper warm-up and cool-down routines, gradually increasing training intensity, using suitable footwear, and listening to your body by addressing any pain or discomfort promptly.
When should I consider surgery for hip bursitis?
Surgery is usually considered when conservative treatments have been ineffective, and symptoms persist despite rehabilitation efforts. It’s typically reserved for severe cases of hip bursitis that significantly impact daily activities and quality of life.
Can physical therapy help with hip bursitis in runners?
Yes, physical therapy is often an integral part of the treatment plan for hip bursitis in runners.
A physical therapist can assess your condition, provide targeted exercises and stretches, address muscle imbalances, improve joint mobility, and guide you through a comprehensive rehabilitation program. They can also provide education on activity modification, pain management techniques, and injury prevention strategies to aid in your recovery and return to running safely.
All right, I hope this article helps to answer some of your questions and give you some guidance around dealing with this hip pain.
Looking for additional guidance?
- Top 13 Hip Strengthening Exercises
- Best Hip Stability Movements
- Video: Foot strengthening Exercises from a Physical Therapist
- Improving Your Foot Strike
- Hip Flexor Stretches
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