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    Move Forward Guide

    Physical Therapist's Guide to Greater Trochanteric Bursitis

    Greater trochanteric bursitis, also known as greater trochanteric pain syndrome, is one of the most common causes of hip pain. While greater trochanteric bursitis affects both active and inactive individuals, it is most common in moderately active, middle-aged females or those who have recently increased their activity level. In all individuals, pain on the outside of the hip from greater trochanteric bursitis can result in a limited ability to lie on the involved side, walk, climb stairs, squat, or participate in recreational activities. To treat greater trochanteric bursitis, physical therapists typically prescribe a combination of stretching and strengthening activities to decrease irritation in the hip and resolve pain.


     

    What is Greater Trochanteric Bursitis?

    Greater trochanteric bursitis is an irritation of the bursa, a fluid-filled sac that sits on top of the greater trochanter, a bony prominence on the outside of the hip bone (femur), the most outside aspect of the hip. The bursa acts as a cushion to decrease friction between the outside of the hip bone and muscles attaching to the bone. Greater trochanteric bursitis results when the bursa on the outside of the hip becomes irritated.

    Most often, greater trochanteric bursitis is the result of repetitive friction to the bursa. This repetitive friction is due to a combination of muscular weakness and tightness that causes increased friction on the outside of the hip, and is most often treated with physical therapy to decrease irritation.

    Greater trochanteric bursitis may result from a combination of several different variables, including:

    • Iliotibial (IT) band tightness (a thick band of tissue that runs along the outside of the leg from the pelvis to the knee)
    • Hip muscle tightness
    • Hip muscle weakness
    • Abnormal hip or knee structure
    • Abnormal hip or knee mechanics
    • Improper technique with repetitive activities
    • Change in an exercise routine or sport activity
     

    How Does it Feel?

    With greater trochanteric bursitis, you may experience:

    • Tenderness to touch on the outside of the hip
    • Pain when lying on the involved side
    • Pain in the hip that may at first feel sharp, then change to a dull ache, and may radiate into the side of the leg
    • Tightness in the hip
    • Pain and stiffness with prolonged sitting, walking (worst with the first few steps), negotiating stairs, or squatting
     

    How Is It Diagnosed?

    Your physical therapist will review your medical history and complete a thorough examination of your hip, and possibly your lower back, knee, and foot. The goals of the initial examination are to assess the degree of the injury and determine the cause and contributing factors to your injury. Greater trochanteric bursitis may be the result of a single injury, such as a direct blow to the outside of the hip, but most likely is a condition that develops as a consequence of repetitive irritation.

    Your physical therapist will assess the mobility and strength of your hip, and may watch you walk, step onto a stair, squat, or balance on 1 leg. The therapist will also gently touch the front, side, and back of your hip to determine exactly where it is most painful.

    Your physical therapist may also ask questions regarding your daily activities, exercise regimens, and footwear to identify other contributing factors to your pain.

    Imaging techniques, such as x-ray or MRI, are typically not needed to diagnose greater trochanteric bursitis.

     

    How Can a Physical Therapist Help?

    You and your physical therapist will work together to develop a plan to help achieve your specific goals. To do so, your physical therapist will select treatment strategies in any or all of the following areas:

    • Pain. Many pain-relief strategies may be implemented; the most common one is to apply ice to the area. A period of decreased selective activities may also help.
    • Range of motion. Your back, hip, or knee joint may be moving improperly causing increased tension at the greater trochanter. Self-stretching techniques may be applied to the lower body to decrease tension and help restore normal motion in the back, hip, and knee.
    • Manual therapy. Your therapist may treat your condition by applying hands-on treatments to move your muscles and joints in order to improve their motion and strength, most likely in your back or hip. These techniques often address areas that are difficult to treat on your own.
    • Muscular strength. Muscular weaknesses or imbalances can result in excessive strain at the greater trochanter. Based on your specific condition, your physical therapist will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremity. You may begin by performing strengthening exercises lying on a table (eg, lifting your leg up while lying in different positions). You then may advance to exercises in a standing position (eg. standing squats). Your physical therapist will choose what exercises are right for you based on your age and physical condition.
    • Functional training. Once your pain, strength, and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension on the hip and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your own unique movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely.
    • Patient education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as exercise selection, the amount of exercise you do, or faulty footwear. The therapist will assess you and recommend improvements, and develop a personal exercise program to help ensure a pain-free return to your desired activities.

    Physical therapy promotes recovery from greater trochanteric bursitis by addressing issues such as pain and any lack of strength, flexibility, or body control. Your physical therapist may also recommend a period of relative rest, then help you slowly resume activities, and carefully guide your progression. When greater trochanteric bursitis remains untreated, however, your pain will persist and result in long-term difficulty performing your desired activities.

     

    Can this Injury or Condition be Prevented?

    Maintaining appropriate lower-extremity mobility and muscular strength, and paying particular attention to your exercise routine—especially changes in an exercise activity, the volume of exercises performed, and your footwear—are the best methods for preventing greater trochanteric bursitis.

    Your physical therapist will help guide you through a process that will progressively reintegrate more demanding activities into your routine without overstraining your hip. Keep in mind that returning to activities too soon after injury often leads to persistent pain, and the condition becomes more difficult to fix.

     

    Real Life Experiences

    Karen is a 47-year-old teacher who is training for her first 5K road race. She runs 3 to 4 days each week, then walks the other days. Over the past 2 weeks, she has begun to experience pain in the outside of her right hip. Her pain is worst while running and lying on her right side; she experiences hip pain and stiffness when taking her first steps in the morning and walking up stairs, and also notes a dull ache with prolonged sitting and standing. She typically performs stretches for 5 minutes before her runs. Karen had not run consistently before she began training for the 5K.

    Karen is concerned about the sharp hip pain she feels when running and her inability to complete her training due to pain. She is worried about her ability to perform daily activities and train for her upcoming race. She consults her physical therapist.

    Karen's physical therapist conducts a comprehensive assessment of her motion, strength, balance, movement, and running mechanics; he gently touches the front, side, and back of her hip to determine the precise location of her pain. Karen describes her typical daily running routine, including distance, pace, and running surface; her stretching routine; and her footwear. Based on these findings, her physical therapist diagnoses greater trochanteric bursitis.

    He and Karen work together to establish short- and long-term goals and identify immediate treatment priorities, including icing and stretching to decrease her pain, as well as gentle hip-strengthening exercises. They also discuss temporary alternative methods for Karen to maintain her fitness without continuing to aggravate her injury and prolong her recovery, including swimming or biking. Karen is also prescribed a home exercise program consisting of a series of activities to perform daily to help her recovery. 

    Together, they outline a 4-week rehabilitation program. Karen sees her physical therapist 1-2 times each week; he assesses her progress, performs manual therapy techniques, and advances her exercise program as appropriate. He also advises her when it is appropriate to resume running, and establishes a day-by-day plan to help her safely build back up to her desired mileage. Karen also performs an independent daily exercise routine at home, including stretching and strengthening activities.

    After 4 weeks of patient work, Karen no longer experiences pain or stiffness in her hip, and resumes her desired training program without pain in preparation for her upcoming 5K race. On the day of the race, Karen runs pain-free and crosses the finish line in a personal-best time!

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat greater trochanteric bursitis. However, you may want to consider:

    • A physical therapist who is experienced in treating people with greater trochanteric bursitis. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
    • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have greater trochanteric bursitis.
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence related to physical therapy treatment of greater trochanteric bursitis. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011;21(5):447-453. Free Article.

    Grumet RC, Frank RM, Slabaugh MA, et al. Lateral hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2010;2(3):191-196. Free Article.

    * PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Allison Mumbleau, PT, DPT, SCS. Reviewed by the MoveForwardPT.com editorial board.

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