What is Hip Bursitis

What is Hip Bursitis

Small containers of fluid are located throughout the body and are known collectively as bursae and individually as a bursa. Functioning much like a pillow or cushion, these containers of fluid are strategically located in the joints and around the ends of important bones like the elbow, knee, heel, and shoulder. Using the medical suffix “itis” to indicate that the tissue has become irritated, hip bursitis is the condition in which the bursae of the upper leg bone which makes contact with the hip are damaged and become tender and irritated.

How Hip Bursitis Injuries Occur

Most cases of hip bursitis are the result of long-term damage to the underlying bursae. As the bursae become damaged from overuse, they can start to become irritated and tender. Some cases of hip bursitis occur after receiving a direct injury to the hip from violent interactions with an object, person, or the ground. Other cases of hip bursitis are the secondary effect of developing bone spurs, arthritis, or a curved spine.

Most sports injuries involving hip bursitis are inflicted on the bursae in the side of the hip due to violent strikes to the exterior of the hip and/or top of the leg. This type of injury is called trochanteric bursitis. Hip bursitis in non-athletes is usually to back side of the hip and is referred to as ischial bursitis.

Who Is Vulnerable to a Hip Bursitis Injury

Sports medicine experts have revealed that the most common type of activity associated with developing hip bursitis is training for marathons as overuse and pressure on the hip joint can result in irritation and inflammation of the bursae. Other vigorous activities with an increased risk of developing a hip bursitis injury include contact sports like hockey, rugby, lacrosse, and American football where players sometimes get a hard object crashing against the outside of the hip.

A number of secondary conditions can lead to an increased risk of developing hip bursitis. These may include:

  • People with a case of gout or what’s known as pseudo-gout.
  • People who stress or push their hips too far.
  • Individuals with another form of hip injury.
  • Damaged immune systems, especially people with a staph infection.
  • Anyone who has diabetes mellitus.
  • People whose legs are not of the same length.
  • Anyone with bone spurs on their hips.
  • People with posture problems, especially individuals with conditions like scoliosis.

Symptoms of a Hip Bursitis Injury

Hip bursitis is usually diagnosed on the spot by laypersons and can be identified through a number of symptoms, including:

  • Aching or tenderness in the hip.
  • Warmth felt in the affected area.
  • Sharp discomfort in the upper leg that fades to a dull aching pain after a while.
  • Tightness and lack of flexibility in the hip.
  • Discomfort that starts at the outside of the hip and then shoots down to the upper leg.
  • Increased discomfort when moving up stairs, squatting, dancing, or walking for a long time.
  • Developing a limp and/or feeling a loss of power in the leg muscles.

Hip bursitis is called acute if the symptoms appear for just a few hours or days. Hip bursitis is called chronic if it lasts for a really long time or continues to disappear and then re-appear.

Treating a Hip Bursitis Injury

Most of the time, cases of hip bursitis are self-diagnosed based on the known checklist of symptoms associated with this type of injury. In more severe cases, trained medical personnel may perform an MRI or X-ray scan in order to accurately diagnose the ailment.

Anyone with a case of hip bursitis is counseled to rest for a couple of days to allow the injury to begin to heal. The standard course of therapy is to apply cold to the site, as long as it is on the outside of the clothes, to the area for 5-15 minutes, repeated two to four times a day. To minimize tenderness and discomfort, people with hip bursitis can take an aspirin or ibuprofen. If the tenderness or discomfort remains severe, crutches can be used to help make walking less uncomfortable.

Once the discomfort has been reduced, the standard course of treatment for hip bursitis is a number of flexibility and strength-building movements.

For more egregious cases of hip bursitis, it may be necessary for a doctor to remove excess fluid from the injured bursa and/or inject the injured area with a drug to minimize tenderness and discomfort. Surgical intervention is only rarely appropriate and then only for the most severe cases of hip bursitis.



A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exact location and cause of your hip and groin pain.

Ultrasound enables you and your therapist to view the hip and groin region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.


Explore more advanced diagnostic tools available only at NYDNRehab:


Hip dysfunction and pain can be a complex issue due to interactions of the trunk, pelvis, low back, groin and hip joint. Physical therapy and rehabilitation that is based only on subjective clinical analysis often addresses the symptoms without resolving the underlying cause.


At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the hip joint and pelvis. Our tests are evidence-based protocols that are considered to be the gold standard in the world of research.

Our testing protocol includes:


Combined lumbopelvic hip stability test using DLEST methodology with C.A.R.E.N., our computer assisted rehab environment


Hip joint stability test using DLEST methodology with C.A.R.E.N.


3D star excursion banner test (SEBT) for assessing the involvement of the hip joint and muscles in postural stability


3D gait or running analysis


3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvis on hip rotation


Rehabilitative ultrasonography for viewing intrinsic hip stabilizing muscle activation patterns

We also perform neuromotor testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility


Surface electromyography (SEMG) may be added to any of the above tests when needed.

Based on our experience and evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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