Diagnosing, treating hip bursitis

The hip joint is one of the true ball-and-socket joints of the body. The hip is surrounded by the thick muscles of the buttock at the back and the thick muscles of the thigh in the front.

The hip is like many other areas in the body where muscles and tendons must slide against one another during movement. At each of these places, a small sac of lubricating fluid helps the muscles and tendons move properly. Usually these sacs of fluid, called bursa, function to reduce friction.

However, it is possible for the bursa to become inflamed (swollen and irritated), which can cause pain. An inflamed bursa is called bursitis.

One common area where this occurs is in the bursa on the outside of the hip, called the trochanteric bursa. This creates a condition known as trochanteric bursitis.

The greater trochanter is the point where the large buttock muscles that move the hip connect to the top leg bone (femur). Another layer of muscle slides over this bump and attaches lower down on the femur. The trochanter has a fairly large bursa overlying it that occasionally becomes irritated, resulting in hip bursitis (trochanteric bursitis).

Friction can build in the bursa during walking if the long tendon on the side of the thigh is tight. When the tendon is tight, it rubs against the bursa. The rubbing causes friction to build in the bursa, leading to irritation and inflammation.

Friction can also start if the outer hip muscle is weak, if one leg is longer than the other, or if you run on banked surfaces. Most cases of trochanteric bursitis appear gradually with no obvious underlying injury or cause.

The first symptom of trochanteric bursitis is usually pain. The pain can be felt in the side of the hip right over the bump that forms the greater trochanter. Eventually the pain may radiate down the side of the thigh. As the problem progresses, the symptoms include development of a limp when walking and stiffness in the hip joint. Eventually the pain will also be present at rest and may even cause a problem with sleeping. It also may get worse with prolonged walking, stair climbing, or squatting.

Trochanteric bursitis can occur after artificial replacement of the hip joint or other types of hip surgery. The cause may be a combination of changes in the way the hip works, the way it is aligned, or the way scar tissue has formed from the healing incision.


A fall on the hip can cause bleeding into the bursa. The bleeding is not serious, but the bursa may react to the blood by becoming inflamed. The inflammation causes the bursa to become thickened over time. This thickening, constant irritation, and inflammation may result in the condition becoming chronic, or long lasting.

The diagnosis of trochanteric bursitis begins with a history and physical examination. In fact, this is usually all that is necessary to make the diagnosis. Your doctor will want to know when the pain began and which motions cause the pain. A physical examination will be done to determine how much stiffness you have in the hip and if you have a limp.

When evaluating for causes of hip bursitis the feet should always be checked for poor or faulty biomechanics. The feet are the foundation of the body and many foot conditions eventually contribute to knee, hip and lower back problems. Orthotics for your shoes and/or sneakers will have a significant effect in reducing excessive biomechanical forces on the hip.

X-rays will usually not show trochanteric bursitis. If X-rays are suggested they are to rule out other problems that may be causing your hip pain. Sometimes it is difficult to tell for certain whether the pain you are suffering is from trochanteric bursitis or underlying arthritis of the hip joint. An X-ray may give more information about the condition of the hip joint itself.

Trochanteric bursitis is often treated successfully with chiropractic care. Chiropractic adjustments/manipulations are performed to help restore normal biomechanics to the hip joint. It is important to manipulate and stretch capsular joint restrictions during the treatment phase.

It will also be necessary to alter the usual daily activities that may have lead to this condition. Repetitious bending of the hip and direct pressure over the hip should be avoided. Do not sleep on the affected side; sleeping on the back is preferable.

Stair climbing, bicycling, and stop-and-go sports (e.g., tennis or squash) create too much friction and irritation and should be avoided until the pain has subsided.