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Bursitis of the Hip or Shoulder: Treatment Options

Bursitis is inflammation of a bursa — a fluid-filled sac cushioning bones and tendons. In the hip and shoulder, it typically develops from repetitive motion or altered movement patterns. Physical therapy is the cornerstone treatment and resolves most cases without surgery.

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What is bursitis and why does it develop?

Bursae are small, slippery sacs found throughout the body at points where tendons, muscles, and bones meet. Their job is to reduce friction. When a bursa is irritated — by sustained pressure, repetitive motion, a direct blow, or altered biomechanics — it becomes inflamed and fills with extra fluid. This is bursitis.

Hip bursitis most commonly involves the trochanteric bursa, located on the outer side of the hip over the greater trochanter. It often causes sharp or aching pain that worsens when lying on the affected side, climbing stairs, or walking for extended periods. The preferred clinical term is now *greater trochanteric pain syndrome (GTPS)*, as research has shown that the pain complex usually involves the gluteal tendons as well as the bursa itself 1.

Shoulder bursitis typically involves the subacromial bursa, which sits between the rotator cuff and the acromion bone above it. Inflammation here frequently occurs alongside rotator cuff tendinopathy and is classified under *rotator cuff-related shoulder pain* in current clinical guidelines 2. It causes pain with overhead lifting, reaching behind the back, or sleeping on the affected side.

What causes hip or shoulder bursitis?

Common contributing factors include:

  • Repetitive movement: Activities that repeatedly load the bursa — running, overhead work, cycling with a high saddle — irritate the tissue over time.
  • Poor movement mechanics: Weakness in the hip abductors (particularly the gluteus medius) or rotator cuff muscles causes the surrounding structures to absorb forces they are not designed for, increasing bursal irritation 1.
  • Prolonged pressure: Sitting on hard surfaces for long periods can compress the ischial bursae; sleeping directly on a bony prominence can inflame the trochanteric bursa.
  • Inflammatory conditions: Rheumatoid arthritis, gout, and calcium deposits can all seed bursal inflammation.
  • Age: Tendons and bursae become less resilient with age, making irritation more likely from loads that would have been tolerated earlier in life.

How does physical therapy treat bursitis?

Physical therapy is typically the first and most effective treatment for bursitis. A PT program for hip or shoulder bursitis generally includes:

Load management. Identifying and modifying the specific activity or posture that provoked the inflammation is the starting point. Complete rest is rarely recommended, as it can allow surrounding muscles to weaken.

Strengthening the supporting muscles. For hip bursitis / GTPS, the priority is gluteus medius strengthening (clamshells, side-lying leg raises, single-leg squats in a controlled range). A 2025 network meta-analysis of 19 RCTs found exercise therapy yielded the greatest improvement in pain and functional outcomes among all conservative interventions for GTPS 1. For shoulder bursitis, rotator cuff and scapular stabilizer exercises — rows, external rotation, prone Y and T — reduce subacromial impingement forces, and the 2025 JOSPT clinical practice guideline recommends active task-oriented rehabilitation as the first-line approach 2.

Manual therapy. Soft tissue work and joint mobilization can reduce pain and improve range of motion, particularly when bursitis has led to secondary stiffness.

Activity modification. A PT can advise on running gait, sleeping position, workstation setup, or sport-specific technique to remove the mechanical driver of inflammation.

What other treatments are used for bursitis?

Ice and heat. Ice (cold applied for 15–20 minutes wrapped in a cloth) can reduce acute swelling in the first 48–72 hours. After the acute phase, some people prefer warmth to relax surrounding muscles before exercise. Individual response varies.

NSAIDs. Over-the-counter anti-inflammatory medications can reduce swelling and pain in the short term, making it easier to participate in physical therapy. Use as directed on the label and discuss with a pharmacist or clinician if you have kidney, stomach, or cardiovascular concerns.

Corticosteroid injection. When bursitis is severe or not responding to conservative care after 6–8 weeks, a clinician may recommend an injection of corticosteroid directly into the bursa. Exercise therapy outperforms corticosteroid injection for long-term outcomes in GTPS 1; for shoulder bursitis, injection may help reduce pain enough to engage productively in PT.

Imaging. Ultrasound or MRI is not usually needed to diagnose bursitis, but imaging helps when the diagnosis is uncertain or when a clinician wants to rule out a rotator cuff tear, gluteal tendon tear, or other co-existing pathology before planning treatment.

How long does bursitis take to heal?

Most cases of hip or shoulder bursitis that are managed with physical therapy improve substantially within 6–12 weeks. The timeline depends on how long the condition has been present, whether underlying weaknesses are addressed, and how consistently load management is maintained during recovery.

Recurrence is common when the contributing factors — muscle weakness, movement habit, activity level — are not corrected. A physical therapist is the right specialist for bursitis management. Gale can help you find a PT and prepare questions for your first visit.

Common questions

Should I rest completely if I have hip or shoulder bursitis?

Complete rest is usually not recommended. Relative rest — reducing the specific activity that provokes pain while maintaining other movement — is more effective and prevents the muscle weakness that can worsen bursitis long-term.

Can bursitis go away on its own?

Mild bursitis sometimes resolves with rest and activity modification alone. However, when underlying muscle weakness or movement patterns are not addressed, it frequently recurs or becomes chronic. Physical therapy addresses the root cause, not just the symptoms.

Is bursitis the same as a rotator cuff tear?

No, though they can occur together. Bursitis is inflammation of the bursa; a rotator cuff tear involves damage to the tendon itself. Imaging can distinguish them when the diagnosis is unclear or treatment is not progressing.

Do I need a referral to see a physical therapist for bursitis?

In most U.S. states, you can see a PT directly without a physician referral under direct access laws. Check your state's rules and your insurance plan, as coverage varies.

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When to seek care promptly for hip or shoulder pain

  • —Sudden severe pain after a fall, collision, or direct blow to the joint
  • —Shoulder or hip that looks visibly deformed or out of place
  • —Numbness or weakness radiating down the arm or leg
  • —Fever, skin redness, and warmth over the joint — may indicate septic bursitis
  • —Pain that is severe and constant, not relieved by rest or position change

Septic (infected) bursitis — characterized by joint swelling, redness, warmth, and fever — requires urgent medical evaluation. Go to an urgent care clinic or emergency department.

This article is general health education and does not replace an evaluation by a physical therapist or physician. Gale can help you find the right specialist.

References

  1. 1.Wang SQ, Guo NY, Liu W, Huang HJ, Xu BB, Wang JQ (2025). Effect of conservative treatment on greater trochanteric pain syndrome: a systematic review and network meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. doi:10.1186/s13018-025-05477-w ✓Network meta-analysis of 19 RCTs (1,701 participants) showing exercise therapy yields the greatest improvement in pain and functional outcomes for GTPS/hip bursitis, superior to corticosteroid injection at longer follow-up
  2. 2.Desmeules F, Roy JS, Lafrance S, Charron M, Dubé MO, Dupuis F, Beneciuk JM, Grimes J, Kim HM, Lamontagne M, McCreesh K, Shanley E, Vukobrat T, Michener LA (2025). Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. doi:10.2519/jospt.2025.13182 ✓JOSPT 2025 clinical practice guideline recommending active, task-oriented rehabilitation (exercises and education) as first-line treatment for rotator cuff-related shoulder pain / subacromial bursitis
  3. 3.Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD011279.pub3 ✓Cochrane overview supporting exercise as a core evidence-based intervention for chronic musculoskeletal pain across adult populations

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.