What is Trochanteric Bursitis?
The Most Common Hip Bursitis
Trochanteric bursitis is inflammation of the bursa (a small, cushioning sac located where tendons pass over areas of bone around the joints), which lies over the prominent bone on the side of your hip (femur).
The superficial trochanteric bursa is located over the greater trochanter. This is the most commonly inflamed bursa. A deep trochanteric bursa lies deeper and can become inflamed in more severe cases.
What is Bursitis?
What Causes Trochanteric Bursitis?
The trochanteric bursa is normally caused by repeated compression of the bursa resulting in inflammation and pain. It is usually associated with weakness of the gluteal muscles, particularly gluteus medius, that results in a Trendelenburg gait pattern that is a sign of hip muscle weakness. It can be related to a previous back or hip injury. Researchers have found that gluteal weakness is a side effect of poorly rehabilitated low back pain or hip pathologies.
The good news is that muscle weakness and Trendelenburg gait can be reversed by an appropriately progressed exercise protocol. The exercises prescribed should be focused on retraining your specifically weak muscles. This is important since different gluteal and hip rotator muscles are strengthened by different exercises. For more specific advice regarding your hip muscle weakness, please seek the advice of your physiotherapist, who has a special interest in gluteal and hip pathologies.
While gluteal muscle weakness does become more prevalent as we age, we certainly also see weakness in the younger active population. In these cases muscle fatiguing activities such as running (with poor muscles control or technique), bushwalking into fatigue, or cycling, especially when the bicycle seat is too high can induce trochanteric bursitis or be related to a gluteal tendinopathy.
Occasionally, acute onset trochanteric bursitis can occur following a fall or a sport-related impact contusion to the hip.
How is Trochanteric Bursitis Diagnosed?
Your physiotherapist or doctor can normally diagnose trochanteric bursitis in the clinic. This will be based upon an assessment of your history and a physical examination of your hip, pelvis and back. A hallmark sign is if you feel tenderness over the bursa or greater trochanter (hip bone) when pressure is applied.
Diagnosis can also be confirmed by medical imaging techniques that include ultrasound scan & MRI.
What are Trochanteric Bursitis Symptoms?
One or more of the following symptoms may be experienced:
What is the Best Treatment for Trochanteric Bursitis?
The best treatment for trochanteric bursitis involves:
Bursitis is an inflammed bursa. Application of ice packs a few times per day is highly recommended to reduce your pain and swelling. Ice is a natural anti-inflammatory that is more likely to assist bursitis than heat packs.
NSAIDs or anti-inflammatory drugs (i.e. ibuprofen) may assist but do appear to be less successful for trochanteric bursitis. Natural anti-inflammatories such as arnica are also trialed by many patients. Use of these medications should be discussed with your doctor to avoid any side effects.
Combined injection of a corticosteroid plus a local anaesthetic into the bursa may be recommended to reduce your bursa inflammation. It is preferable to have this injection using ultrasound guidance. The local anaesthetic will provide immediate short-term relief (a day or two). The cortisone is slower acting and will take a few days up to a week to act on inflammation reduction.
How Can You Prevent Trochanteric Bursitis?
Muscle weakness, muscle fatigue or gluteal tendinopathy are thought to be the major causes of trochanteric bursitis. Addressing your muscle strength and endurance is recommended to avoid a recurrence. Wearing adequate footwear which supports any biomechanical imbalances in your feet is also a key preventative measure.
Successful weight management
Trochanteric Bursitis Treatment
PHASE I - Pain Relief & Protection
Managing your pain. Pain is the main reason that you seek treatment for trochanteric bursitis. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Bursa inflammation it best eased via ice therapy, cortisone injections, supportive taping techniques or exercises that encourage your muscles to decompress the bursa.
Your physiotherapist may use an array of treatment tools to reduce your pain and inflammation. These can include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.
PHASE II - Restoring Normal ROM, Strength
As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal hip joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
Hip researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of: deep, then intermediate and finally superficial muscle firing patterns in normal pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients to regain normal hip muscle control. Please ask your physio for their advice.
PHASE III - Restoring Full Function
The final stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some people, it simply be to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.
PHASE IV - Preventing a Recurrence
Trochanteric bursitis does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation.
In addition to your muscle control, your physiotherapist will assess your hip biomechanics and start correcting any defects. It may be as simple as providing you with gluteal or deep hip rotator exercises to address any biomechanical faults in your leg. Your physiotherapist will guide you based upon your assessment.
Fine-tuning your hip stability and function by addressing any deficits in core strength and balance, learning self-management techniques and achieving the ultimate goal of safely returning to your previous sporting or leisure activities.
Trochanteric Bursitis Surgery
Surgery is not a common path. However, in persistent cases, removal of the bursa (bursectomy), can be performed.
What Results Can You Expect for Trochanteric Bursitis?
While some people can respond quickly to physiotherapy treatment within a few weeks, more chronic cases where gluteal tendinopathy exists in the gluteal muscle group under the bursa can require a few weeks and sometimes months to achieve recovery.
Trochanteric bursitis is successfully managed in the vast majority over a period of approximately six weeks. It is important to not stop your rehabilitation exercises as soon as you pain abates. You may be recommended some prevention exercises to perform as a part of your weekly health and wellbeing program.
Excellent hip muscle control is your best rehabilitation and prevention strategy. Please follow the advice of your physiotherapist or doctor.
Common Trochanteric & Hip Bursitis Treatments
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