Pedaling Past the Pain: Understanding and Managing Hip Bursitis When Cycling. Don't let hip pain from bursitis hold you back—what you need to overcome hip bursitis when cycling with a 4-step prevention and treatment plan.
Hip bursitis is a common condition that affects many cyclists, young or old, competitive or recreational. It is a painful inflammation of the bursae, tiny fluid-filled sacs that cushion the joints and help reduce friction between bones, tendons, and muscles. Bursitis can occur in any joint, but it is most common in the hips, shoulders, and knees.
Cycling is a popular recreational sport involving intense and repetitive hip joint movements. This improper repetitive motion can cause irritation and inflammation of the bursae, leading to hip bursitis.
Hip bursitis can be a painful and debilitating condition affecting a cyclist’s performance and quality of life. It is essential to address the situation early to prevent long-term damage. Understanding the causes and symptoms of hip bursitis can help cyclists take preventive measures and seek treatment promptly.
If lateral hip discomfort interferes with your riding enjoyment, read further to explore the causes, symptoms, prevention, and treatment of hip bursitis in cyclists.
Hip Bursitis When Cycling
The prevalence of hip bursitis in the general population needs to be better established, as it is often underdiagnosed, misdiagnosed, or unreported. However, experts estimate that hip bursitis accounts for approximately 15% of all cases of lower extremity bursitis.
In cyclists, the prevalence of hip bursitis is higher due to the repetitive nature of the sport. A study published in the Journal of Science and Cycling found that hip bursitis was the most common overuse injury in competitive cyclists, with a prevalence of 17.9%. Another study published in the Journal of Sports Medicine and Physical Fitness found that hip bursitis accounted for 10.3% of all cycling-related injuries.
It’s important to note that these studies focused on competitive cyclists, and the prevalence of hip bursitis may vary among recreational cyclists. However, hip bursitis is a common injury that all cyclists shouldn’t overlook. Taking preventive measures and seeking treatment can help cyclists avoid long-term damage and continue to enjoy the sport they love.
Anatomy of the Hip—What a Cyclist With Hip Bursitis Needs To Know
As an athlete, it’s crucial to understand the anatomy of your hip joint and the surrounding structures to prevent injury and optimize performance. The hip joint is a ball-and-socket joint that connects the femur (the long thigh bone) to the pelvis. Several structures surround it, including muscles, tendons, ligaments, and bursae.
Bursae are small fluid-filled sacs that function as cushions between bones, tendons, and muscles. They help reduce friction and allow smooth movement of the joint. Bursae occur in our bodies in joint regions where there is a lot of repetitive rubbing of the structures overlying boney points. The hip joint has two main bursae—the trochanteric bursa and the iliopsoas bursa.
The trochanteric bursa is on the outside of the hip joint, between the femur and the muscles that attach to it. The iliopsoas bursa is on the inside of the hip joint, between the iliopsoas muscle and the femur.
Cyclists are prone to repeated hip joint motion that stresses these structures, leading to irritation and inflammation of the bursae, causing hip bursitis.
What is Hip Bursitis?
Hip bursitis is a condition that occurs when the bursa—a small fluid-filled sac—in the hip joint becomes inflamed. The bursae that most commonly cause cycling pain, the trochanteric bursae, is between the hip bone and the tendons or muscles that surround the joint, and it acts as a cushion to reduce friction and allow smooth movement.
When the bursa becomes inflamed, it can cause pain and stiffness in the hip joint, especially when walking, running, climbing stairs—and cycling. Hip bursitis is an overuse or repetitive motion injury, but it can also be due to underlying conditions such as arthritis or a traumatic injury.
Symptoms of Hip Bursitis When Cycling
As a cyclist, it is essential to be aware of the symptoms of hip bursitis to seek treatment early and avoid further injury.
Symptoms of hip bursitis can include:
- Pain in the hip joint: Hip bursitis can cause dull, achy, and throbbing pain on the outside of the thigh at the hip joint, especially when cycling or doing other activities that put repetitive stress on the hip.
- Stiffness in the hip joint: You may feel stiffness in the hip joint, especially when getting up after sitting for a long time or when first starting to cycle.
- Tenderness or swelling in the hip: The affected area may feel tender to the touch, and you may notice swelling around the hip joint.
- Limited range of motion: Hip bursitis can cause a limited range of motion in the hip joint, making it difficult to move your leg in specific directions, like crossing your legs and turning your foot inward.
- Pain when lying on that side: You may experience pain when rolling on the affected hip, making it difficult to get a good night’s sleep or find a comfortable position.
Ask yourself the following questions
- Do you experience dull pain on the outside of your hip below where the boney bump sticks out when you ride?
- Does pressing behind the boney spot on your hip cause the same pain you feel when cycling?
- Does the pain worsen and travel to your thigh or calf the more you ride?
- Do you feel tightness and lack of flexibility on the outside of your thigh and front of your hips?
- Has it been a long time since you had a proper bike fit?
- Did you recently have a sudden increase in mileage or intensity?
- Are you an aggressive pedaler, or do you primarily use a low cadence?
- Does pain outside your hip wake you up when you lie on that side?
If you answered “yes” to five or more, you might suffer from a cycling-related overuse injury called Hip Bursitis When Cycling.
An injury to bones, muscles, tendons, the hip joint, or the sciatic nerve can cause similar symptoms. There are a few basic rules of thumb to rule them out.
- You may have injured your hip joint or suffered a stress fracture in your pelvis or femur (long thigh bone) if you experience pain hopping on one leg. An X-ray usually reveals a joint injury, but only a bone scan shows a stress fracture.
- If you experience pain in your buttock when you stretch your legs out straight, you may have a torn muscle or tendon running down the backs of your thighs.
- You might have irritated your piriformis muscle if you feel pain in your buttock when sitting on a hard surface.
- If your lower-leg pain radiates into your buttocks and extends down to your feet when you bend backward, you may have a herniated disk pressing against your sciatic nerve.
Causes of Hip Bursitis When Cycling
Hip bursitis when cycling can be a frustrating, chronic, and painful condition. It occurs when the bursa sac near the hip joint becomes inflamed due to repeated friction or pressure, an often unavoidable consequence of riding.
It happens when your bike fit is not optimal, your position is incorrect, or your riding posture is abnormal, causing your hips to experience repetitive strain.
Overuse and muscle imbalances are also common culprits. Cyclists who spend long hours on their bikes with their trunks flexed forward or sit for long hours at work or home develop flexor tightness contributing to hip bursitis when cycling. Tightness of the outer and posterior thigh structures, like the iliotibial band and hamstrings, will put excessive pressure on the hip bursae.
Additionally, weakness in certain posterior muscle groups, such as the glutes or core muscles, can increase the risk of developing this nagging niggle.
Pre-existing conditions such as arthritis, diabetes, thyroid disease, or gout can also contribute to hip bursitis. It’s critical to seek medical attention if you suspect you have an underlying condition that could be causing your symptoms.
When it comes to preventing or managing hip bursitis, it’s essential to ensure your bike fit is optimal. A professional bike fitter can help ensure your bike fits your body, reducing the risk of improper positioning. It’s also important to vary your training routine and avoid overuse, especially if you are experiencing early symptoms of hip bursitis.
Finally, incorporating exercises that strengthen the glutes and hip flexors can help reduce the risk of developing hip bursitis. Stretching and foam rolling can also help alleviate pain and inflammation.
To maintain the ability to enjoy the beautiful sport of cycling, prioritize your health and take steps to prevent and manage hip bursitis.
Prevention of Hip Bursitis When Cycling
There are several ways a cyclist can prevent hip bursitis:
1. Proper bike fit: Ensuring your bike is set up correctly for your body can help prevent unnecessary pressure on your hips. A professional bike fitting can help you achieve the right fit.
Pain in the hip is due to positioning, which causes the rider to bend excessively at the trunk or causes the hip to flex. You can correct this by adjusting the crank length, handlebar size and position, saddle height, and fore-aft position to avoid exceeding the athlete’s range of hip motion at the top of the pedal stroke.
By adjusting your cleat position inward towards the crank, your foot will move outward, placing less stress on the structures of the outer thigh hip—by reducing the Q-angle. If you have flat feet and lack support in your cycling shoes, your lower leg will rotate inward, increasing the Q-angle. Cycling-specific footbeds are a good idea.
2. Varying your training routine: Avoid overuse by varying your training routine, including the duration and intensity of your rides. It helps prevent repetitive strain and reduces the risk of developing hip bursitis. When riding, focus on a comfortable cadence and smooth pedal stroke, and avoid pushing too hard during the downstroke.
3. Strengthening exercises: Incorporating exercises that strengthen the glutes and core can help reduce the risk of developing hip bursitis. Keep reading for some suggestions.
4. Stretching: Stretching can help improve flexibility and reduce the risk of muscle imbalances. Focus on stretching the hip flexors, hamstrings, and iliotibial band. You will find a list of hip bursitis when cycling-specific stretches below.
5. Rest and recovery: Rest is essential to preventing overuse injuries. Make sure to give your body time to recover between rides. Include a foam roller in your recovery routine. There’s a foam roller routine to follow.
6. Pain management: If you experience pain or discomfort in your hips, don’t ignore it. Seek medical attention and consider using ice or heat to manage pain and inflammation.
If the pain is the result of a recent injury or is acute (sudden onset within ~24 hours) with swelling, control the symptoms by following the ‘PRICE principle’ (an acronym which stands for Protect, Rest, Ice, Compression, and Elevation) immediately for the next 2 to 3 days.
By taking these steps, a cyclist can help prevent hip bursitis and maintain good overall hip health.
Treatment of Hip Bursitis When Cycling
The treatment for hip bursitis when cycling usually involves a combination of rest, medication, physical therapy, and lifestyle modifications. Here are some standard treatment options:
1. Rest: Taking a break from cycling can help reduce inflammation and allow the bursa to heal. Avoid activities aggravating the hip, such as running or other high-impact exercises.
2. Medication: Over-the-counter pain relievers such as ibuprofen or naproxen can help reduce pain and inflammation. Your doctor may also recommend a corticosteroid injection to reduce inflammation. Seek the advice of your healthcare professional before beginning a medication regimen.
3. Physical therapy: A physical therapist can help you develop a stretching and strengthening program to improve flexibility and reduce muscle imbalances. They may also use techniques such as massage or ultrasound therapy to help reduce inflammation
4. Surgery: In rare cases, surgery may be necessary to remove the bursa if other treatments are ineffective.
It’s critical to consult with a healthcare professional, PT, athletic trainer, or coach to determine the best course of treatment for your individual needs. With proper treatment and lifestyle modifications, a cyclist can successfully manage cases of hip bursitis.
A Four-Step Piriformis Syndrome When Cycling Plan
Step One: Perform a Foam Roller Routine
Rolling the muscles of your legs will make them more relaxed, making it easier to stretch, thereby improving your flexibility. In addition, by relaxing the glute muscles, the spasm which occurs due to being overworked will decrease too. Here’s how:
Step Two: Perform a Stretching Program
Adding hip flexor, adductor, piriformis, ITB, and hamstring stretching to your daily routine will counteract the adverse effects of prolonged periods in the saddle. Here’s how:
Also Read:
Step Three: Perform a Muscle Activation Routine
Muscle activating your glutes before riding will stimulate inactive muscle groups to improve their function. Focus on the glute muscles and visualize them to fire. It will improve contraction strength through enhanced fiber recruitment.
Concentrate on the muscles you’re trying to activate in your mind. Perform each exercise slowly and control the movement through a full range of motion. The goal is to warm up and engage the specific muscle groups without fatigue. Follow this link to learn more.
Follow These Glute Muscle Activation Tips
Activation exercises are simple motions to isolate and activate a specific muscle group. A quad dominance routine targets the glutes and spinal muscles to help you feel them contract and know they’re engaged and ready. Here are a few tips you can use along the way.
- The key to pre-activation is waking up and activating the proper muscles by concentrating on a full contraction.
- Take it slow and controlled, making each repetition deliberate for a maximal contraction through a full range of motion.
- Focus on really thinking about the muscles you’re trying to activate.
- Maintain constant tension through the band during all phases of the movement
Step Four: Perform a Strengthening Routine
A program focused on improving and maintaining glute and hip extensor strength and addressing the core will prevent hip bursitis when cycling and improve performance.
Quadruped Bent Knee Hip Extension with Elastic Band
Start in a quadruped position, on your hands and knees, with a band around your knees. Hands should be directly under your shoulders and knees directly under your hips. Begin by extending your leg back, with your knee bent at 90 degrees. Make sure to keep your core engaged and squeeze through your glute at the top of this motion. Bring your leg back to starting position. Try to keep your weight center and do not use your back in this motion.
Quadruped Alternating Upper and Lower with Elastic Band
Start on your hands and knees with your hands directly under your shoulders and knees under your hips. Wrap an elastic band around each foot. Extend one leg while ensuring the lumbar spine is held still throughout the movement and not allowed to arch. Extend the leg until it is straight, as shown. Reach with the opposite hand with or without holding a weight.
Standing Hip Extension with Elastic Band
Place an elastic band around your ankles. With straight knees, move the target leg back and then slowly return.
These glute-targeting exercises are only the start. Follow this link to the Training & Performance page of The Zommunique’ to learn how to up your muscle balance game. Add some core strengthening too. Here you go!
Conclusion—Hip Bursitis When Cycling
Hip bursitis is a common overuse injury in cyclists due to repeated pressure and friction on the bursa sac near the hip joint. While it can be a frustrating and painful condition, several effective ways exist to prevent and manage hip bursitis.
You can reduce the risk of developing hip bursitis by focusing on proper bike fit, varying your training routine, incorporating strengthening exercises, stretching, and seeking appropriate medical treatment. If you experience symptoms of hip bursitis, seeking medical attention and taking steps to manage the condition is essential.
As a cyclist and physical therapist, I recommend prioritizing your health and taking proactive measures to maintain good hip health. With the proper care and attention, you can continue to enjoy cycling while minimizing the risk of hip bursitis and other overuse injuries.
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!
