If you’ve been feeling a deep, aching pain on the side of your hip, especially when lying on it, walking up stairs, or after a long day of activity, you might be dealing with hip bursitis. This frustrating condition can make even simple movements painful and can linger if not treated properly. The good news? Physiotherapy can be incredibly effective at resolving hip bursitis, and in many cases, patients can avoid more invasive treatments like cortisone injections.

Let’s take a deep dive into what hip bursitis is, why it happens, and how you can get on top of it with the right physiotherapy approach.

What is Hip Bursitis?

Hip bursitis refers to inflammation of the bursa, a small fluid-filled sac that sits between your bones and soft tissues to reduce friction. The most common type is trochanteric bursitis, which affects the bursa on the outer side of the hip, near the bony prominence called the greater trochanter.

When this bursa becomes irritated, it can swell and cause pain, making activities like walking, running, or even sleeping on your side quite uncomfortable.

What Causes Hip Bursitis?

There’s no single cause of hip bursitis, but it often results from one or more of the following:

• Overuse or repetitive movement – Activities like long-distance running, cycling, or stair climbing can place excessive strain on the hip bursa.
• Weakness in the hip muscles – Weak glutes and other hip stabilisers can lead to poor movement patterns, increasing strain on the bursa.
• Tight IT band – The iliotibial (IT) band, which runs along the outer thigh, can become tight and rub against the bursa, causing irritation.
• Direct trauma – A fall onto the side of your hip can lead to bursitis.
• Postural Issues – The most common position that causes hip bursitis is sitting with legs crossed or sleeping with the knee crossing the mid line of the body. 
• Gait Abnormalities – If you walk with an altered gait due to knee or back pain, this can overload the hip bursa.
• Arthritis or other inflammatory conditions – Conditions like rheumatoid arthritis can increase the risk of bursitis.

Symptoms of Hip Bursitis

• Pain on the outer side of the hip, which may radiate down the thigh.
• Pain when lying on the affected side, especially at night.
• Discomfort when walking, climbing stairs, or standing up after sitting for a while.
• Swelling or tenderness over the greater trochanter.

Physiotherapy Treatment for Hip Bursitis

Physiotherapy plays a key role in treating hip bursitis by addressing the underlying causes of the irritation rather than just the symptoms. A good physio-led rehab program will focus on reducing pain, improving mobility, and strengthening the surrounding muscles to prevent recurrence.

1. Reducing Pain and Inflammation

In the early stages, treatment may involve:

• Activity modification – Avoiding aggravating activities like prolonged standing or crossing your legs.
• Ice therapy – Applying an ice pack for 15-20 minutes can help reduce inflammation.
• Soft tissue massage and dry needling – These techniques can help release tight muscles around the hip.

2. Hip Strengthening Exercises

Weak glutes and hip stabilisers are often a culprit in hip bursitis, so a targeted strength program is crucial.

Some key exercises include:

• Isometric External Rotation – using a belt or resistance band around knees, trying to separate the knees from eachother with out any movement.
• Side-lying hip abductions – Lifting the leg while lying on your side helps strengthen the glutes.
• Clamshells – Activates the gluteus medius, an important stabiliser of the hip.
• Bridges – Helps build strength in the glutes and core.
• Standing hip hikes – Improves pelvic control and stability.

3. Improving Hip Mobility and Flexibility

Tight hip structures, like the IT band and hip flexors, can contribute to bursitis. Physiotherapy often includes:

• Foam rolling the IT band
• Stretching the hip flexors and quadriceps
• Gentle yoga-style movements to promote mobility

4. Gait and Postural Correction

Your physiotherapist will assess how you move and walk to determine if any biomechanical issues need addressing. Correcting poor movement patterns can significantly reduce strain on the hip over time.

5. Gradual Return to Activity

Once pain levels have improved, your physio will guide you through a progressive return to activities, ensuring that your hip is strong and ready to handle the demands of exercise and daily life.

Case Study: Avoiding a Cortisone Injection Through Physiotherapy

A recent patient, Karen came into our clinic with persistent lateral hip pain that had been troubling her for months. She had been to her GP, who recommended a cortisone injection, but she was hesitant as she had a severe needle phobia.

When Karen arrived at our clinic, she was struggling with pain at night, especially when lying on her left side. She also experienced sharp pain walking up hills and during long walks. After a thorough assessment, we identified that her glute medius was significantly weak, and she had a very tight IT band contributing to her bursitis.

We started her on a structured physiotherapy program that included:

• Soft tissue release techniques to ease tightness in her lateral hip muscles.
• Hip strengthening exercises focusing on glute activation.
• Postural awareness training to reduce excessive hip drop during walking.
• Gradual activity modification – we encouraged her to take breaks during long walks and avoid crossing her legs while sitting.

After six weeks of treatment, Karen reported a significant reduction in pain. By the eight-week mark, she was back to pain-free walking and sleeping on her side. She was thrilled to have avoided the cortisone injection and felt more confident in managing her symptoms long-term.

When is a Cortisone Injection Needed?

While physiotherapy is the best long-term solution for hip bursitis, there are some cases where a cortisone injection may be beneficial. If a patient has severe pain that is not responding to treatment, an injection may help provide short-term relief, allowing them to participate in rehab exercises. However, it’s important to remember that cortisone is not a cure—it simply reduces inflammation temporarily. Cortisone will only remain in the area it is injected for six weeks. 

Final Thoughts: Why Physiotherapy is the Best Option for Hip Bursitis

Hip bursitis can be stubborn, but the right approach can make a world of difference. Rather than relying on short-term fixes like cortisone injections, a solid physiotherapy plan focuses on addressing the root cause of the issue, ensuring that you not only get pain relief but also reduce the chances of the problem coming back.

If you’ve been struggling with hip pain, don’t put off getting help. Physiotherapy can be a game-changer in getting you back to comfortable, pain-free movement! Find out today by calling XPhysio on 9806 3077.

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References & Further Reading:

• Australian Physiotherapy Association: https://australian.physio/
• Health Direct Australia on Bursitis: https://www.healthdirect.gov.au/bursitis
• Running Physio Blog on Hip Bursitis: https://www.running-physio.com/trochanteric-bursitis/