PT on the Net Research

Hip Bursitis


I have a client who has bursitis in her hip joint, which developed six years ago while practicing ballet. She no longer does ballet, but she wants to start training - her goals are to increase muscle tone/strength/fitness. I was wondering if you have any information regarding such a condition and the safe training procedures associated.


Bursitis is the inflammation of the bursae sac. A bursae sac is really a synovial membrane that forms a sac and is filled with synovial fluid. Bursae sacs are everywhere throughout the muscular system. They are frequently found around joints that have a large variation of motion, like the hip.

Impact trauma or repetitive trauma (over use injury) are the usual suspects in bursitis. When the bursae becomes irritated or injured it starts to produce excessive synovial fluid. The sac becomes enlarged and places unusual stress on the surrounding tissues. Running through the surrounding tissues are nerves. As the bursae becomes more swollen it places greater pressure on the nerve and pain is the result. Bursae related pain is relieved by decreasing the size of the bursae sac that is inflamed and swollen.

With repetitive trauma injury it is accomplished by not doing whatever motion caused it in the first place. You can also assist the healing of the injury by using ice immediately after training, whatever NSAIDs are tolerated by your client and letting the joint rest from the mechanism of injury. To this, we can add improving muscle strength surrounding the effected joint and some balance work for improved proprioception.

Your client of unknown age, height and weight has created some type of trauma, in her hip, from the ballet training. In ballet the athletes are twisting and twirling in all directions and create large repetitive trauma issues. The hours of relentless practice and excessive stretching probably does not help the situation in her hip.

It is difficult to suggest precise training protocols without knowing about your client’s training background. However, any training protocol is going to need “fine tuning” so a general direction will work. Because the hip is such a “huge” joint for us we really are talking about working the body. The first rule of thumb is, stop if it causes pain. That would indicate some type of bursae irritation and around the pain cycle we go again. The hip moves in many directions. Start with flexion/extension with range of motion exercises. If there is no pain, add light weight and, with time, staircase into some loads that are tolerable, but difficult.

A few hip flexion/ extension exercises can start with the hip extension machine, move into back extensions and maybe finish with some type of leg press or squat movement. Hip flexion can begin with some abdominal work; floor sit-ups with feet fixed under something to allow hip flexor involvement, reverse abdominal curl-ups and move into hanging knee raises. Balance work can start with simply standing on one foot, on the floor and move into a wobble board or disc. With your experience and your clients feed back you can keep moving her forward.

The PTontheNet Exercise Library has many great ideas for training the hip region. Muscle tone will increase as the lifting gets “harder.”

Good luck with the training!