Our hips are amazingly flexible and stable due to the way the joint and soft issues articulate. When we walk, they give us power and stability. When we jump, they can handle the impact. The hip joint is one of the largest and strongest joints in the human body. However, the hip can take a beating, and when that happens, we may feel pain – usually resulting from overload.
At Pure Physiotherapy, we often see people who have been diagnosed with ‘bursitis’ of the hip, which is an inflammation of the bursa. These fluid-filled sacs are found around the body and serve as cushions between bones and soft tissues such muscles, tendons, and skin. Each hip has two major bursae. The outside point of the hip – which is called the Greater Trochanter, has a bursa called the Trochanteric bursa (The other bursa – on the inside of the hip area, is called the Iliopsoas bursa).
When that bursa on the outside of the hip gets inflamed, you have trochanteric bursitis. This is also referred to as greater trochanteric pain syndrome (GTPS) which is a common condition and easily treatable.
You’ll first notice Trochanteric bursitis when you feel pain at the outside of your hip. At first, the pain may be sharp, but with time, it may turn into a dull ache. Moving your hip, particularly going down stairs, might make the pain worse.
If left untreated, the pain may start going down your upper leg. You’ll likely feel it when you lay on the side of your affected hip and when getting up from a chair. The joint becomes stiff, and the bursa itself is sensitive to touch.
In extreme cases, your hip joint may become red and swollen and you may even have a fever. If you’ve had these symptoms for more than 3 weeks without improvement, you should discuss the symptoms with your Physio or GP.
You’ll find bursa sacs at many of the body’s major joints, including the elbow, shoulder, and knee. The small pouches are filled with a thick fluid and are meant to lubricate joints and protect body parts from friction.
The Trochanteric bursa, like other bursae, may become inflamed if the hip is overused or injured. Most issues causing bursitis are linked to poor hip strength and stability (lack of exercise) resulting in weak muscles which struggle to cope with the physical demands being forced on them in normal life – leading to excessive pressure on other soft tissues and inflammation.
Adults who rapidly increase their walking, running, or cycling may be susceptible to overloading the hip structures and triggering Trochanteric bursitis (but this is less common than the de-conditioning/lack of exercise trigger). The side of the leg includes a long piece of connective tissue called the Iliotibial band (ITB), which runs from the hip to the knee. If the ITB is tight from hard use, it may irritate the Trochanteric bursa leading to bursitis.
Other causes of Trochanteric bursitis include:
Trochanteric bursitis is said to affect about five of every 1,000 adults and generally occurs in middle-aged or older people, though people of any age may get the condition.
A physical exam – including your clinician asking some specific questions, will help establish how long you’ve had the condition and identify specific movements that cause pain. In the vast majority of cases, a clear and accurate diagnosis can be made by taking a good history & thorough assessment, without the need for further investigation.
In rare cases, X-rays may be ordered to support differential diagnosis, as bursitis itself doesn’t show up on X-rays.
What is a Gluteal Tendinopathy?
Up until recently hip bursitis was diagnosed as the main cause of lateral hip pain but recent studies suggest that an irritation of the Gluteal muscle tendons are the most likely cause. The tendons attach onto a bony prominence (Greater Trochanter) where they can be subjected to compressive forces, leading to irritation. This can result in pain around the lateral hip, which can refer down the outside of the thigh and into the knee. Therefore, it’s important to recognise that an accurate diagnosis is important and informs the best treatment planning.
How common is Gluteal tendinopathy?
Gluteal tendinopathy is relatively common affecting 10-25% of the population. It is 3 times more prevalent in women than men and is most common in women between the ages of 40 and 60. One of the reasons for this is women tend to have a greater angle at their hip joint increasing compressive forces on the tendon. A good assessment by an experienced Physiotherapist will identify the diagnosis more accurately and ensure the right treatment for the right problem.
For more information on Gluteal Tendinopathy please click on the link
There is a lot you can do to help manage your symptoms and support your recovery at home. Your Physiotherapist will suggest:
You can stop Trochanteric bursitis from becoming worse – or prevent ever developing it at all, if you take care of your hips (and the rest of your body) properly. Among the things you can do:
Our expert Physiotherapists can give you exercises to improve flexibility and strengthen your muscles. We manage a large amount of people suffering with these issues on a daily basis. In the vast majority of cases the situation is relatively easy to address though Physiotherapy. You will be provided with a bespoke and progressive home exercise plan that will tailored towards helping you achieve the goals you will establish with your clinician.
Other treatments that are occasionally used might include: