What is Hip Bursitis or Trochanteric Bursitis?
Hip bursitis is also called as trochanteric bursitis.
Hip Bursitis could be explained as an inflammation of the bursa that is a sac filled with fluid adjacent to the joints that acts like a cushion for the joint. A bursa is a sac that is filled with lubricating fluid situated between tissues like muscles, tendons, skin and bone that lessens irritation and friction between the tissues. The bursa causes pain in the hip when subjected to continual trauma resulting in swelling and inflammation. Hip Bursitis or Trochanteric Bursitis could strongly affect athletes such as runners, footballers and soccer players who frequently put the entire weight of their body on their hips.
The Bursae That Surround the Joint of the Hip Include:
- Trochanteric Bursa: Trochanteric bursa is located on the outer side of the hip between the greater trochanter and place where the gluteal muscles get connected.
- Gluteus Medius Bursa: Gluteus medius bursa is a small bursa, which is located between the greater trochanter and gluteus medius muscle.
- Iliopsoas Bursa: Iliopsoas bursa is located between the iliopsoas muscle which is present at the front side of the joint of the hip and the underlying bone. Bursitis in this region is also called as iliopectineal bursitis.
- Ischial Bursa: Ischial bursa is located between the base of the pelvis and the hamstring tendons.
However among all of the bursae, the most commonly affected hip bursa is the trochanteric bursa. Trochanteric bursa can be affected in two ways, either in the form of traumatic bursitis that may result from a direct impact to the bursa due to falling down on to the outer hip or by repetitive friction caused by the overlying tendons and muscles that may occur while running. This repeated friction forces the bursa to become swollen and inflamed as the tendons keep on rubbing the bursa resulting in pain. Hip bursitis or trochanteric bursitis is very frequent among runners or athletes who participate in running-oriented sports.
Causes and Risk Factors of Hip Bursitis or Trochanteric Bursitis:
- Hip Bursitis or Trochanteric Bursitis caused due to trauma or traumatic bursitis is caused by falling onto the side of the hip.
- Majority of cases of bursitis of the hips are causes as a result of overuse injuries resulting from biomechanical abnormalities.
- Over pronation can also cause hip or trochanteric bursitis because this bends the knee inwards increasing the angle of the hip.
- Weakness caused in the hip abductors, particularly gluteus medius, can also cause a similar effect.
- Tightness in the structures around the hip like the hip flexors, hamstrings and iliotibial band.
- A bone spur may also result in aggravation of bursal inflammation causing hip bursitis or trochanteric bursitis.
Signs and Symptoms of Hip Bursitis or Trochanteric Bursitis:
- One of the common symptoms of hip bursitis or trochanteric bursitis is Pain which is experienced on outer side of the hip.
- Exacerbation of pain while performing activities like climbing stairs, getting out of a car and running can also be a symptom of hip or trochanteric bursitis.
- Gradual worsening of pain.
- Pain is experienced while pressing on the outer side of the hip.
- Pain associated with hip bursitis may also spread down the outer thigh.
Treatment for Hip Bursitis or Trochanteric Bursitis:
- Rest. One of the best ways to treat hip bursitis or trochanteric bursitis is to provide enough rest.
- Cold therapy can be a useful treatment to ease the pain associated with bursitis of the hip.
- Avoiding activities that aggravate the symptoms can help ease the symptoms of hip bursitis.
- Anti-inflammatory medications such as ibuprofen, aspirin, Celebrex and naproxen may help in reducing inflammation and swelling and relieving pain associated with hip or trochanteric bursitis.
- Fine needle aspiration of bursa to remove extra fluid from the affected region.
- Corticosteroid injections where the medication is injected into the bursa, which not only helps in reducing the inflammation, but also alleviates the symptoms of bursitis of the hip.
- Surgery is required in very rare cases. Surgery is usually performed to remove the inflamed bursa.
Physical Therapy Hip Bursitis or Trochanteric Bursitis:
Physical therapy for hip or trochanteric bursitisis is important in speeding up the healing process. Physical therapy also decreases the likelihood of recurrences of conditions like bursitis of the hip in the future. Physical therapy may include:
- Application of heat and ice is the most effective physical therapy for hip bursitis.
- Electrotherapy like TENS and ultrasound. Ultrasound therapy for the treatment of hip or trochanteric bursitis creates sound or pressure waves that penetrates through the layers of the skin to create micro-vibrations that stimulate your body in a similar way as exercise. Ultrasound therapy is beneficial in increasing blood flow and relaxes the soft tissues.
- Soft tissue massage. This is a useful treatment to speed up the healing time for hip bursitis or trochanteric bursitis as massage helps improve circulation, it stimulates the release of endorphins that can help control the pain.
- Stretches. Performing stretches helps in decreasing muscle tightness which could be a contributing factor for trochanteric bursitis. Stretches to help relieve hip bursitis are typically held for a couple of seconds to as long as a person can hold and for effective results it should be repeated several times per day. More about exercises and stretches are explained below.
- Dry needling. This is an effective treatment for people with hip pain in which one can avoid the potential harmful effects of steroids. Dry needling is as effective as cortisone injection in reducing pain associated with this condition.
- Joint mobilization.
- Using crutches.
- Correction of abnormal biomechanics such as using orthotics.
- Anti-inflammatory advice.
- Exercises of the muscles and tendons surrounding the area to improve strength and flexibility, especially of the iliotibial band.
- Activity modification and training.
- Appropriate plan for return to activity.
Exercises for Hip Bursitis or Trochanteric Bursitis:
Gluteal Stretching Exercise:
This exercise for hip bursitis or trochanteric bursitis is performed by lying down on the back. With the help of hands, bring the knee towards the opposite shoulder until a mild to moderate pain-free stretch is felt along the buttocks or at the front side of the hip. Hold the position for about 15 seconds and release. Repeat four times ensuring there is no exacerbation of pain.
Transversus Abdominis Activation Exercise:
This exercise for hip bursitis or trochanteric bursitis is performed by lying down on the back. Now gradually pull the belly button inwards away from the belt line and breathe normally. Make sure that the rib cage remains relaxed and does not elevate while performing this exercise. Muscle contraction should be felt if pressed deeply 2 cm from the bony prominence at the front of the pelvis. Practice holding this muscle at one third of a maximal contraction during everyday activities provided it is pain free.
Test to Diagnose Hip Bursitis or Trochanteric Bursitis:
Generally a complete subjective, objective and physical examination is performed to diagnose the condition of bursitis of hip. Other tests that help in diagnosing and assessing the severity may include:
Watch 3D Video of Hip Bursitis or Trochanteric Bursitis:
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