Hip Bursitis

Managing Trochanteric Bursitis

What is Trochanteric Bursitis?

Trochanteric bursitis stands out as the most prevalent type of hip bursitis, significantly contributing to Greater Trochanteric Pain Syndrome (GTPS). It develops from the inflammation of the bursa, a tiny sac that provides cushioning at points where tendons cross joints. Specifically, this condition affects the superficial trochanteric bursa, located by the prominent bone on the hip’s side (femur). In more severe cases, a deeper bursa may also become inflamed.

Causes of Trochanteric Bursitis

Typically, repeated compression of the bursa leads to trochanteric bursitis, causing inflammation and pain. Weakness in the gluteal muscles, notably the gluteus medius, often accompanies this condition, resulting in a Trendelenburg gait pattern, indicative of hip muscle weakness. Research suggests that inadequately rehabilitated low back pain or hip pathologies can lead to such muscle weaknesses. However, properly tailored exercise protocols focusing on muscle strengthening can effectively reverse this condition. Such exercises should concentrate on individually weak muscles to enhance the strength of gluteal and hip rotator muscles.

Young, active individuals and older adults with gluteal muscle weakness are susceptible to trochanteric bursitis. Activities often linked to this condition include running with poor muscle control, bushwalking to the point of fatigue, and cycling with a high seat causing muscle strain. Acute cases may arise from falls or sports-related impacts on the hip. For advice on hip muscle weakness, consulting a physiotherapist experienced in gluteal and hip pathologies is crucial.

Diagnosing Trochanteric Bursitis

Diagnosis typically occurs during a clinical consultation, involving a review of medical history and a physical examination of the hip, pelvis, and back. Additional diagnostic tools like ultrasound scans or MRI may be employed for confirmation. A key diagnostic indicator is tenderness over the greater trochanter (hip bone) when pressure is applied.

Trochanteric Bursitis Symptoms

Common symptoms of trochanteric bursitis include:

• Pain and swelling over the side of the hip bone.
• Referred pain travelling down the outer thigh, possibly reaching the knee.
• Discomfort when sleeping on the affected hip or after prolonged sitting.
• Pain during activities such as stair climbing, running, walking, or standing for extended periods. Seeking advice from a trusted hip physiotherapist or doctor is advisable if these symptoms are present.

Effective Treatments for Trochanteric Bursitis

Treatment strategies include:

• Early pain relief and anti-inflammatory measures.
• Corrective exercises targeting specific muscle weaknesses.
• Preventative exercises to reduce future bursa irritation. Using ice packs several times a day can help alleviate pain and swelling, as ice acts as a natural anti-inflammatory. Discussing the use of NSAIDs or natural anti-inflammatories like arnica with your doctor is important to avoid side effects.

A combined corticosteroid injection and local anaesthetic into the bursa can significantly reduce inflammation, with the local anaesthetic providing immediate relief and the cortisone working over a few days.

Phased Trochanteric Bursitis Treatment Approach

• Phase I: Focuses on alleviating pain and protecting the hip, employing strategies like active rest, ice therapy, and cortisone injections. Treatment techniques may include ice, electrotherapy, acupuncture, de-loading taping techniques, and the temporary use of mobility aids.
• Phase II: Aims to restore normal hip function, including joint range of motion, muscle length, strength, and walking patterns. PhysioWorks’ “Hip Core Stabilisation Program” assists in regaining standard hip muscle control.
• Phase III: The final stage targets returning to desired activities, with rehabilitation tailored to individual functional goals.

Surgery, specifically a bursectomy, remains a rare treatment option for persistent cases.

Expected Results and Prevention

Physiotherapy often yields positive outcomes within weeks, though chronic cases may take longer. Maintaining rehabilitation exercises even after pain subsides is crucial for preventing recurrence. The best prevention strategy includes excellent hip muscle control, guided by your physiotherapist or doctor.

Conclusion

Trochanteric bursitis can restrict your daily activities due to discomfort, but proper treatment and rehabilitation can lead to significant improvements. Always work closely with your physiotherapist or doctor, adhere to their advice, and continue your exercises to avoid recurrence. If experiencing symptoms of trochanteric bursitis, seek professional help