Hip Bursitis Treatment in Brampton

What is commonly called "hip bursitis" is now more accurately described as greater trochanteric pain syndrome (GTPS) — a cluster of conditions involving the gluteus medius and minimus tendons, the trochanteric bursae, and the iliotibial band (Grimaldi & Fearon, Br J Sports Med 2015). Typical features include: lateral hip pain centered over the greater trochanter, often sharp initially and progressing to a deep aching. Night pain — difficulty sleeping on the affected side (the most functionally disabling symptom reported by patients). Pain aggravated by sustained single-leg loading — walking, climbing stairs, prolonged standing, getting out of a low chair, crossing legs, or sitting with legs crossed. Referred pain that may radiate down the lateral thigh to (but usually not below) the knee. Tenderness to palpation over the greater trochanter. Trendelenburg gait — hip drop during single-leg stance reflects gluteal weakness. Reduced hip-abduction strength and endurance on objective testing. Pain with the 30-second Single-Leg Stance Test and the Resisted External Derotation Test supports the diagnosis.

GTPS results from compressive and tensile overload of the gluteus medius and minimus tendons at their trochanteric insertion — analogous to rotator cuff tendinopathy at the shoulder (Grimaldi 2017; Mellor 2018). Gluteal tendinopathy is the dominant pathology in most patients (not a primary inflammatory bursitis). Compression of the tendon against the trochanter occurs with hip adduction (sitting cross-legged, standing "hanging" on one hip, side-lying on the affected side, running with narrow gait). Gluteal weakness and deconditioning — gluteus medius inability to stabilize the pelvis leads to hip drop and further compressive loading. Female sex — 4:1 predominance; peri- and post-menopausal women are at highest risk due to hormonal effects on tendon structure and pelvic geometry. Age 40–60 — peak incidence. Obesity — increased lateral-hip compressive loading. Biomechanical contributors — leg-length discrepancy, lumbar dysfunction, foot overpronation, previous hip or knee surgery, total hip arthroplasty. Activity-related — running (particularly narrow-gait or downhill), hiking, rapid training-load increases. Less common — true inflammatory bursitis, gluteal tendon tears, ischiofemoral impingement, L4–L5 radiculopathy referring laterally (important differential).

The single most important piece of evidence guiding modern GTPS care is the LEAP trial (Mellor et al., BMJ 2018) — a three-arm randomized controlled trial comparing education-plus-exercise, corticosteroid injection, and wait-and-see in 204 patients. At 8 weeks, both treatments outperformed wait-and-see; at 52 weeks, education-plus-exercise produced significantly better global outcomes and lower recurrence than cortisone injection. This evidence has reshaped international guidance and our Brampton protocol.

Our assessment includes: objective hip-abductor strength testing (hand-held dynamometry in side-lying), Single-Leg Stance Test (pain reproduction within 30 s), Resisted External Derotation Test, FABER and FADIR to screen intra-articular pathology, and Oswestry / STarT Back screening to rule in lumbar contribution. Outcome measures include the Victorian Institute of Sport Assessment — Gluteal (VISA-G), the Hip disability and Osteoarthritis Outcome Score (HOOS), and the Patient-Specific Functional Scale.

For Brampton patients whose lateral hip pain is linked to a motor vehicle collision — often secondary to compensatory gait from lower-limb injury — we submit OCF-18 plans under Ontario’s SABS and produce insurer-ready progress reports. For repetitive-exposure cases in occupations involving prolonged single-leg loading (nursing, cleaning, policing), we support WSIB claims with Form 2647 and Functional Abilities Forms. Imaging is not routinely required; ultrasound or MRI is reserved for suspected full-thickness gluteal tendon tear or for patients who fail 8–12 weeks of structured care. All clinicians are registered in good standing with the College of Physiotherapists of Ontario.

Platinum Physiotherapy Brampton delivers a LEAP-protocol-aligned GTPS program. Education on load management is foundational — avoidance of hip-adducted postures (sitting cross-legged, "hip-hanging," side-lying on the symptomatic hip unsupported, narrow-gait walking/running). We coach patients on sleep positioning (pillow between knees; side-lying on the unaffected hip with top-leg supported), sitting posture, and gait width. Progressive gluteal loading — the core of treatment. Stage 1: isometric hip-abduction holds (side-lying, standing wall-press). Stage 2: isotonic abduction with progressive load (side-lying hip abduction, clamshells, banded abduction, short-lever bridges). Stage 3: functional loading (single-leg stance, single-leg squats, step-ups, Bulgarian split squats). Stage 4: energy-storage loading (running drills, plyometrics) for athletic patients. Avoid stretches that compress the tendon — cross-body IT-band stretches and piriformis stretches in adduction frequently worsen GTPS. Manual therapy for symptom modulation — soft-tissue work, joint mobilization when indicated, dry needling / IMS for myofascial contributors. Gait retraining — increase step width, reduce hip drop, cue gluteal activation. Shockwave therapy (ESWT) has evidence for recalcitrant gluteal tendinopathy (Furia 2009; Rompe 2009). LLLT, TENS, and ultrasound provide adjunctive pain relief. Orthotics and footwear review when foot pronation or leg-length discrepancy contributes. Weight-management support where relevant. Cortisone injection provides short-term relief (benefit at 4–8 weeks) but is inferior to structured exercise at 12 months (LEAP 2018) — considered selectively for patients unable to tolerate loading due to severe pain. PRP and surgical repair are reserved for full-thickness gluteal tendon tears — we co-manage with an orthopaedic hip surgeon.

Weeks 1–2 (Load Reduction & Isometrics): Education on aggravating postures (sleep, sitting, gait), isometric abductor holds, gentle soft-tissue work, night-pain management strategies.
Weeks 3–6 (Isotonic Loading): Progressive abductor and posterior-chain strengthening, bridging progressions, introduction of single-leg work.
Weeks 6–12 (Functional & Gait Retraining): Single-leg squat, step-ups, Bulgarian split squats, gait-width cueing, lumbar and core integration.
Weeks 12+ (Return to Sport / Work): Energy-storage loading for runners/athletes, work-specific task progression, maintenance strength program. Most patients see clinically meaningful improvement at 8 weeks; the LEAP trial demonstrated durable benefit at 52 weeks. Compliance with home exercise is the strongest predictor of outcome.

GTPS is highly preventable, and relapse can be minimized. Maintain gluteal strength and capacity — hip-abduction and posterior-chain loading 2×/week, even when asymptomatic. Avoid sustained compressive postures — do not sit cross-legged for prolonged periods, avoid "hip hanging" during standing, use a pillow between knees when side-sleeping. Progress training volume gradually — the 10% rule applies to running mileage and hiking distance. Widen running/walking gait if narrow-gait / crossover running is present. Address leg-length discrepancies (>1 cm) with heel lifts when clinically appropriate. Manage body weight — lateral-hip compressive load scales with BMI. Appropriate footwear to support lower-limb biomechanics.

See a physiotherapist in Brampton for persistent lateral hip pain, night pain disturbing sleep, pain with stairs / prolonged standing / getting out of chairs, or a limp due to hip pain. Seek earlier medical review if you have sudden onset lateral hip pain after a fall (possible greater trochanter fracture or acute gluteal tendon rupture), progressive weakness (inability to lift the leg sideways), fever with hip pain (septic bursitis), or radiating pain below the knee (possible L4–L5 radiculopathy). Book a free consultation at Platinum Physiotherapy Brampton.

• Is it really bursitis or a tendon problem? Most "hip bursitis" today is understood as gluteal tendinopathy (GTPS). Treatment targeting the tendon, not just the bursa, produces better outcomes.
• Should I get a cortisone injection? Cortisone helps short-term (weeks) but the LEAP trial showed education-plus-exercise produces better 12-month outcomes. Cortisone is reserved for patients unable to tolerate loading due to severe pain.
• Do IT-band stretches help? Cross-body IT-band stretches often worsen GTPS by compressing the gluteal tendon against the trochanter. We typically avoid them early in rehab.
• Why is it worse at night? Side-lying compresses the trochanteric tendons; we coach specific sleep-positioning strategies (pillow between knees, side change, top-leg support).
• Do I need an MRI or ultrasound? Usually not — diagnosis is clinical. Imaging is reserved for suspected full-thickness gluteal tendon tear or failure of 8–12 weeks of appropriate physiotherapy.
• Is treatment covered by OHIP, SABS, or WSIB? OHIP coverage is limited. Most patients use extended health benefits, SABS (MVA), or WSIB — we assist with OCF-18 and Form 2647 submissions.