What is the initial treatment for hip bursitis?

Initial Treatment for Hip Bursitis

The initial treatment for hip bursitis should include a combination of non-pharmacological approaches such as exercise therapy, weight loss if overweight, and pharmacological management with acetaminophen or NSAIDs such as naproxen. 1, 2

Non-pharmacological Management

Exercise Therapy

• Participate in cardiovascular and/or resistance land-based exercise programs focusing on strengthening the quadriceps and proximal hip girdle muscles 1
• Engage in aquatic exercises which can reduce joint loading while maintaining strength 1
• Start with exercises that are within your capability and gradually build up intensity over several months 1
• Aim for regular, individualized daily exercise regimens that include:
  • Strengthening exercises for both legs
  • Aerobic activity
  • Range of motion/stretching exercises 1

Physical Modalities

• Apply thermal agents (heat or ice) to reduce pain and inflammation 1
• Consider manual therapy in combination with supervised exercise, but not manual therapy alone 1
• Ultrasound therapy may be beneficial, particularly for calcific bursitis 3, 4

Assistive Devices

• Use walking aids (such as a cane used on the opposite side) if needed to reduce pain and improve mobility 1
• Consider appropriate and comfortable footwear to reduce stress on the hip 1

Weight Management

• For overweight patients, implement weight loss strategies including:
  • Regular self-monitoring of weight
  • Increased physical activity
  • Structured meal planning
  • Reduced fat and sugar intake
  • Portion control 1

Pharmacological Management

First-line Medications

• Acetaminophen: Start with this as it has a favorable safety profile 1
• Oral NSAIDs (e.g., naproxen): Consider when acetaminophen is insufficient
  • Initial dose of naproxen 500mg, followed by 500mg every 12 hours or 250mg every 6-8 hours as needed
  • Do not exceed 1250mg on first day, then maximum 1000mg daily thereafter 2
• Use caution with NSAIDs in elderly patients and those with renal or hepatic impairment 2

Second-line Interventions

• Intra-bursal corticosteroid injections: Consider when oral medications and non-pharmacological approaches fail 1, 5
• Tramadol: May be used when acetaminophen and NSAIDs are ineffective or contraindicated 1

Self-Management Strategies

• Participate in self-management education programs that address:
  • Understanding of the condition
  • Causes and prognosis
  • Activity pacing techniques
  • Coping strategies 1
• Set both short-term and long-term goals with regular evaluation 1

Common Pitfalls to Avoid

• Relying solely on medications without implementing exercise and weight management strategies 1
• Continuing high-impact activities during acute phases of bursitis 5
• Delaying appropriate treatment, which may lead to chronic pain and disability 6
• Using chondroitin sulfate or glucosamine, which are not recommended for hip OA 1

When to Consider Further Intervention

• If symptoms persist despite 4-6 weeks of conservative management 5
• For refractory cases, surgical intervention may be considered, but only after exhausting non-surgical options 5, 7