Trochanteric Bursitis

1. Introduction

Trochanteric bursitis is a condition used to describe pain and inflammation of tissues that are situated around the outer part of the hip or upper thigh ⁽¹⁾. The greater trochanter is a large, bony point that you can feel on the outside of the upper thigh. It serves as a useful attachment point for muscles that help stabilise your pelvis. The bursa is a type of thick tissue that helps to reduce friction between the bone (greater trochanter) and the tendons (gluteal tendon). In some cases, irritation of these bursae tissues can lead to pain and inflammation. This is how the term “trochanteric bursitis” originated ⁽²⁾.

In recent years it has been more widely appreciated that trochanteric bursitis may also be linked to pain originating from the tendons that insert into the greater trochanter ⁽³⁾. Sometimes the pain can refer down the thigh or into the buttock. It is possible that the pain is radiating from the lower back and for this reason, a thorough assessment is necessary to accurately diagnose the condition ⁽⁴⁾.

Treatment of trochanteric bursitis will aim to reduce compression, modify the load on the irritated bursa and gradually strengthen around the hip. If the pain is in fact referring from the lower back, the treatment may be quite different. Further description of low back pain and referred pain can be found in the relevant section of the website.

4. Risk Factors

This is not an exhaustive list. These factors could increase the likelihood of someone developing trochanteric pain syndrome or gluteal tendinopathy. It does not mean everyone with these risk factors will develop symptoms.

• People aged 40-60 years are most likely to develop trochanteric bursitis.
• Gender – Women are 80% more likely to develop trochanteric pain syndrome than men.
• Being overweight – as this increases the load on the area.
• A sudden increase in activity especially if it involves stairs, hills or running/plyometric exercise.
• Poor strength in the abductor (outer) muscles of the hip.
• Poor postural habits such as standing ‘hanging off the hip’ or sitting with legs crossed ^{(4, 5, 8)}.

8. Rehabilitation

Rehabilitation of trochanteric bursitis can be modified dependant on the severity of your symptoms and the tasks or hobbies you want to return to. The aim of treatment is to reduce compression, modify the load on the bursa/tendon and strengthen the muscles that help stabilise your hip.

You can reduce compression on the bursa and tendon by ^(8,10):

• Trying to stand equally on both legs; if you stand on one leg, do not let your hip push out to the side. This is probably a habit so ask family and friends to watch you.
• Avoid sitting with your legs crossed.
• Avoid sitting on low chairs.
• Avoid firm mattresses; you may find using a softer mattress overlay is helpful.
• Avoid lying on the affected hip at night. Use a large pillow between your legs when lying on your unaffected side to keep your hips in a neutral position.
• Avoid stretching the bottom muscles. The position of stretch increases compression over the outer hip.

Modify the load on the irritable tissues:

• Reduce your exercise, especially if it involves stairs or hills.
• When walking, try to avoid overstriding.
• If the pain is very severe you may need to rest completely from exercise. However, it is beneficial to keep doing something if possible. You can measure if you have done too much by checking whether your pain is much worse at night or the next day.

Strengthening the hip muscles:

It is important to strengthen the muscles that stabilise the hip to help to stop the hip from dropping from side to side when doing the one-legged activity. The exercise challenge will slowly increase as your symptoms improve.

10. Return to Sport/Normal Life

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to the sport, a rehabilitation programme should incorporate plyometric based exercises; this might include things like bounding, cutting, and sprinting exercises ^{(5, 9, 10)}.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

Book an Appointment

Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

We have Pure Physiotherapy clinics across the country including Norwich, Ipswich, Manchester, Bolton, Wakefield and Sheffield. Please view our clinics to find the closest physiotherapy clinic for you.