Hip Bursitis

Question:

My client has bursitis in her left hip. Hip flexion seems to cause it to act up. Her doctor recommended she do some exercises to strengthen up the muscles that stabilize her hip. She hasn't been able to go more than three weeks exercising without it causing her so much pain she has to stop for months. My plan is to have her do SMR and stretch before the workout and then do a workout that does not involve hip flexion and has more stability exercises. I plan on ending with more stretching and possibly icing her hip. Does this sound appropriate? Also, what exercises would be best to strengthen up her hips without flexion?

Answer:

I always like to say, “If you want to find a leak, don’t look at the puddle.” Anterior hip pain is most often caused from posterior issues. Famed physical therapist Shirley Sahrmann has postulated that hamstring dominance can cause anterior hip pain. Noted back expert Stuart McGill refers to gluteal amnesia. Just remember, bursitis is a symptom, not a diagnosis. People love to have a diagnosis. “I have bursitis.” The better question is, “Why?”

You say hip flexion causes pain. In what form? Running? If she is a distance runner, using a different mode of hip flexion may solve the problem. I have seen people who cannot jog but can run. There is a difference.

Think about singe leg bridges, what we like to call a Cook Hip Lift. Gray Cook recommends single leg bridges done with the opposite hip flexed. You may initially need to hold the opposite leg to the chest. This forces glute involvement versus lumbar extension. Another sure fire clue that you have a hamstring dominance issue is a hamstring cramp in a single leg bridge.

Also, do not use ice for chronic pain. Ice should be used for inflammation in the short term. And don’t bother with long term use of anti inflammatories. Another quick clue is to ask, “Does this exercise hurt?” If it hurts, don’t do it. It’s that simple. There is never anything beneficial about working with or through pain. If your client tells you anything but no, that’s a yes.

Simple formula: Work on the back side, forget the front. Think about looking on the roof for a clue, versus cleaning up the puddle.