Hip bursitis

We start with where it hurts and what sets it off: stairs, hills, a long walk or run, lying on that side, standing on one leg. We ask what changed before it began: a new running plan, a big hiking week, a job with far more stairs. Then we examine the hip:

• we press on the bony point of the hip (the greater trochanter) to find where it is tender
• we test the strength of the muscles at the side and back of the hip, and watch you balance and step down on one leg
• we look at how you stand, sit and walk, because leaning onto one hip or crossing your legs presses the tendons on the bone
• we check the lower back and the hip joint, because both can send pain to the same spot

The sore tendons are being squashed against the bone and overloaded. Treatment takes that load off, then builds their tolerance back up. It usually includes:

• Load management: for a while we ease back what presses the tendons on the bone. That means no stretching the outer hip, no crossing your legs and no leaning onto one hip when you stand. Sleeping on the sore side goes too; a pillow between the knees helps. Walking, stairs and hills stay at a level that makes the pain no more than a little worse.
• Graded strengthening: exercises for the buttock muscles that hold the pelvis level when you stand on one leg. They start gently, with the hip held still, and build to standing, stepping and single-leg work. This is the main treatment, because the right loading is what lets the tendons adapt.
• Hands-on treatment: we work the muscles around the hip and the lower back to ease pain and tightness; see manual therapy. We do not press hard on the sore tendons, since that adds to the compression.
• Shockwave therapy: one option when tendon pain lingers despite a good strengthening program, alongside it rather than instead of it. See shockwave therapy.

Runners and hikers get this often, usually after a change in training: more distance, more hills, a return after a break or a big alpine trip. It is also more common in women in middle age. The way back is stepped. We start with shorter, flatter outings, such as a loop of the Valley Trail. Distance comes back before climbing and descending, which the outer hip copes with last. You move on from each step when the pain the next day is no more than a little worse.

There is no set date for a return to full training. Once the basics are solid, strength and conditioning takes over. It builds towards what work, study and sport ask of the hip: long shifts on your feet, a full hiking week or a hilly run.

Book an assessment if pain on the outside of your hip wakes you at night, stops you on stairs or hills, or cuts your runs and hikes short. Book too if it has lingered despite rest, or comes back each time you return to running.

Go to the emergency department right away, or call 911, if any of these happen:

• you cannot put weight on the leg after a fall
• the hip is hot and swollen and you have a fever
• after a fall, the leg looks shorter or turned outward