Ask the Doctors: Hip bursitis can be caused by underuse

Eve Glazier, M.D., and Elizabeth Ko
Elizabeth Ko, M.D. and Eve Glazier, M.D.

Dear Doctor: I never had hip problems, but after weeks of quarantine, the outsides of my hips ache and even wake me up when I am asleep. My doctor says it's bursitis, but I thought that's from when you exercise too much. I've hardly even been outside. How did this happen?

Dear Reader: Bursitis is the name of a condition that occurs when the small, fluid-filled sacs that sit near joints throughout the body become inflamed. Known as bursae (or a bursa, when you're talking about just one), they act as cushions that ease friction between the bone and other moving parts within the joint, such as tendons and muscles. When a bursa becomes inflamed or irritated, it fills with fluid. The swelling leads to more irritation, as well as pain and a limited range of motion.

Although bursae are present in joints throughout the body, bursitis is most common around the major joints. That includes the hip joints, as you've been experiencing, as well as the knee, shoulder and elbow. And you're correct that bursitis most often occurs due to overuse, particularly through activities that include repetitive motion. Activities like raking, painting and gardening, and sports like tennis, skiing, running, biking and golf can lead to stress and inflammation. Bursitis also is linked to gout, rheumatoid arthritis and psoriatic arthritis; it can result from physical injury; and it may be triggered by reactions to certain medications.

Interestingly, hip bursitis can arise as the result of inactivity. The hip abductor muscles, which we use to move the leg away from the body and to rotate it within the hip joint, can become weak through lack of use. This results in increased pressure on the bursae. Prolonged sitting and standing can also lead to stress and inflammation.

Symptoms of hip bursitis include tenderness and swelling and the ache that you describe on the outside of the hip. This typically increases when rising from a sitting position, walking up stairs or when lying on one's side. Any problems you may have with your lower limbs, such as knee or foot pain, can cause you to move in such a way that irritates the hip bursae.

Treatment focuses on the dual goals of reducing inflammation and strengthening the supporting hip muscles. Your doctor may prescribe the use of anti-inflammatory medications, and will likely show you some home-based exercises to increase strength and improve muscle tone in the abductors. Some people find that ice can help to minimize swelling and reduce pain. In some cases, the bursae can become infected, which necessitates the use of oral antibiotics. When more conservative treatment approaches don't bring relief, injections of a corticosteroid may be recommended.

For people who develop hip bursitis due to repetitive overuse, rest is a crucial part of their recovery. In your case, the challenge will be strengthening the supporting muscles without causing additional irritation and inflammation. Avoid prolonged sitting or standing, follow the exercise guidelines that your doctor gives you, and don't be tempted to overdo it.
