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.
Conclusion
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:
Guidance on preventing and self-treating Hip Bursitis as well as many other common running related injuries, including Runner’s Knee, IT Band Syndrome, Piriformis Syndrome, and more!
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:
I just have to comment. I am a physician and inhad a bad hip bursitis (greater trochanteric bursitis). I tried it all but ncluding going on a 3 week trial of perscription anti-inflammatory meds. The things that helped me were 1. Strengthening my gluts/hips through a focused strength training regimen and 2. A steroid injection into the bursa (my Dr. Used fluoro guidance). Not only was i able increase mileage to weekly numbers i never before achieved, but i have been pain free since.
Thanks Tom…..excellent advice. Sometimes the the inflammation and pain can be so severe that a direct injection of a steroid (anti-inflammatory) is needed to help the person get over the hump while working on addressing the initial causative factors. I also prefer when MD’s use fluoroscopy to help guide the injections. Glad you are back to pain free running. Take Care!
I see over and over again the need to do focused strength exercises for the glues and hips–so show me what I need to do.
Hi Bill, Glad you asked. If you comb through many of the articles I have written on my website or the Marathon Training Academy website you will find many ways to strengthen those areas. If you want a nice convenient package with step by step instructions that his injury specific or area specific check out the Resilient Runner Program. https://marathontrainingacademy.clickfunnels.com/optin10735340
This article does not show when clicked on. Can you repost? I’ve been suffering from terrible hip bursitis for 12 years and am desperate for help and would love the exercises you recommend!
Hi Bill, I think I know the answer but I am due to do a power walking marathon in 4 weeks, I have trained well for it but in the last 4 weeks my bursitis in my hip has gotten worse and worse. I am taking Ibuprofen, I also do hip and glute focused strength exercises (I am predominantly a weigh lifter). It is getting to the point where I can only get to a few miles into my training power walk without pain and then the pain continues daily until my next session. Would I benefit from a steroid injection? Should I pull out of the marathon (this would be last resort obviously). Will I do long term damage if I continue? Many thanks
Hi Phoebe, Tough questions. Only you can decide how much pain you want to take. A steroid injection would likely help and would most likely allow you to complete the race. There are risks with steroid injections and so one should consider that before making the decision. At this point I would stop activities that make it worse and cross train to keep your fitness levels up. Aqua jogging is great to maintain cardiovascular fitness. You can also utilize this technique as a way to self mobilize the tissue. Hope this info helps your decision process. https://www.youtube.com/watch?v=5acTiBYEszU
I’m a long distance runner, half marathons are my favorite, I’m 61, I make sure I only run 6 months out of the year, the other half is riding a bike! I was just diagnosed with trochanteric bursitis maybe from a fall on wet tile on my patio! I got the steroid injection, which was so helpful, got me over the hump! I have never stopped riding, stretching and strengthening is so important to recovery, My question is, I’m just getting back into running, run/walk, at just 4 miles, all though I can feel a little bit of discomfort in my hip, it does not last, do you think I’m ok to continue running!
Hi Flo, It sounds like the injury was from direct trauma. Which is slightly different than bursitis from overuse. I would definitely continue to cross train and follow through with the exercises that may help overuse bursitis or bursitis caused by a biomechanical issues. Running should be okay but I would taper up the distances, intensity and volume slower than in past years just to be on the safe side. Best of luck!
Hi, not sure if you could give me any advice or not but here goes…
I’m a cross country runner and have had a pain In my glute for the last few weeks. It started off as pain in my hip, then found itself in my mid butt cheek (a dull pain at the back), and now is closer to the outside of my hip. It doesn’t hurt when I walk around, only running at this point. I’m regularly doing PT to correct muscle imbalances that appear to be the root cause of my issue.
I got an ultrasound where they stated I had fluid in my right subgluties maximus but no torn muscles etc.
I’m taking anti inflammatories but am not sure if these are enough to help.
Just wondering if you have any points about what to do?
It’s driving me up the wall because it keeps moving around and I don’t know exactly what the issue is.
HI Courtney….it is tough to give a thorough answer without a full assessment. But it is clear that you are having overuse/repetitive motion issues leading to pain and inflammation. This is almost always due to muscle imbalances and/or poor running form. In my experience the most commonly missed muscle group that could be causing these imbalances is the deep hip external rotators. Your PT should be able to assess the strength of these muscles and compare side to side. Also remember imbalances can start at the foot/ankle and work up or start with the pelvis and hips and work down or both. So you need to evaluate the entire lower half. Hope that helps. Ben
Hi Ben- I have had hip bursitis for nearly a year now. In January I was diagnosed and was about to start marathon training. I saw a physio who treated me fortnightly with massage and I ran four times a week, encouraged by him to run through the pain. It worked and I managed to do my marathon. The problem is I cannot get rid of the hip bursitis. I feel as though I am paying for all that constant running I did in training. I have just finished a rest period of six weeks, did a two mile run yesterday and it is always hurting. I sometimes can’t walk the dog without it aching and it achesnint eh night. I don’t know what more to do- am exercising and stretching. Have net seen physio since April as he suggested I had t leant to live with it. I am ok in daily activities – but desperate to get back running pain free. Any advice? Thank you
Hi Anne,
At this point, your case has gotten pretty chronic so the treatment plan would need to change. The hip itself would likely need aggressive manual therapy while working on the root cause for the bursitis which is almost always a muscle imbalance and possible running technique issue. I would find a PT that is a runner and knows manual therapy. Hip external rotation strength and foot placement when running will be important to look at.
But learning to “live with it” should not be an option. This is something you can get past.
Hope this helps.
What do you mean by manual therapy? (Having same issues)
Hi , I experienced hip bursitis because my gym was closed and had to run outside on the pavement. I have never had any problems until them. It started in April and my hip is still swollen but the pain is in my glute and lower back. I had a cortisone shot in August and it didn’t help the swelling. I have been doing the eliptical for 2 weeks and completely quit running. I am sore in the morning when I wake up then it gets better, the pain is in my lower left side but does not run down my leg. Any thoughts of when I can run again?
Hi Kelly, Pain in your glut and lower back is not hip bursitis. There is something else causing your pain. You may have developed some bursitis as well, but there is likely more going on then just that. It could be a muscle imbalance or a lumbar related issue. Since you have already had some medical intervention without improvement I would suggest a thorough PT eval from a run savvy manual physical therapist. Ask around at the local running shops who has a good reputation. Keep us posted!
I have a new pair of running shoes and now with just 20km on them have outer hip pain that I have never before experienced, with lower back stiffness also. I’m 51, and run 2-3 times a week up to 5k, mixed in with bodyweight HIIT training. Running has always been a mix of street and trail as I live near a nature reserve and it’s much nicer on the trail, though uneven and hilly. Is this something you’ve seen before? For now I will need to stay off my feet and get back on the bike as this is going to take some recovery. Thanks!
HI Peter….well….if the question is…..could the shoes be the cause of the pain? Well yes they could be. If there were no previous issues, no change in your running or training and the only change was to the footwear then I would definitely suspect that the shoes altered your gait enough to cause you pain. Treat the symptoms and try some new shoes or go back to your old ones and see how you feel. Once you start running again start a little slow and then taper back into your normal 5k runs. Best of luck!
Hi Ben. Many thanks for your insight above. I am recovering from pain on the right outer-side hip bursa. I normally train on hills and long-distance (up to 100 miles p/w and 15,000ft of ascent). I’ve taken about 4 weeks completely off running/cross training. I’m still getting some hip pain around the tender area when I strongly flex my hip and also when I massage the tender area with deep freeze. Day to day activities such as walking to the shops or walking upstairs are pain free.
I’m looking forward to gradually get back into running. My question is whether I need to experience zero-hip pain before I start running or whether I can start running low mileage when there is still some pain drom massaging the affected area? Thanks again for your useful info on this page.
Hi George….I typically have my clients start back slow and steady on the mileage, even if they are a little sore. But they have to stop if the pain significantly worsens. Try to only manage one variable at a time. Meaning I start them off flat and preferably on a softer surface like a bark trail or running track. Be very slow and methodical about tapering up mileage. Don’t introduce hills or rough terrain until you are sure you have recovered. Hope that helps.
I still have bursitis pain 8 weeks after my first marathon. It came on early in the marathon unexpectedly. I know that i cannot run at the moment with aggravating it but what else can I do cardio wise that would make things worse or become chronic. I have a bike and eliptical trainer at my disposal but unsure if they would be slowing down the healing process?
In July last year I got this, my bio was pulling. I took time off and slowly eased back in November. I think I’d got it by upping my weekly milage too quick. I enjoy being able to run long (for me) runs. I had done 15 miles and a few half marathons last year.
I managed a 10 miles the other week then a few days later did a 10k since then it has been quite dull and achey. I’m worried I’ll never be able to up my distance and keep it up, or I’ll never be able to run fast efforts without it flaring up. I try do hip strengthening exercises, home workouts and cycling now the weather is getting better.
What advice do you have? I know I should gently increase milage again.
Gemma….you got it. Slow and steady is the name of the game. And the cross training and spot training are critical. Its not something you can do for a week or two then stop. It has to be part of the training routine. Just like your fueling is an ongoing thing so is cross training and working on strengthening. Some people are lucky and never have to work on this, then there is the rest of us. Don’t get discouraged. Its all about the activity. Its good for you and can be fun 🙂 Be sure to work the entire lower chain and put mental effort into it as well. That way you are working on the right areas and not letting the stronger muscle groups over compensate and defeat the purpose of the spot training. Best of luck!
2 weeks before i fell down on the ground while playing soccer and hurt my back hip bone
at first i could not walk but i could walk within few days and could sleep in sides because hip hurts and now i could run but sometimes the pain occurs should i take rest another 2 more weeks or
seek medical treatment it is still swollen but i feel lot confartable than before 2 weeks and improved a lot but still there is a bit pain .
Based off of your description, it sounds as though you were healing appropriately. It’s a judgment call if you want to slowly start tapering back to exercise or wait another week or two. If you decide to start back to exercise, then taper up slowly and if the pain worsens, then discontinue the exercise and give it a little bit more rest. Hope that helps!
Training for my third marathon (running 30 ish miles a week) and got plantar fasciitis. I’m assuming that because of this I changed my running gait because the outside of my hip started to hurt. Sharp pains when running that would travel to my groin/sometimes down my quad. Haven’t run in a week or so but still a dull ache in my side hip (can’t sleep on it, hurts to sit, sometimes walk with a limp). Got an MRI and seeing a doctor in a week but is swimming and the elliptical fine? any suggestions?
Hi. Unfortunately, pain in one region will often cause altered mechanics and then developing to pain in multiple regions. It’s important to address all of it at once to prevent ongoing issues. Likely your hip pain is just from altered biomechanics due to the plantar fasciitis. You need to get to the root cause of why you developed the plantar fasciitis and start addressing that as well as treating the other areas that are now bothersome. In the interim, anything you can do to stay active as good as long as it doesn’t cause additional pain. Swimming is often a good choice. Elliptical or biking can also be OK it’s really up to the individual. Best of luck!
What if my hip bursitis is caused by uneven leg lengths? What can I do to overcome this? I’ve been running longer runs and as a result having chronic hip bursitis. Shortly before pandemic, I got a free training session at my gym. During stretches on the bench, she noticed that my left leg was slightly longer. And I can feel the slight difference when I stand on one leg and then shift to the other. However when my runs are short and fast I don’t seem to have this issue.
Great question. Leg length discrepancies are more nuanced than many give credit for. The first thing that needs to be determined is whether or not it is caused from a poorly aligned spine or pelvis vs the leg bones actually being different lengths. Spine or pelvic alignment issues will cause a “functional” discrepancy which is different than a “structural” discrepancy. If there is a structural discrepancy, it does not mean it has to be addressed. Many times any difference less than a centimeter or two does not need to be addressed as the body has already accommodated for the difference and “fixing” it may actually make things worse. However, to address a small discrepancy, all you need to do is add an extra insole or heel lift into the shoe and see how it goes. Start by wearing it a few hours a day and slowly taper into full time use. If the difference is 3+ centimeters, then you may consider having custom shoe modifications to address the issue. Let us know how it turns out. We can all learn from others’ experiences. Take care!
I have very tight hips and a bad it band issue. I have not done any activity using my legs in 5 months now. I believe this all correlates to my greater trochanter. I am a college runner and used to run 80 miles a week for about a year. I have been seeing a PT for 3 months now. Would you agree and how would you recommend approaching this?
Hi Aidan,
Since I have not evaluated you, I cannot say the true cause of the ITB issues. In my experience, it stems from how the foot interacts with the ground. This means the foot needs to be assessed and often times the deep hip external rotators need significantly more strength as they also play a role in how the foot interacts with the ground. Hope that helps!
I have very tight hips and a bad it band issue. I have not done any activity using my legs in 5 months now. I believe this all correlates to my greater trochanter. I am a college runner and used to run 80 miles a week for about a year. I have been seeing a PT for 3 months now. Would you agree and how would you recommend approaching this?
Hi! Doc diagnosed me with hip bursitis in June. I had been in pain since March, hip pain was due to a running injury in March. I got a shot to help with pain and I just finished 4 weeks of PT.. I have zero improvement and hip pain is still there. After sitting for a long time, standing, hurts bad. I am frustrated that after PT there has been zero improvement. I am now wondering if I have been doing the wrong exercises etc. Just doesn’t make since to me. I have stopped all running since March, but walk very often. I am now riding the Peleton to get some cardio and going to research the best exercises I can do for my hip to do at home. I am desperate to rid this pain for good. Any insight would help immensely