Pain in the lateral (outside) of the hip or leg can be associated with a condition known as hip bursitis or trochanteric bursitis. This condition is almost always a repetitive motion injury, but it could also be initially caused by direct trauma. In the case of a runner, the condition is most likely a repetitive overuse injury.
As an overuse injury, hip bursitis is caused by repetitive friction over the greater trochanter of the hip bone (which ultimately leads to pain). This excessive friction is almost always due to faulty biomechanics. In this case, it’s faulty running mechanics.
9 Tips to Self-Treat Hip Bursitis
The greater trochanter is a portion of the femur (leg bone) that is easily felt. It’s the harder portion of the hip bone on the side of the hip. A bursa is a fluid-filled sac that is around and near boney areas and tendons areas where there is the potential for the tendon to rub or have friction. The job of the bursa sac is to reduce friction by providing cushion and a viscous synovial fluid for the tendon to slide through. This sac and/or the associated tendon can become inflamed and painful.
Runners will often develop hip bursitis after running on uneven terrain or downhill or running higher mileage or at a slower pace than one is used to. Pain can range from the lateral side of the leg around the greater trochanter area, back toward the buttocks or down the leg along the IT Band. The pain can be very debilitating to the point that running or hiking activities have to be stopped. Even walking becomes difficult. It’s more commonly diagnosed in women, but both genders can develop this condition.
Risk factors for Hip Bursitis include:
- Gender. Females are at a higher risk for developing hip bursitis because of the shape and size of the hips and pelvis.
- Poor hip abductor and/or hip external rotator strength. This includes weakness in the gluteus medius and/or tensor fasciae latae muscle (TFL).
- Improper foot biomechanics during the single leg stance phase of the gait cycle or the mid foot strike during running.
- Leg length differences.
- Running on cambered surfaces (like the tilted edge of a road or trail). Running on one side of a crowned road or trail, the “high side”, causes the foot to pronate more.
- Overtraining. This condition often occurs when increasing your training volume too quickly (too much, too soon).
9 Tips to Self-Treat Hip Bursitis (Side of the Hip Pain)
- Rest. In this case, rest would indicate stopping all running activity for a period of time and tapering down from your regular exercise activity and any activity that worsens your symptoms. You should not return to running until you can be pain-free throughout the day.
- Ice. Hip bursitis is usually due to overuse which causes the inflammatory process. I typically apply ice to the lateral part of the hip over and near the greater trochanter, but place it on your most painful location(s). The rule for icing is to apply ice no more than twenty minutes per hour. Don’t place the ice directly against the skin, especially if you are using a gel pack style. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be a cheap alternative or you could use one of my favorite gel pack style cold packs.
- Reduce training volume. Initially, discontinue running and any other aggravating factor until you can be pain-free throughout the day. It’s important to reduce the training volume and intensity in order to allow the tissue time to heal as you adequately rehabilitate. Be particularly cautious by reducing activities for at least a few weeks as you rehabilitate.
- Anti-inflammatories. Consider speaking with your medical professional about a short course of anti-inflammatory medication to help speed up your recovery. In severe cases, a cortisone injection may also be warranted. Addressing the biomechanical causes for the pain is the only way to prevent it from re-occurring.
- Improve your mobility. Mobility issues and myofascial restrictions are highly correlated with hip bursitis. Tightness in the IT Band (or in the deep hip internal or external rotators) is a contributing factor. Use self-mobilization techniques to work on the areas above, below, and around the painful area. Avoid the painful area as it tends to be too inflamed and boney to be easily or effectively self-mobilized.
- I recommend using a foam roller to address tightness in the quadriceps or IT Band. You may also utilize a tennis or lacrosse ball to mobilize the tensor fasciae latae (TFL) appropriately. The foam roller and roller massager don’t work as well because the greater trochanter of the hip (the boney part of the hip that sticks out) tends to be in the way. Using a plunger or “cupping” can also be an effective method of mobilizing the tissues particularly in this area of the body.
- Kinesiological taping. The purpose of the tape is to help support the tissue and aid in lymphatic drainage. It can also possibly help with kinesthetic awareness to insure proper mechanics.
- Strengthen your hip muscles. This is usually the most important component of your rehabilitation and for prevention long term. Weakness in the hip external rotators and the hip abductors, like the gluteus medius and the tensor fasciae latae (TFL), can lead to hip bursitis, IT Band Syndrome or other knee related issues. Core muscle weakness can also be associated with hip bursitis.
- Check your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. This could result in IT Band Syndrome or other hip, knee, or ankle related issues.
Shoes typically only last 350-500 miles. If you are nearing those miles, then it may be time to change. If you’re unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe. If you continue to experience pain and you feel it is related to your foot or footwear, then you may need to consult with a physical therapist that specializes in feet and orthotics.
- Have your gait analyzed while running. Gait or running abnormalities can increase your risk of developing hip bursitis. Over striding tends to occur while running downhill. Scissoring occurs when your leg crosses over the midline with each step. Both over striding and scissoring are easily recognized by a professional. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running. Then watch the recording to see if you notice either over striding or scissoring.
The best way to rehabilitate hip bursitis is to avoid it in the first place! Be sure to work on lower leg mobility as part of your recovery protocol. Implement a strength training routine that targets the hip musculature as part of your ongoing cross training. If your race includes many hills, then be sure to adequately train for both the uphill and downhill portion so that your body is ready for the stress.
If you develop hip bursitis, then start your rehabilitation by resting while tapering down intensity and training volume. You will likely have to stop running for a portion of time.
After the acute pain subsides, initiate a strengthening program for the hips. Utilize a foam roller for tissue mobilization and implement hip strengthening exercises as part of an ongoing prevention and recovery strategy.
More specific strategies (including the exercises that address the most common muscle imbalances found in those suffering from hip bursitis) are covered in the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.
What’s Inside the Resilient Runner Program:
Specific guidelines on when and how to return to running after experiencing an injury.
Rehabilitation guides with step-by-step photos demonstrating recommended exercises.
Step-by-step instructions on how to apply Kinesiological tape.
Downloadable podcasts, videos, and more!
If you’re tired of ongoing aches, pains, and injuries, learn how to become a resilient runner so that you can continue to train and compete in order to meet your goals!
Read more about the Resilient Runner here: